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End Incivek - heart problems
My husband completed the 12 wk of the Incivek on 7/6 - the next two days he felt pretty good. On 7/9 he felt great in the am - went to work and within 2 hours he was taken by ambulance because of a racing heart. The cardio doctor (not the gastro doctor) is treating him for A-Fib. After 24 hours his heart rate was normal and the stress and Echo showed fine. But this new cardio doctor loaded him up with medicine to treat A-fib (like there was not an underlining issue). He prescribed Zarelto, Diltiazem and Amodarone. I asked that the gastro dr and cardio doctor consult and supposedly they did....but I don't feel real confident since they are in opposing hospitals. My husband and I are not real keen on these added drugs when the real problem is the harsh side effects from the Incivek. Do any of you have any insight into this. The cardio guy wants to see him in FOUR weeks....hell that is a long time to take extra medicines that might not be needed..
Meant to copy all the interactions on all drugs he is taking :
Actually the two drugs Diltiazem & Amiodarone seem to have the most interaction
Drug interactions for the following 4 drug(s):
Amiodarone
Diltiazem Hydrochloride CD (diltiazem)
Pegasys (peginterferon alfa-2a)
Xarelto (rivaroxaban)
Interactions between your selected drugs
amiodarone ↔ diltiazem
Applies to: amiodarone, Diltiazem Hydrochloride CD (diltiazem)
MONITOR CLOSELY: Amiodarone and diltiazem or verapamil may have additive pharmacodynamic effects when administered concurrently. Sinus arrest, reduced myocardial contractility, and hypotension could result.
MANAGEMENT: The patient's hemodynamic and electrocardiographic status should be closely monitored, especially during amiodarone loading.
amiodarone ↔ peginterferon alfa-2a
Applies to: amiodarone, Pegasys (peginterferon alfa-2a)
MONITOR: The risk of peripheral neuropathy may be increased during concurrent use of two or more agents that are associated with this adverse effect. In some cases, the neuropathy may progress or become irreversible despite discontinuation of the medications.
MANAGEMENT: Caution is advised during concomitant use of agents with neurotoxic effects. Patients should be monitored closely for symptoms of neuropathy such as burning, tingling, pain, or numbness in the hands and feet. Since the development of peripheral neuropathy may be dose-related for many drugs, the recommended dosages should generally not be exceeded. Consideration should be given to dosage reductions or immediate discontinuation of these medications in patients who develop peripheral neuropathy to limit further damage. If necessary, therapy should generally be reinstituted only after resolution of neuropathy symptoms or return of symptoms to baseline status. In some cases, reduced dosages may be required
Actually the two drugs Diltiazem & Amiodarone seem to have the most interaction
Drug interactions for the following 4 drug(s):
Amiodarone
Diltiazem Hydrochloride CD (diltiazem)
Pegasys (peginterferon alfa-2a)
Xarelto (rivaroxaban)
Interactions between your selected drugs
amiodarone ↔ diltiazem
Applies to: amiodarone, Diltiazem Hydrochloride CD (diltiazem)
MONITOR CLOSELY: Amiodarone and diltiazem or verapamil may have additive pharmacodynamic effects when administered concurrently. Sinus arrest, reduced myocardial contractility, and hypotension could result.
MANAGEMENT: The patient's hemodynamic and electrocardiographic status should be closely monitored, especially during amiodarone loading.
amiodarone ↔ peginterferon alfa-2a
Applies to: amiodarone, Pegasys (peginterferon alfa-2a)
MONITOR: The risk of peripheral neuropathy may be increased during concurrent use of two or more agents that are associated with this adverse effect. In some cases, the neuropathy may progress or become irreversible despite discontinuation of the medications.
MANAGEMENT: Caution is advised during concomitant use of agents with neurotoxic effects. Patients should be monitored closely for symptoms of neuropathy such as burning, tingling, pain, or numbness in the hands and feet. Since the development of peripheral neuropathy may be dose-related for many drugs, the recommended dosages should generally not be exceeded. Consideration should be given to dosage reductions or immediate discontinuation of these medications in patients who develop peripheral neuropathy to limit further damage. If necessary, therapy should generally be reinstituted only after resolution of neuropathy symptoms or return of symptoms to baseline status. In some cases, reduced dosages may be required
Hi.
This is an unfortunate situation that he can not see the Gastro until the 24th ,however it is only 12 days away and taking these medications are not contraindicated with the HCV therapy drugs as I looked them up on this site :
http://www.drugs.com/drug_interactions.html
Having said that it seems very odd that a emergency room doctor ,seeing your husband obviously only once and probably for only a short period of time ,and after doing a heart function test(stress echo) would then prescribe three very powerful medications(one anti-coagulant and two anti-arithymia drugs ) when no previous heart problems were present and also the fact he is already on a very powerful therapy for HCV
I ,as a laymen would never tell a member to cease taking any drug a doctor prescribes ,however I still feel personally his symptoms are from the HCV drug induced "hemolytic anemia"(seen this very often here) and that once he sees his treating doctor and the Riba is possibly adjusted further or the growth factor "Procrit " is introduced these symptoms will be relieved.
Again like I said tho taking these drugs may be unnecessary however doing them for 12 days will not harm his overall success with the HCV drugs.
Good luck
Will
This is an unfortunate situation that he can not see the Gastro until the 24th ,however it is only 12 days away and taking these medications are not contraindicated with the HCV therapy drugs as I looked them up on this site :
http://www.drugs.com/drug_interactions.html
Having said that it seems very odd that a emergency room doctor ,seeing your husband obviously only once and probably for only a short period of time ,and after doing a heart function test(stress echo) would then prescribe three very powerful medications(one anti-coagulant and two anti-arithymia drugs ) when no previous heart problems were present and also the fact he is already on a very powerful therapy for HCV
I ,as a laymen would never tell a member to cease taking any drug a doctor prescribes ,however I still feel personally his symptoms are from the HCV drug induced "hemolytic anemia"(seen this very often here) and that once he sees his treating doctor and the Riba is possibly adjusted further or the growth factor "Procrit " is introduced these symptoms will be relieved.
Again like I said tho taking these drugs may be unnecessary however doing them for 12 days will not harm his overall success with the HCV drugs.
Good luck
Will
I was not able to get an appt with gastro dr until July 24. My husband has not been prescribed Procrit. He is feeling better (went to work today for 1/2 day) but still excessively tired. Heart is normal but he is on the three new a-fib meds. He has NEVER had any health issues except the hepC...(and that was not a problem except being detected in his enzyme levels). He's at wk one after the Incivek completion on 7/6. He has 11 wks to go to total completion. I know doctors do not like wives telling them to prescribe another med (especially when I have complained about the new 3 heart meds) so I really don't know what to do. The dr did lower his riva from 6 pills a day to 5....his potassium was also low on last blood test. Next blood test is scheduled for 7/17. Any advice?
When my hemolytic anemia initially set in, before my Procrit perscription came thru, I did have a racing heart, and was aware of my heart beating fast and hard, a few times. This happened when my HGB was around 9.3
I am wondering what level your husbands' HGB was at. Make sure you
two talk with his Gastro, asap, about your concerns with the new meds, and I would go with his opinion, about wether these meds are neccesary.
I'm always wary of consulting other Doctors, while I am on this Tx, becuase it carries a very specialized and unusual set of side effects. Many Doctors that dont specialize Hep C Tx, just no so very little about the Treatment. The danger is: they wont admit it, and also, act as if they aren't aware of how important this Treatment is to us, and how much we have invested in it~
I am wondering what level your husbands' HGB was at. Make sure you
two talk with his Gastro, asap, about your concerns with the new meds, and I would go with his opinion, about wether these meds are neccesary.
I'm always wary of consulting other Doctors, while I am on this Tx, becuase it carries a very specialized and unusual set of side effects. Many Doctors that dont specialize Hep C Tx, just no so very little about the Treatment. The danger is: they wont admit it, and also, act as if they aren't aware of how important this Treatment is to us, and how much we have invested in it~
I see poor communication and knowledge between these 2 doctors,that's a shame.I hope your husband stabilizes his blood work soon and will not need these extra meds/watch also for electrolytes like Potassium,Sodium,magnesium out of range beside Hg which can cause arrhythmia/.I was drinking too much water and not eating well at one time,diluted Sodium and started some heart palpitations and cramps in my leg.I wish your husband to get better soon ,also we all know it best what stress can do to our bodies/organs
yes i had that too when in tx! it is scary. i had to take the procrit.
my normal hema is in the high 14's and when it went down to 11, i lost it. definitely have that checked, asap. it will make him feel better to boost the RBC's.
stay out of heat and drink LOTS of water.
my normal hema is in the high 14's and when it went down to 11, i lost it. definitely have that checked, asap. it will make him feel better to boost the RBC's.
stay out of heat and drink LOTS of water.
Hi Tom.
Hang around this crazy place long enough, it's just by osmosis I guess :o)
Hope your tx. is going along ok......
Will
Hang around this crazy place long enough, it's just by osmosis I guess :o)
Hope your tx. is going along ok......
Will
Hmm, thanks for bringing this up. I have had some discomfort in my chest but I haven't had any helper drugs and its not a real pain just a tick. My EKG did show a right bundle block and I plan to get that checked out as soon as I get off the tx train.
Dang Will, where do you get all your knowledge?
Dang Will, where do you get all your knowledge?
I agree with Will. 15 to 9 is a pretty radical decrease in hemoglobin and it could possibly cause the symptoms he had. I too would be concerned about the excess medicine in the system. Please let us know what the GI says today.
Has your husband ever had any heart issues including high blood pressure before? Sounds like the doctor did dose reduction alone, and has not prescribed Procrit or any other red blood cell helper. Is that correct? Even without the Incevik, the anemia can continue. Is he on track for 24 week treatment?
I don't know how you make doctors talk to one another. You think it would be a given, but -- especially in this situation -- opposing hospitals and all -- I wonder if they will. Perhaps your GI has a cardiologist in his hospital hubby can see.
frijole
Has your husband ever had any heart issues including high blood pressure before? Sounds like the doctor did dose reduction alone, and has not prescribed Procrit or any other red blood cell helper. Is that correct? Even without the Incevik, the anemia can continue. Is he on track for 24 week treatment?
I don't know how you make doctors talk to one another. You think it would be a given, but -- especially in this situation -- opposing hospitals and all -- I wonder if they will. Perhaps your GI has a cardiologist in his hospital hubby can see.
frijole
Thanks for the response - His hemo went from 15.5 at start to 9.8, The gastro doctor just changed him a week ago to 3 Riba's in the am and only 2 in the evening (one less).
I will call the gastro again today because he has worked with my husband for 10 years...the cardio guy just met him in the emergency room.
I will call the gastro again today because he has worked with my husband for 10 years...the cardio guy just met him in the emergency room.
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These are documented known side from this type of anemia .
I say this as you mention he had a "stress echo "and it showed his heart function to be normal
Often if the anemia is treated by reducing the Ribaviran and/or the introduction of the red cell growth factor Procrit these symptoms will be regulated
You would hope the cardiologist would be aware of these symptoms most likely due to the anemia and would act accordingly ..however it is the Gastro that needs to be fully aware of any additions medications he has been prescribed as well as treat his anemia..
Also you never mentioned what his blood HGB is (the gauge for anemia).
Best of luck to you both..
Will