Copegus 800 mg enough?

[wonderingwhen]

Hello everyone, I am not new to his forum just mostly read all the posts, this time I have a question.  Some good info!
Just started tx on the 16th of Sept. So far sides are not as bad as I thought they might be. But in doing a little reading I found that I should be taking 1000 mg of riba, not the 800 mg I was prescribed. Being that I am type 1, stage 2-3 56 yrs young, 160lbs and treatment is scheduled for 48 weeks and not for 24. I have a call in to my Dr to ask if this is correct. Any input out there will be greatly appreciated.

Thanks
Chuck

[jmjm530]

800 mg is too little unless you have other medical issues.

At 160 lbs you should be on 1000 mg/day and are close enough to the cut-off point of 165 lbs (I think that's the cut off) to take 1200 mg/day. I started tx at 176 pounds at 1200 mg/day. I know weigh 150 lbs and still take 1200 mg/day although my NP suggested I could cut back to 1000 if I wanted.

Ask your doctor why you're on such a low dose. If the answer is persuasive, I'd press the issue or change doctors.

BTW have you had a PCR test done yet? Try and get a week 4 if you can with a sensitivity of at least 50 IU/ml.

-- Jim

[jmjm530]

These numbers are off the top of my head so hopefully someone will double-check but I'm almost positive your dose is too low for geno 1's at your weight.

[wonderingwhen]

I am starting out with low platelets and wbc. I know that dr is wathcing these close. I am having blood work done at two weeks and then at four, with the results discussed at the four week dr visit. What does PCR stand for? Sorry but I am not up on all the acronyms yet.

[jmjm530]

Let me modify my last post a bit. I do believe (and so does my doctor) that Pegasys may be a better choice if you're not overweight. But my doctor still recommended Pegasys to me when I started at tx at 176. I think it's probably for folks over 200 lbs where they might get concerned that there's not enough Pegasys in the standard dose.

[bobbyullc]

THANKS FOR THE INFO ON WBC. I JUST GOT MY FIRST REPORT AND MINE SHOWED 3.0 ON A SCALE OF 4.0-10.7 AND I WAS WORRIED. I DO NOT SEE ANC ON THE SHEET BUT THERE IS A "NUET %'. WHICH IS 42.3 ON A SCALE OF 43-75? IS THAT THE SAME. THANKS.

PS I AM 140LBS AND TAKE 1000 MG RIBA.

[susan400]

I'm on high dose Riba, 1400mg a day.  My weight is in the 130's. This is because of my previous and chronic non-responder status. I should find out if this is doing anything in a couple of weeks when I get my PCR.

Susan

[jmjm530]

Your WBC is more than adequate. Look for something that says "neutrophyils, absolute" or something similar. Same as ANC.

Susan,

Good for you on the high dose riba. Here's hoping it gives you the edge this time. For those not familiar, at a certain point moving the riba up too high has certain risks and your doctor should always be in the loop.

[cougareyes]

Your counts look good, my test list out the neutrophils the same way. You get the ANC by multiplying the two. I forget what denomination the numbers are listed as, but if my calculation is correct your ANC would be 1269,which is good. But if you are still concerned check w/ your doc; I'm not an expert.  Good Luck

[Fisheress]

I am female 140 pounds (have not lost or gained any wait as of yet) 46 years young and started treatment on the 12th of this month.  I also take Copegus, 1000mg per day.  400mg in the morning w/my cheerios & milk and 600mg in the evening after dinner.  So far so good with few sides.  Had hip pain during the night a few days ago, got up took 1 tylenol pm and was fine the next morning.  Although I am having occasional muscle pain in my thigh and calf in my right leg since I did injection in that leg on Sat. night, my study cordinator told me to take ibprophen during the day for that.  It has helped.  Think I like the tummy fat for injections better.  Also hope I don't lose any weight or I won't have that lil roll to depend on for injections! (:

I hope you speak w/your doctor about the low dosage you are receiving as it sounds like others here feel you are getting too low a dose also.

Good luck to ya!

Fisheress
P.S. They told me I would have a PCR test on my 4th week. They are so COOL at my clinic, make me feel as if I am their only patient!

[GoofyDad]

Jim's right on the weight cutoff. It's 75 kg or 165 lbs. I'm 163 undressed and I'm on 1,200. I started 10 days ago & Doc told me to cut myself back if I dropped below 75kg. Well, I started below 75kg, so I plan to stay at 1,200 unless I lose more than 10 lbs or so. My plateletes & WBC are also a bit out of range to the low side.

PCR = Polymer Chain Replication or some-such nonsense. Essentially its the quantitative measure of the HVC. There are other tests too, but PCR has a finer graduation.

Jim, at week four, even with a 0 pcr we know we harbor the virus. So is it material whether that's <200 copies, or <50  copies per unit of measure? I mean, I see it as almost the same: You still have HVC either way. You know it's just a tiny bit either way. So is it material whether that tiny bit is a tiny-tiny bit, or a little bit bigger tiny bit?

You can prolly see where I'm going with this. I'm scheduled for wks 4, 8, and 12 quantatative tests, but they are branched chain vs. PC whatever chain.

[wonderingwhen]

I am looking at my lab forms as I write. My 2 week lab ask for ALT(SGPT) and CBC(HEMOGRAM/PLT/DIFF 4 week asks for the same plus liver profile it does NOT have the HCV RNA QT, PCR-NICHOLS checked.

[jmjm530]

So check the box. LOL. Just kidding (sort of). Most docs do not order the week 4 PCR but many do.

Regarding your platelets and low WBC. My knowledge on these values is limited mostly to after treatment starts and not pre-treatment.

That said, many doctors tend to overreact on both these values while they ironically underreact with hemoglobin. Go figure.

In any event, once you start treatment, the important number is ANC (absolute Neutrephils). My doctor doesn't get concdened until they drop below 500. Currently my ANC is bouncing between 600-900 and my WBC is 1.4.

I'd really press him on the riba dose and/or get a second opinion. And definitely get that week 4 PCR if you can to see how things are working out. You're looking for at least a one-log drop in four weeks but ideally you'll have two-logs or better.

-- Jim

[cougareyes]

Can't really spell out what PCR means right now but it is the viral load, amount of HCV in your blood.
By the way, interferon is what effects your platelets and wbc; so that can't be the reason your riba dose is lower. Good Luck

[jmjm530]

Goofy said prev: "I'm 163 undressed and I'm on 1,200. "
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I was about to sit down to eat dinner and that is more information than I needed. :)

I started 1200 when I weighed 176 and have stayed with it down to 150.  In the beginning the NP was pressing me to reduce the riba as I lost weight. So I'd get on the scale with my heaviest boots and pockets loaded with coins. LOL. Now everyone leaves me alone because they know I don't listen anyway. :) The only way I'd reduce riba now is if my hemoglobin drops to a level I'm uncomfortable with and my weekly Procrit injections can't fix. This could happen as my hemoglobin is down a point the last couple of weeks.

Regarding the test sensitivity...

Ideally, you would match test sensitivity to whatever study you're basing a decision on. 50 IU/ml seems to be the standard a lot of them use but each study publishes their standard somewhere. Hopefully. :)

Would a 200 IU/ml sensitivity make any difference? Maybe not but if it were me, I'd fork out the cost if needbe at least for the week 4 PCR. Especially if I were basing a tx decision on a study that used a more sensitive test.

-- Jim

[jmjm530]

Cougareyes makes a good point about the riba. When you speak to your doctor point out that recent studies show full-dose ribavirin -- especially during the first 12 weeks -- to be very important for SVR. Have you had any bloodwork yet? For example did you get your hemoglobin checked yet?

[mikesimon]

I agree that 800 mg. is not ideal for type 1s. I'd try to take at least 1000mg. I don't recall that ribavirin affects platelet count. I know it can impact RBCs and hemoglobin but I thought interferon is the culprit as far as platelets are concerned. Someone will correct me if I am wrong here but that is my recollection. Mike

[snook_man]

I was started on 1000mg, and I also started tx at 176lbs.. I didn't lose a pound til about week 16, where I dropped to 165lbs.
Then around week 28-32 maybe I dropped to 149lbs. Ended tx at 160lbs. I was also under the impression that 1200mg of Riba is for 180lbs and over, 165lbs is cut off for Pegasys.

[jmjm530]

Unless you go off label, Pegasys is one dose for all weights. Riba is weight based. They also wanted to start me at 1000 mg which may be one of a couple of weight-based standards floating around. The other cuts 1200 and 1000 at 165 pounds.

[snook_man]

Pegasys is not weight based, and one dose "fits" all, but any Doc familiar with HCV will tell you that they do not recommend Pegasys for over weight patients. It is thought to be "optimal" for patients under 165lbs. Ask your Dr on your next visit or phone call..Gaurantee he will confirm this.

[Tonyz]

Riba is weight based. I believe 75Kg's is the point at which 1000 and 1200 Mg is defined.


              Blessings


                  TonyZ

[jmjm530]

Pegasys is prescribed all the time for people over 165 lbs and there is no "cut off" in the standard definition of that term. That is what I meant.

I also believe that Pegasys is better for those under 165 lbs and have previously recommended Peg Intron for those overweight. Don't have to call my doc, he's on the same page.

[GoofyDad]

Jim: "I was about to sit down to eat dinner and that is more information than I needed." Damn, and we're s'posed to bulking you up. Well tell ya what... I'll spare you the photos :O)

Hey Fish! Good to see you around. How are things?

WW: Jim has cited a study before that indicates increased riba absorbtion when taken with a high fat meal. IIRC, 35gr fat yeilds upto 70% increased absorbtion. You might want to read that & see what you think.

Holly Parmessian Batman! I just found this and it says 58gr/fat! http://www.fda.gov/cder/pediatric/labels/Rebetronl.doc

    

[GoofyDad]

errr, uh, make that absorption. Dooooh!

[jmjm530]

Bobby,

1000mg sounds good. I'll probably also be at that dose by the time my weight falls to 140lbs. At 150lbs I'm already starting to feel the effects a little more than I'd like. My pre-tx hemoglobin was 14.8 and low-point at week 2 was around 11.2. I stablized in the 13's with 40,000 Procrit/wk until recently. Now my hemoglobin is 11.9. Not a low absolute number, but perhaps getting low for an old guy like me. :)

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Susan 400 said prev: "I'm on high dose Riba, 1400mg a day. My weight is in the 130's

Curious what your hemoglobin was pre-tx and now. Did they put you on Procrit and if so how much? What is the plan with the riba? Do they plan to keep it at 1400 or will they make adjustments depending on your next PCR?