MISSED AM RIBA DOSE ---What do I do?

[hopeful587]

Believe that I got distracted this morning ( springbreak with my grdaughter) and think that I missed my am 800mg Riba dose.  I knew that I felt better than usual today.  Took my 5th shot peg last night and have taken my pm Riba dose.  I cannot get through to my hepatologist until tomorrow am.  Any of you exp'd on tx, could you give me some advice?  I am going in for my 4 wk viral load labs on Thur.  Platelets two wks ago were at 65,ooo. I'm asking God's help in that this won't be a setback.  

Many thanks,
Hopeful 587

[Tippyclubb]

Copied from rx:

If you miss a dose of copegus and remember the same day, take the missed dose as soon as you remember.  If the whole day has passed, ask your health care provider.  Do not take doses at the same time.

[HCA]

Forget about it!
Missing one dose won't affect anything,ribavirin has a long half-life,and after five weeks you will have accumulated decent serum levels.
You are presumably quite a small person if you are on 800mg.
Ribavirin is used to induce genetic sampling error rather than to eliminate virus,so your four week test won't be influenced.

[FlGuy]

Tippy gave you the book version.  If you remember before your next dose, take.  If you don't remember before your next dose, then skip it.  The way many play the game is to add one riba (assuming you are on 200mg pills or capsules) to each of your subsequent dosing times until you are caught up.  Are you sure you take 800 mg in the AM?  Thats a pretty healthy dose for someone who can even acknowledge spring break with a grand kid.

[HCA]

Sorry,misread-you are taking 800mg in the am not daily.
Advice stands though-you can top up if you are worried,but it's not an issue.

[jmjm530]

At this point, most doctor's will probably tell you to forget the missed dose and pick up where you left off tomorrow, as opposed to doubling up tonight  and btw 1600 is a lot of riba in one day unless you're on a high-dose riba strategy.

That said, some of us have made up skipped doses in various ways including taking a double dose or more conservatively spreading the missed dose over the next day or so.

Since you appear to be on high-dose ribavirin, I would strongly suggest you do not double-up unless so directed by your treatment physician. As to "making it up" over the next few days, something you might want to discuss with your doctor with consideration I presume to how you're handling sfx's, including your hgb drop from baseline.

-- Jim

[jmjm530]

If I read you correctly, your injection night is Monday (shot 5 last night) and you're planning on going in for your week 4 viral load test this coming Thursday.

Not to contradict your medical team, but from what I've been told the best day for your four-week test would be the day *before* your fifth injection, or the day of your fifth injection but before the injection. This way you get a more conservative "trough" result which in theory is a more solid UND, assuming that's what you will be.

Given that you can't turn the clock back, personally I might skip the Thursday draw and have blood drawn on Monday (before your 6th injection) which would give you a trough reading for the week 5 test. This is something you might want to discuss with your doctor although I could see an argument getting tested Thursday since it is closer to your fifth injection and therefore might correlate better with week 4 study data.  Or indeed, you could do both, if insurance allows. Personally, I tested viral load weekly until UND as have a few others here and it was never questioned by my insurance company.

-- Jim

[hopeful587]

Once again...you've proved how valuable this forum is to so me and so very many fighting Hep C.  God is using you.   Thanks for your support, knowledge, and sense of humor -- and for coming to my aid so quickly!  And yes, spring break is a  fun, busy time but MUCH EASIER when she's 16 and  also a big help to me.  Many thanks...

Y'all are the Best!
Hopeful587  

[hopeful587]

OK...appears I got alittle flustered earlier.  Let em back up.  I take a TOTAL of 800mg Riba daily, or 400 am and 400 pm. I'm petite....  Is 800 the lowest dose?

  I understand your point, Jim.  Because I have been out of town, Thur is the earliest day following 4th injection that I can get labs drawn.  I would prefer to have my VL checked more frequently.   I'll ask Dr.  Don't know what to expect from BCBS/Cobra.  Current coverage is good, but ends 12/31/09...BEFORE my 48 wks are completed.  So I'm hoping this round of Tx will be successful.

Always Hopeful

[Marcia2202]

The best time to get the PCR done would be ON the day of your 5th shot, but BEFORE you do your shot. That would be exactly 4 weeks after you started treatment.

[jmjm530]

Sounds like she already took her fifth injection, i.e. missed her week 4 PCR, therefore my suggestion although perhaps she will clarify as per the riba dose.

All the best,

-- Jim