Missed Riba Dose

Calling All the Big Guns!!  Finally after 40 weeks I missed yesterday morning's riba dose.  Just realised now when I went to take this morning's pills and I saw yesterday's pinkies still there.  I have been 100% compliant up until this but now I'm freaking out.  A chink in my armour, a hole in my bucket.  What should I do?

I am thinking of adding an extra one per day (at lunchtime) until the the missing 3 are made up.  I'm in my prep week at work so could easily stay home if things got a bit difficult.

Missing a dose is quite different to lowering a dose and I am really scared that this will cause a massive dip in my serum levels and one of the mutated little a-holes might have a chance to regrow an arm or what not and get a hold again.

I'm not trying to be humorous, I think that's just the place I go when I'm really freaking.

Any thoughts, advice, experiences, studies, even opinions, will be greatly appreciated!!!

Thanking you in advance...

Epi :)

[GreatBird]

DON'T PANIC!  :)  

My understanding is that riba levels are so strong and persistent it shouldn't matter. Plus, since you've been 100% compliant up until now it shouldn't make a whit of difference. I wouldn't dose up--but that might just be me. I'm not sure what it would do for you and (at least my experience so far is that) this is so much like walking a tightrope and trying not to fall into the great sx abyss, that it's not worth the risk. You are so far into your tx right now it shouldn't make any difference.

GB
(a small gun)

[meakea]

Epi, I'm sorry you're going through this.  I don't have any words of wisdom for you but I know the BIG GUNS will as soon as they see this post.  I seriously doubt that missing one dose of pills will make any difference in your treatment but I know how you are feeling right now!

[Deb_c430]

Gb got it right,  I think I have done that also, it takes like 10 days to even weaken in your system.

You can if you like maybe add one a day till you catch up.  Don't panic.  

[mkp13]

Yup.  GB is right.  It won't matter that you missed a dose.  If you'd been in the first few weeks it might have made a difference, but not now.   The official literature from Roche for Copegus says that if you remember on the same day, take the missed dose when you remember, otherwise consult your doctor.  It's not bad advice.  You could give your doc (or the nurse) a call.

[CockSparrow]

We have all done it so dont worry.
This far into Tx the Riba half life is around 12 days so you will hardly even notice it was missing.

I would just take them with the next dose. Thats what i did.
You could split them up over the next two if you prefer.

CS

[Trinity4]

Ditto on all of the above.  Missed pm dose over Christmas.  Just took am dose as usual.
You are so far along and have a good serum level of riba now that you'll be fine.

[jmjm530]

I am thinking of adding an extra one per day (at lunchtime) until the the missing 3 are made up
------------
That's reasonable or depending on what time it is, you could still take your two complete doses today, it's just that they won't be 12 hours apart which really isn't necessary anyway. Will it make a difference to miss a single dose? Probably not but I always made up for my forgotten doses in one way shape or form, as have some others. So, whatever suits you :)

-- Jim

[JennyPenny]

At 40 weeks missing a dose is just not a problem at all. I wouldn't suggest making it up, just try not to miss another one. The half life of ribavirin is many days so you still have plenty left in your body.

[Bill1954]

Hi there, Epi—

One more vote of confidence here; I missed four doses during the last two years of treatment. Two I made up the next dose, and the other two I just skipped. For what it’s worth, I’m now SVR. I faxed a note to my doctors informing them of my errors, and they didn’t seem in the least bit concerned. I totally agree with others; I don’t believe this event will make much, if any difference in the end result.

Hang in there, and good luck—

Bill

[Trish77]

After the 12 week mark, you can take up to 7 days of a riba dosage reduction with no impact.  Based on that, you've got a one-day dosage reduction at 40 weeks with full adherence all this time so I wouldn't worry.  I missed a dose once and chose to take three doses in one day and spreading them out instead of two and then back to usual the next day.  We've all done it, so make it back in whatever way it makes sense to you or suck it up and carry on...whatever works for you.  I wouldn't let it fret you, Epi.  Take care.

Trish

[Rockerforlife]

Is their anyone out there that has never missed a dose that has went tru tx?....i thought i was invinceable....ill thinkn of carrying the pills around my neck in a case with flashing lights (blue) and sirens that go off at feeding time

[epiphiny]

Thank you so much for all your responses.  It's so great to know the support is here, we just have to ask....

Anyway, I have decided to make up the missed dose, mainly because of my perfectionism streak.  I took two at a lunchtime and will take four either tonight or tomorrow morning.  4 equals my usual dose plus the one owed.

Would actually prefer to get it out of the way today but am concerned about sleeplessness tonight.  I already have enough trouble getting to sleep without adding more riba-crack to the mix!

[Rockerforlife]

youll be ok....we all do it...one missed dose wont matter ...i even thinkn it proberly even taken in too account ....the way they designed the tx sceduling...but its one thinh you DO NOT want to repeat

[epiphiny]

Yeah, I'll say!  Getting a bit complacent these days. Used to get hubby to double check me back in the beginning but we slipped out of the habit.  We're reinstating the check from now on.

[CMcH]

I think we have all missed doses. At 40 weeks there should be no concern. My doc has told me not to double up to make up for it although I have before.
No worries buddy you are in the home stretch.
SVR is next!

[epiphiny]

The Home Stretch...  How sweet that sounds...

[Rockerforlife]

I would sneak in a pill between does...as a matter of fact...i would do one extra with each dose till i got in all in....for ex:  i usually do 3 at a time...id pop 4 until the missing dose is done...to me your kickn some exta bu.tt

[epiphiny]

I'm all caught up now, and back on original schedule.

[Rockerforlife]

Now you feel better i bet?..isnt it strange how life or death is decided of 3 little pills?

[Trinity4]

Seriously, missing 3 pills at week 40 would not be a life or death situation.  In my opinion, SVR is somewhat if not already determined at this point.  It's more less where our comfort zone is.  I would have skipped and taken the next dosage and been comfortable with that.  Epi felt better making up the dosage.  

[Rockerforlife]

i did not say : missing 3 pills at week 40 would not be a life or death situation


i just made a gereral comment how our lives do depend on the meds...

[Trinity4]

OK :)

[lalapple]

lol Epi, you're such a perfectionist.  but i have to admit, tx has made me very very OCD.

[epiphiny]

Yup, I think tx has brought out the OCD in me too!!

Here's some irony:  Nursey just rang to tell me hb is down to 97 (9.7) and she wants me to dose reduce by one riba per day.  After all the hou-ha about making up the missing dose, now they want me to take less anyway.

I'm not happy about it yet don't know what to do....  I feel much better than last week and she won't order a blood test for me til next week...  

It would be foolish to disregard her advice (but I want to) and she doesn't seem to think it will come back without a reduction, a break from the fatigue would be awesome, but as we have all discussed before consistency is the key...

Trin, do you really think SVR is decided by now, halfway through week 41?

Feel like I am living on a merry-go-round...but it ain't so merry today...

Btw, no rescue drugs available here in NZ...

[Deb_c430]

Epi, may I ask what your dose is now? Is it weight based?

I went through this as well,  was on 1000 ml of riba ,(which was 200 more than my weight base should of been anyway.

I was and still am  on 60 procrit  but my hgb tanked anyway. Had ferratin was way high and b12 checked, they were ok,   as long as you do not go below 600, you are ok.

My heart goes out to you, I know how awful you feel.  

Lowering this far along will be ok,  i know some will argue about this, but I finally did and I leveled out again.

With out rescue drugs, you are a brave woman to carry on.

xoxoxo

Deb

[DragonSlayer45]

I think we have all done the same thing. Don't sweat it, I paniced early when i did it and the doctor was it was not a problem. They also told me not to make it up. You have been clear since week 4 and are in the home stretch now anyway. I think you on well on your way to SVR. I also think the phase II has some arms that are reducing peg and riba to 24 weeks. I am guessing that may be the dosing for the future with this drug. We shall see.

Sorry to hear your count dropped. I think you'll be fine.

[nygirl7]

In my opinion, SVR is somewhat if not already determined at this point.


Yes - ALL of the doctors would tell you not to sweat it or make them up but since you already have at least it is good information for the next guy who forgets some.

[lalapple]

how ironic!!!  the same thing happened to me 3 weeks ago, PA called to tell me to reduce dose until i got my Procrit bc hg was down to 9.8.  but knowing how irresponsible she is, i kept my full dose (2 morning, 2 at night)  and guess what, 3 weeks later, i still haven't gotten any Procrit and i was still alive on full does.  PA called and asked why i hadn't done my labs in 2 weeks and i just bluntly told her that i saw no point since i had a pretty bad rash and i never got the Procrit, the the bloodwork would be the same.  turns out, they didn't order the drugs until they talked to me 3 weeks later.  ridiculous?!  finally got Procrit but haven't taken it yet, bc my birthday was past weekends and didn't want to be on a new shot on my birthday.  

as you can see, i have a very reckless little girl, but i wasn't gonna let anybody's mistake put me at risk for not getting the best results out of the tx!   medical staffs get paid as professionals better start acting like professionals too.

[lalapple]

last post meant:  "i AM a very reckless little girl", not "have"  tx is starting to mess with my head.  

[Deb_c430]

lalalal 600 is ineffective!  Your not reckless, smarter than the average Panda bear if you ask me!

You have to push and push advocate!