RIBAVIRIN DOSAGE

[GINGERPAL]

I am starting triple treatment soon.
I treated in 2008 and I took 1000 mg ribavirin a day and 180 ug of pegasys injection once per week – I reached UND at week 16, but stopped tx because I did not want to treat for 72 wks with low odds and I decided to wait for new PI.
Now my (new) doctor is going to treat me with PI and wants to only give me 800 mg of ribavirin a day (I will be taking pegasys and incivek).
The new doctor said I get 800 mg of riba because I weigh 115 lbs,  but that was what I weighed in 2008 when I was prescribed the 1000 mg of riba per day.  New doctor mentioned I will get Riba-Pack which I did not have the last time.
I have some ribavirin left over….not sure if it is still good to take, but I am almost tempted to take an extra pill each day , especially in the beginning or until I am cleared - because I did not clear until week 16 in 2008 with the 1000 mg dose.
I don’t know why I got 1000 mg a day of riba before, and now I am only getting 800 mg.  Just wondering what riba dosage everyone else is taking and what is your weight ?  Is there any literature out there that says  what the dose should be – if I can support taking 1000 mg. then maybe the doctor will agree.
Thanks....Gingerpal

[GINGERPAL]

Thanks again all for your helpful feedback.
We don’t know what to expect from a doctor until we have a situation…not only do we want the right dosage, we hope to have the right rescue drugs, and hopefully have a doctor who listens and answers.  Each step along the way is an adventure.  All I know is that I want to do this the best I can.

[pcds]

My wise friend Dave.  He makes excellent points. Always does.
Judy

[spectda]

As you mentioned your doctor's experience is quite extensive. People often post who have doctors that are not the best for HCV tx. Hopefully your doctor will be respectful about your advocating for yourself and consider your questions or provide you with a satisfactory answer.  

It sounds like lower starting HGB then last time and cancer plus decent hgb decline previously and a higher percentage of anemia with Incivek might be good reasons for your doctor to want to be cautious. Another very experienced Hepatologist may see it differently with your phenotype and past response though and as you mentioned you want to make this time count.

I would ask your doc if he would start with the 1000mg, monitor with labs more often then usual, and be ready with the procrit as Cando mentioned in the event that you have a sharp decline in a short period of time.

At 115 lbs 800mg is 15.33 mg per kilo which is a decent amount if weight basing means anything. At 1000 mg you would be at 19.17 mg per kilo which is a hefty dose. Maybe if he won't go for the 1000mg daily you could negotiate alternating between 1000 and 800 every other day :)

Good luck, let us know how it goes.
Dave

[pcds]

Personally, I wouldn't start treatment with this doctor unless you see some else to confirm this dosage.  I am on 1000 riba a few pounds heavier 125lbs.  Once you start you are committed.  Now I am only speaking for myself.  

[GINGERPAL]

Hi
You guys come up with the best thoughts and suggestions.  
I checked my recent blood work and on 6/29/11 my HGB was 13.5.
My heart is ok.   Last year I was diagnosed with cancer, and am taking oral medication which I was told has no impact on H-C treatment or the treatment drugs.
The doctor is Dr Wolf at Westchester Medical Center in Westchester County in Valhalla, NY.
I am definitely going to follow-up with the doctor about this….as you said it may be the last and best chance at SVR.
I am at an age where I want to give it my all….don’t think I can try this again. Thanks...ginger p

[can-do-man]

If you find out what Will says is true from your doctor, to me that would not be a very good excuse. My HGB tanked out on my first tx and i needed procrit. So when i started in the bocepriver trial we knew that it alone would cause anemia. So we planned on having to use procrit when the time came.

[willbb]

Hi Ginger...you mention that your HGB. stayed in acceptable levels during your last treatment....however do you happen to know what your HGB. is at present,perhaps it is low..therefore him being overly cautious...just a thought as to why he may have suggested this.
Good luck
Will..

[GINGERPAL]

thanks for getting back to me.  i have not started tx with this doctor yet...he is supposed to be a top liver md who was involved in incivik trials.   i looked at the link you sent and it surely says that for genotype 1 the riba dose should be 1000 mg - I will send this to the doctor. My hemoglobin when i treated in 2008 started at 14.5,  and at 2 wks it was 12.0,  at 4 wks it was 10.4,  at 8 wks it was 10.0,  at 12 wk it was 9.9, and at 16 wk it was 9.8 and i never took any rescue drugs.  New doctor said I can take rescue drugs.    I am very concerned about this riba dose!  I guess if this doctor does not agree to the 1000 mg dose, I will ask the reason, and then decide about going to a new doctor.  thanks for your help...ginger p.
  

[spectda]

If you are going to be using Incivek and Pegasys your dose of riba should be 1,000 mg per day just as it was in all the Incivek trials, especially since you are TT phenotype and a slow responder previously.
http://www.drugs.com/dosage/copegus.html

Did you become anemic before? Have you discussed rescue drugs with the doc if needed? If you have not started tx, this would be a red flag to me unless there is a good reason for the doctor not following protocol.
-Dave

[can-do-man]

Hi Gimger, i agree with you it doesn't make sense, 1000mg a day is what you should be on, just because you now on incivekis no reason to lower your riba..... If it was me i would want to know his reason. This might be your last best chance at SVR. Remember the doc works for you.... Good luck

[spectda]

Are you seeing a hepatologist? Which PI are you taking?
-Dave