Aa
Aa
A
A
A
Close
Avatar universal

Reduced dosage?

Is it unheard of to be able to reduce the dosages of Riba/Inter medication? UND @ 6 weeks of 24 weeks. Horrible sides ! Anyone know if dosage reduction would be a a possibility?  Thank you for your time.
8 Responses
Sort by: Helpful Oldest Newest
Avatar universal
My husband started his treatment at reduced dosages.  He is post-liver transplant.  Shortly after the transplant he began treatment at standard dosage but had a rejection episode, though that most likely began slightly before he began treatment.  His hepatologist feared another rejection episode so they started him at 90mcg of Pegasys alpha-2a and 400mg per day of ribavirin.  At 4 weeks his viral load dropped more than 3 logs.  At 5 weeks Pegasys was increased to 135mcg.  By 12 weeks he was undetected.  Pegasys was eventually increased to 180mcg, then riba to 800mg per day.  He had to drop the riba altogether for about 5 weeks because it was too hard on his kidneys, but he has been back on 400mg a day for more than 6 months now. Even at 400mg of riba he has had to take several injections of Procrit because of low hemoglobin. His viral load at week 24 and week 43 was still undetected. We are hoping for the best.  And I wish you all the best as well.
Helpful - 0
Avatar universal
Hi. Chigglewhisper. I thought I would let you know my situation and what happened to me. I agree with others you should of course discuss the situation with your doctors. Lowering the dose is risky for not clearing or relapsing.

I am g1b, 1 million at start of treatment. I had horrible sides from the interferon. I was okay up to 11 weeks, experiencing the same sides as others, fatigue, rash, flu symptoms etc, but maybe a bit more severe, compared to the stories of others here anyway. But gradually over 11 weeks, the sides got worse and worse and by week 11, I had developed profound weakness, anorexia and insomnia. I couldn't eat more than a few bites and I was full. Seemed like parastalsis was almost to a halt. No blockage but food just didn't go down like normal. I also slept less and less at night too, but not realizing it until I ended up in the ER to get help figuring out what was happening. Can't think clearly when you're not sleeping.  I am petite, 5'1" 111 pounds. I definitely overdosed on the interferon although there doesn't seem to be much about this and no research to back this us that I can find. If you google interferon alpha2a overdose, all I find is basically is something like this --

"Seek emergency medical attention if an overdose is suspected.
Symptoms of interferon alfa-2a overdose are not well known but may include decreased appetite, chills, fever, and muscle aches."

I am on Pegasys and the dose is supposed to be fixed but there is no doubt 180 mcg was too much for me.

To get to your question, I had to either stop treatment altogether or reduce the dose. I really want to get rid of this thing so I decided, along with my doctor, to reduce the dose. It took me a week and a half to detox to the point where I could begin to eat and sleep somewhat. I had to miss one dose of Pegasys and 9 days of ribavirin. I was very concerned I would relapse. I restrarted the riba 10 days later at 600 mg a day and Pegasys at 90 mcg, half the dose. I had a PCR at 13 weeks 4 days and, thankfully!!, I was undetectable, even with being off the meds. Since then I have kept to the 600 mg of riba until last week, when I went back up to 800 mg which is the prescribed dose for me, and after one week of 90 mcg of Peg, I went up to between the 90 and 135 mark and have been on that for three weeks. My doc and I decided it was be a good idea to have PCRs done monthly to be sure I am still undetectable at the dose I am taking. I just had a 16 week PCR done and it was undetectable as well. I cried when I heard this as I was so worried the dose reduction would have me relapse.    

My treatment plan at this point is to gradually go up on the Pegasys to 135 mcg and stay at that until the end of treatment along with 800 mg of riba. I still have the sides of flu symptoms and, even at this low dose of interferon, I still have trouble sleeping at night. I take a quarter to a half a tab of Dramamine and this works very well for me. I can only hope this works for me. I had to take the risk.

Hope you feel better soon! I feel for you.... Pam
Helpful - 0
Avatar universal
I'm assuming from your comment that your friend is in for 24 weeks of treatment that he's a Genotype 2 or 3.  You say he was UND at 6 weeks.  Did he have PCR tests for viral load any earlier as well, such as at 4 weeks?  If yes, assuming he was still detectable for the virus at 4 weeks?

Side effects you listed:   Severe weight loss, nausea, debilitating cough and shortness of breath, migraines,severe mood swings,extreme fatigue, insomnia, leg cramps, etc.

Nausea is a common side effect.  Can sometimes be dealt with via adding ginger something or other to the mix and sometimes using an over the counter drug.  Shortness of breath occurs if his HGB has dropped...less oxygen in the blood means he'll run out of breath faster when he does activity that would have been normal before treatment.  So he needs to conserve his energy and use it wisely.  Fatigue is also a result of the same thing.  Choose rest periods wisely, conserve energy for the important things.  Ask the doctor to check his thryoid levels if he's having insomnia.  That's when my insomnia started, when I went hyper-thyroid.  

If the side effects can be treated, that's always the preference over reducing drugs, particularly in the earlier part of treatment where it's more critical.  Will wait for your answer on if your friend had viral load tests before 6 weeks and when before saying more on that.

Trish
Helpful - 0
Avatar universal
Sounds like the side effects your friend is experiencing are common. He has what that call "riba cough". Not sure if you would want to lower the riba dose for this. It is usually lowered for anemia when HGB drops below 10, and even that is avoided when possible with drugs that build up HGB (Procrit, etc).

A good Hepatologist that treats many HCV patients can treat most symptoms with other meds instead of lowering doses, in most cases.

Hopefully your friend had pcrs done? If for instance he had a neg pcr at 4 & 12 weeks it could be possible to lower the riba for a few weeks without comprimising  treatment.

At this point have them eat anything possible, i.e. ice cream, glasses of whole milk, protein drinks. Anything is better then nothing.

Best of luck
Helpful - 0
Avatar universal
Thank you! Med lists so far by Dr.

:2 rounds of strong antibiotics, for cough~ noneffective
Clear chest x-rays (3)
Cough med, with cod, ~didn't touch the cough
Tussi Pearls~noneffective
Advair Inhaler ~little relief
Ambien~ reluctant to take because of other weird sides (still working with this)
Pristique ~ not helping so far with depression, mood swings, and overall personality changes
Plz forgive any (sp) Do not have bottles right in front of me. So new to all this, too.
Cough is sounding like whooping cough, has had it since 1 day after 1st shot.
Helpful - 0
Avatar universal
You're welcome.
There are things that help a lot of sides,for the nausea the Doc can give him meds to help (I hatred that part too!) the weight loss is just normal (but he may need to lower his Riba dose now) if his riba dose is weight dosed.
Migranes, more meds from Doc., Mood swings,he may need antidepressants, most of us need them on tx. He is probably anaemic and low red blood cells(shortness of breath & fatigue), he could probably do with some sleeping pills too,they really helped me.Magnesium can help leg cramps.
Look, what I'm trying to say is that his doctor can help with a lot of those things,
just make sure he insists, sometimes the doctors seem to just shrug at the sides a bit.
Really hope he gets to feel better soon,he's lucky to be UND....& to have a caring friend like you.

~Ozgirl  xx
Helpful - 0
Avatar universal
Hi Ozgirl,

Thank you so much for your quick response. I was just wondering if anyone has reduced meds with a fairly early UND?

I think surely this will be talked about with the Dr. on Monday, but I thought I would ask here in advance.

I am not the one being treated.  This is for a friend. Male and never sick before starting treatment.

Sides: Severe weight loss, nausea, debilitating cough and shortness of breath, migraines,severe mood swings,extreme fatigue, insomnia, leg cramps, etc.

Still managing to eat a little with Riba doses, and so far water intake is good. Food starting to be repulsive to him, as he says it tastes like pure salt no matter what the food is.
Thank you so much for your time and kindness Ozgirl ~
Helpful - 0
Avatar universal
Hi chigglewhisper,
  
What does your specialist think? You should ring him and ask.

I don't think it's good to reduce meds if possible.
I know I HAD to because my Neuts dropped too low ,
and we don't get rescue drugs here in Australia,
I would have prefered not to lower the dose.

You have more chance of killing the virus for good if the dose isn't reduced.

What sides are you having? Are you drinking lots of water? Eating with the Ribas? Getting enough rest?Have you lost a lot of weight?

Hope your sides are  kinder to you soon

~ Ozgirl  x
Helpful - 0
Have an Answer?

You are reading content posted in the Hepatitis C Community

Top Hepatitis Answerers
317787 tn?1473358451
DC
683231 tn?1467323017
Auburn, WA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Answer a few simple questions about your Hep C treatment journey.

Those who qualify may receive up to $100 for their time.
Explore More In Our Hep C Learning Center
image description
Learn about this treatable virus.
image description
Getting tested for this viral infection.
image description
3 key steps to getting on treatment.
image description
4 steps to getting on therapy.
image description
What you need to know about Hep C drugs.
image description
How the drugs might affect you.
image description
These tips may up your chances of a cure.
Popular Resources
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.