Riba and fiber question...

[Kathy73]

I start SOC on Thursday and saw in a thread today that fiber may inhibit the absorbsion of riba. I'm on the Atkins style diet and eat alot of fiber. Does the fiber matter when the pills are taken or at all times? Anything else I should know about riba?

[CoWriter]

"First, there seems to be some confusion regarding bioavailability versus rate of absorption. Several times you refer to the slower absorption of ribavirin with a high fat meal as if it’s a negative."


On a previous post, you said......

"As mentioned, taking riba with a high-fat snack (high-fat meal better) has been shown to increased riba absorption"

I was just making a point.  A high-fat meal DECREASES Riba absorption.  I think I've got it straight.


"And while the studies aren’t perfect – more on that later – taking riba with a high-fat meal has been shown to increase bioavailability up to 70%."

Compared to people who were fasting.  That means that we don't know whether bioavailability would be 69% or 71% or whatever if people eat a regular, non high-fat meal because they didn't look at that.  They compared people who ate a high fat meal to people who ate nothing.  

And they looked at bioavailability after ONE dose of Riba.  Bioavailability after multiple dosing may be totally different.


"I’d take my riba with a high fat meal because I think there's reasonable info that it will give you an edge and I will also eat to survive (cheese omelets and all :)  "

1 egg has 5 grams of fat.  I doubt that you ate 10-11 eggs to consumme the amount of fat per meal suggested by the study.  

I agree, if it means survival, it's better to eat junk than to eat nothing at all.  At that point, getting calories is the important thing, doesn't matter where they come from.

But I can't agree with suggesting people starting treatment eat 54 grams of fat twice a day (as suggested by the study) to maybe increase Riba bioavailability.  Not when up to two thirds of them may have insulin resistance and many of them have steatosis.

A high fat diet promotes oxidative stress, steatohepatitis, hyperglycemia, hepatic insulin resistance, hyperinsulinemia, an increase in CYP2E1, and cytokine-induced beta-cell death.

I suppose since hyperinsulinemia makes interferon ineffective, then we wouldn't have to worry about the bioavailability of Riba.

[Deb_c430]

I spoke to my Drug company nurse about this,  The point is you do need fat, if you are on a fat free diet, it does help with nasuea,   Fat is found in most foods, I am not speaking Mcdonalds! I am talking a salad with olive oil, a small piece of meat cooked in olive oil,  Nuts, icecream.  Even with out the riba question you need some fat in your diet, skin, hair, ect.

If for no other reason, you need fat for naseaua.   For skin, for hair,

When I first started visiting here, my VL actually went up!  Ny and jim both suggested a higher fat diet, it worked.  

[jmjm530]

Thanks for joining the riba discussion.

I’ve read the Medscape article you referenced and if I had to treat again today, I’d still take my riba with a high fat meal for a number of reasons.

First, there seems to be some confusion regarding bioavailability versus rate of absorption. Several times you refer to the slower absorption of ribavirin with a high fat meal as if it’s a negative.

In fact, slower absorption is often associated with HIGHER bioavailabity which to simplify  means how much of the drug taken becomes available.

“The clinician is concerned primarily with bioavailability rather than absorption.”
http://www.accessmedicine.com/content.aspx?aID=935828

And while the studies aren’t perfect – more on that later – taking riba with a high-fat meal has been shown to increase bioavailability up to 70%.

The second reason is because some (not all) of us find taking riba with fat produces less gastric discomfort. I, like many others, had constant gastric problems and I'm sure the riba didn't help.

And lastly, because many of us, including myself, had signficant weight loss during treatment and therefore needed the fat as calories.

This is a conversation we’ve had previously, and I’ve felt you have been both dismissive about what I contend is a non-preventable issue in many (not all) of us.

You seem to think that dietary intervention can both prevent weight loss and the grossly altered taste/appetite sensations that many of us have. I disagree.

Prior to treating, I had a relatively healthy Mediterranean style diet supplemented with protein shakes. I loved fish, vegetables, tofu, etc.

During treatment, the thought of a vegetable or Tofu would give me the Willies. I know that “willies” isn’t a scientific term but believe me many of us got it from even thinking about certain foods. For that reason, eating was more survival than anything else during treatment. Yes, I would loved to have eaten healthier --- and used healthier fats – but I couldn’t. Many of us can't.
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As to Antacids, your Medscape quote for some reason became truncated but the complete quote says that the bioavailability was reduced by 14%. The figure you included (Cmax) is not as important because it doesn't measure steady state. Is it unlikely to be of clinical significance as stated (but not in caps as you suggested) I really don't know. But again, I would in no way take the chance and chase my riba with Maalox, when there are better alternatives such as PPIs (like Nexium) and H-2 blockers like Pepsid, Zantac, etc.
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I do understand the study data is inconclusive in this area and that almost all citations end with the caveat that no clinical implications can be drawn. That’s not unusual because the studies have been quite limited. So we read the studies and we make up your own mind. Draw our own implications.

And to come back to the beginning,  to do it all over again – g*d forbid :) -- I’d take my riba with a high fat meal because I think there's reasonable info that it will give you an edge and I will also eat to survive (cheese omelets and all :) )because that was the only way I was able to eat on treatment and equally imporant, it was the only way I was able to stay on treatment due to significant weight loss.

Lastly, want to clear up your comment on what someone posted regarding riba needing fat to find to it. Not that you attributed that statement to me, but since I'm the only one you referenced in your two posts that confusion may exist. Someone else said that. I didn't.


-- Jim

[Kathy73]

Thank you all so much for your wonderful information. It is truly appreciated.

[CoWriter]

One last thing......

As per the info on Riba pharmacokinetics......

"Coadministration with an antacid (containing magnesium, aluminum, and simethicone, Mylanta) reduced the bioavailability of ribavirin.  Cmax (Maximum Concentration) WAS REDUCED BY 3%.  THIS CHANGE IS UNLIKELY TO BE OF CLINICAL RELEVANCE. "


http://www.medscape.com/viewarticle/416602_2

[epiphiny]

Thanks for that, one of the more comprehensive posts on this topic I have seen.  And I am really glad you decided to post it as I spent ages looking for info a few months back with limited success. I noticed that some of the study you quote is also in the latest Copegus Medicine Info Sheet ie increased bioavailabilty of riba when taken with food as against fasting.

Anyway, for a while I tried to really up my fat intake with my riba meals and all I really succeeded in doing is making myself feel very fat and bloated and adding a few kilos!!  In the end I have taken the 'in moderation approach' and have included some healthy fats in my breakfast and dinner and have gone back to my normal weight.

Thanks again,

Epi.