Riba dose question

Question

Hi, My Gastro Doc just called me wanting me to increase Riba from 600 to 900. TX is triple incevik. Long story short, I'm coming up on week 14,I've been on 600 Riba since week 4 (from 1200). UND weeks 4, 8 and 12. After 3 transfusions and 7 procrit shots hgb hung around 7.2. Last Thursday it was 6.6, today it's at 7.6. Because of the jump in the last few days he wants me to increase Riba. My question is, is the chance of achieving SVR by increasing the Riba at this point worth the hgb drop I will most likely take?

Thanks

orphanedhawk · Answer

Yes, of course what's done is done.
Did you ever ask your doctor why he wanted to increase the riba dosage?
Just curious ?

I have on occasion asked my doc a question and you can almost see the light bulb flash~ "oh right, I hadn't thought of that'.
They often go by routine.

Good luck,
OH

dn7582 · Answer

That was my exact point to my doc. 600 mg of Riba has worked for 14 weeks, and still have severe anemia at that dose. Albeit hgb is up a bit 8.2 after stopping the Incevik.I guess to achieve SVR, he feels more is better (Maybe??). Anyway, it's done...I raised Riba to 800 and will monitor hgb closely.

I really appreciate all the support I have received over these trying last couple weeks....thanks  a lot. 
Dan

orphanedhawk · Answer

Personally, I don't understand why you need to change the dosage as long as you are UND.
The idea is to be und, and doses are not an exact science.
Why change what's working just because some 'guide' says this is the dose for someone of your body weight?

dn7582 · Answer

"Would it be helpful to ask your doctor if you could increase it in increments (e.g. 600 -> 800 this week and add more next week)?"

My thinking too. I increased to 800 today...hopefully I can raise it more after next cbc....yesterdays hgb was 8.2 woot!

Thanks again,
Dan

Advocate1955 · Answer

PS:  Keep in mind, your doctor is trying to get you to SVR.  
Advocate1955

Advocate1955 · Answer

You also just finished Incivek two weeks ago, right?  Incivek can also cause or contribute to anemia, so it may be possible that now that you're finished with the Incivek, the anemia will continue to improve even if the Riba is increased again.  Would it be helpful to ask your doctor if you could increase it in increments (e.g. 600 -> 800 this week and add more next week)?  I don't know about your pills, but my husband's come in 200 mg. tablets.  Would you cut one pill in half to get 900 mg or do yours come in different mgs?  Also, another suggestion would be as you increase the Riba gradually would your doctor allow you to have Procrit on hand in case your hgb goes back down (so you don't have to wait for it to be shipped)?  Just my thoughts.  I know that with triple tx, the protocol is to reduce Riba in favor of adding Procrit.
Advocate1955

fredpacc · Answer

Hi, My hgb dropped to 7.4 and my Dr Stopped my Riba, the standard protocol from Vertex is to reduce Riba not increase it. Also, stopping Riba treatment for a short time has no statistical effect on SVR. I would really try to get a second opinion on this call. I can't even believe you are able to function at such low levels of HGB, I couldn't even move at 7.4...Best of luck - Fred

fredpacc · Answer

Hi, My hgb dropped to 7.4 and my Dr Stopped my Riba, the standard protocol from Vertex is to reduce Riba not increase it. Also, stopping Riba treatment for a short time has no statistical effect on SVR. I would really try to get a second opinion on this call. I can't even believe you are able to function at such low levels of HGB, I couldn't even move at 7.4...Best of luck - Fred

dn7582 · Answer

Good info, Thank you very much.

beeblessed · Answer

OMG you got down to 6.6?!!

----------------------------------------------------
WHO Grading of anemia:[17][18]

Grade 1 (Mild Anemia): 10 g/dl - cutoff point for ages
Grade 2 (Moderate Anemia): 7-10 g/dl
Grade 3 (Severe Anemia): below 7 g/dl
National Cancer Institute Grading of Anemia:[19]

Grade 0 (within normal limits) 12.0–16.0 g/dl for women and 14.0–18.0 g/ dl for men
Grade 1 (Mild) 10 g/dl to levels within normal limits
Grade 2 (Moderate) 8.0–10.0 g/dl
Grade 3 (Severe) 6.5–7.9 g/dl
Grade 4 (Life threatening) <6.5 g/dl


http://en.wikipedia.org/wiki/Anemia

Also, have a look at the info on this page about anemia related reasons to discontinue:
http://www.drugs.com/pro/ribavirin.html

dn7582 · Answer

He's knows 7.2 is low. He's basing the Riba increase on a 4 day trend, going from 6.6 to 7.6. I told him I wasn't gonna increase it till I get my cbc on Thursday to be SURE hgb is continuing to rise (am I risking SVR?)...he was ok with that but is really pushing for a higher Riba dose to complete 24 week tx. He admits to not knowing the effect of continuing a decreased (600) Riba dose through the double tx 12 week period. These triple therapies are new to Doctors too, mine anyway....I'm his 4th on triple but no others experienced the degree of anemia I have.