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Ribavirin/antacids/Drug Interactions

I'm taking PPI's (Nexium, Aciphex, etc.) and H2 blockers (Zantac, Pepcid AC, etc.) for LPR reflux. Sometimes also take antacids like Tums, Mylanta and Gaviscon.

My concern with the antacids is that they might intefere with ribavirin absorption. Very little in the literature conclusive one way or the other.

Wondering if any of you also take antacids and if you take them right after meals with your riba, or if you try to time the antacids a few hours before or after the riba.
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Avatar universal
Scott,,,,I agree with Ina,,,,With your HGB at 7.7,,,That is getting low.  I don't think at this point,,the walking 1 to 2 miles is a great idea.  I'm wondering if your procrit needs to be increased as it is surprising that your HGB has dropped so low.  Let us know what the doc says and please take care of yourself!  Keep your eye on the prize Scott and you will win!
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Ina, if you are not a nutritionalist by practice you SHOULD BE!!  Your information you so willingly shared with me was so thorough and so HELPFUL!!!  I am amazed at how much knowledge you have gleened by going through your problem stomach "journey" as well!!  There is alot in your letter to "digest" so I have printed it out and will be analyzing what my approach will be.  I was very interested in so many tips you gave me that are simple changes to diet...such as tomatoes being too harsh, no vinegar (I hadn't thought of this) with my salads, milk/ cream a potential problem, too many oranges/strawberries (my favorite)etc.  I don't purchase any non-organic meats to eat so I know the additive problem isn't an issue for me..thank goodnes for organic farms!...otherwise those meats in the stores are deadly!
I will discuss compazine with my doctor.....I prefer the oral but no problem if I have to take the suppository....whatever helps!  I suspected onions and garlic were a problem...thank you so much for confirming this for me. I am interested in the cabbage juice route but will try this after I adjust some of my eating habits now with your suggestions.  I guess I'm avoiding it a bit as I seem to not have enough time in a day now to accomplish all I have to and can't imagine the daily "clean up" of the extractor....however I will do what I have to if this doesn't let up soon.  I'm so excited to take your dietary suggestions and see if they help.  I will of course spend time reading through your letter very carefully and making the adjustments TODAY!  Since we had correspondence I decided to eat much less at breakfast and lunch to see if this helps.  I usually don't have an appetite at dinner so I was eating more at breakfast and lunch to compensate as my weight loss is a problem.  Now that I've conciously been eating less at breakfast and lunch I've noticed my stomach is aching less and the nausea seems better in the late afternoon.  I've also noticed an increase in my appetite at dinnertime which I'm pleased about.  Possibly I was forcing myself to eat too much (small meals by standard diets however) at the first two meals.  I have also stopped eating oranges as I suspected this was a problem and you confirmed it as well.  I have made another change since we had contact....I am now forcing myself to walk 1.5 to 2 miles everyday even when feeling not good and I have noticed my stomach is much less painful and less nauseated.  I'm sure there is a relation there and will continue to see if I find relief also with more activity.
On a different note I got my blood work done this past friday and it wasn't good so I now have to deal with this new issue so I will take your advice listed and make changes to my diet while I deal with my blood problems.  I am on Procrit every week but my Hemoglobin has now dropped to 7.7 and my white blood counts also suddenly dropped to 1.7 for the past 4 weeks.  The doctor is very concerned and I just had more blood work done this a.m. to be sure there wasn't an error.  For several months I've been holding steady with Hemoglobin at 9.3.(with Procrit weekly)and wbc at 3.2 so the shift has them concerned.  I have to go to a hemotologist and get started on Nuepogen if todays tests come out in the same range.  Still overall doing very well, remaining optimistic as I am now undetectable....I just have to hang in there through all the various sides that have decided I was thier next viable candidate to bother!  I only have 5 months to go which seems like only tomorrow!
Thank you SO MUCH Ina for all your support and knowledge and great CARE!  I got more from your support than I did when I discussed my stomach issue with my doctor....once again I have learned to play my own doctor!  I think it is too early to tell but the small changes I've already made to my diet are helping as well as the increased excercise (hard to do however with hemo at 7.7!).  I look forward to making more changes starting today on the diet as you suggested and I will keep you posted. Thank you again Ina ....you are wonderful and the forum is so lucky you are HERE!
I hope you are doing well.  How are YOU?
Best to you, Scott
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Just for the record-After years of acid reflux and an ulcer-various dietary approaches and lots of antacids I moved from the city to the country and found that well water(untreated) versus treated city water made a hugh difference in how I reacted to the various foods that used to cause heartburn.If you drink treated city water take this into consideration also. Also used the cabbage juice approach which helped quite a bit when I was still using city water. frank
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Latextuality????
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Your apron has my name on it!  One little tip on the arugula sandwich.....roast some red peppers and a yellow one in the oven or under the broiler, then scrape off the blackened skin and put these on the sandwich as well...if you have pesto (basil or arugula pesto) on hand a little of that too will make that sandwich sing! As you can tell I'm a "foodie"....love it when I HAVE an appetite. (less and less lately however)

Now for Ina's great idea of having latex gloves on hand which is an admirable commitment to hygiene in public places: this may be advisable to help those NOT on tx understand our various days.

red latex gloves: yet ANOTHER blood test day.
blue latex gloves:  Depressed today. Hugs needed ASAP.
green latex gloves: Surprise: another nauseous day!
yellow latex gloves: MORE water? I'm peeing my brains out day!
orange latex gloves: WARNING: riba rage day. Beware!
purple latex gloves: Confused "hazy" day......BRAINFOG.....? UGH.
white latex gloves: Don't get me sick! Low WBC counts!
black latex gloves: Can't see the light at the end-day.

This list could go on forever........... Hope you all are well today!
Scott
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What ever works!

Scott
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Avatar universal
"I don't think you started out with stomach problems, nor did I ,       but I think jimjim did..am I correct? "

---------

I started out with ear pressure, then ear aches, then swallowing problems, lump in my throat (globus), sore throats, hoarseness, sinus pressure, headaches and generally feeling lousy from the neck up.

I did have some stomach problems but it turned out most of the stomach problems were related to the the double Aciphex (PPI) that I took for a couple of months. Now that I'm temporarily off PPI's, my stomach is fine. Sometimes it growls a little but I think that is due to the Pepcid AC, which is like Aciphex Light. LOL.

What I have is called LPR (laryngopharyngeal reflux). It's when the acid or bile rises past the esophagus and into the vocal cords and throat. Sometimes even into the lungs.

It was hard in the beginning to figure out which problems were from the LPR and which from the hep c treatment. But by intentionally varying my diet, and stopping and starting various medications, I was finally able to isolate  those symptons to the LPR. In addition, I've had a  endoscophy and my larynx scoped that confirmed reflux activity.

My new approach (I'm on day 3) is to wean off the reflux drugs and try a sedative/muscle relaxer like Xanax to counteract the physical effects of the ribavirin which often has me tighter than a drum.  Stress is a known factor for all types of reflux.

I'm not crazy about taking sedatives, but if it will help the LPR so be it. If that doesn't work, it will probably be back to the PPI's which I don't tolerate very well. They do have an operation, but it doesn't make any sense to have it during treatment.
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Avatar universal
Sounds like a good diet to me.

Maybe you've already investigated it, but stomach pain two hours after eating sounds like a classical ulcer.

If your doctor won't take it seriously, find another gastro who will. Usually for dx they do an upper GI series and/or an endoscophy. Depending on what they find, they may change your meds or even put you on antibiotics.

You really want to check out all the possiblities. I don't have to tell you how bad gastro problems are along side the hep c treatment.
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Califia:  I apologize I didn't thank you for your comments.  I reread the whole thread to be sure I didn't miss anyone and of course I did....sorry.....not blaming brain fog but it is a good excuse!...or maybe it was B.F.!?  I will try the peppermint oil...I love the idea of natural aids to help instead of more meds...but I just can't give up Zantac yet.....I'd be even more miserable I'm afraid....I'll try the combo.

Ina: You are so kind! My diet has been fairly healthy for many years...could be better however I'm sure. 80's I was macrobiotic....90's vegitarian....2000....eat only organic foods and now eat organic meat.  My typical diet is a.m.: whole grain cereal with bananna and yogurt, keifer, or occassional cottage cheese with blueberries....or a fruit salad I pull together. Of course with my Riba. I seem to never have a problem in the early a.m. with the stomach. Lunch: miso soup often, tuna salad sandwich on whole wheat bread, fruit, toasted arugula/ asagio cheese sandwich, sometimes organic turkey breast on a bed of lettuce or in a sandwich, bean soups and lots of fruit. my reflux/ stomach pains are the worst about 2 hours after lunch EVERY day. I usually feel very nauseated by 4:00p.m. every day. I take Zantac BEFORE it starts but it always flairs up terribly just as my fatigue starts to hit me in addition from the days energy spent. I usually end up taking 3 Zantac every afternoon...sometimes helps, sometimes doesn't.  Dinner is my most dificult meal...I have lost alot of my dinner appetite (and weight now..20lbs!) as I don't think I'm eating enough 'little' meals through the day.  Dinner is typically pasta with fresh veggies, or grilled chicken breast with  brown basmati rice with a side veggie, or a large mixed green salad with avacodo,lots of grilled fish too. On rare occassions I make myself eat some red meat like a lean steak or sometimes a small pork chop but this is really unappealing to me right now and I feel nauseous often afterwards. I do cook with butter alot as weight isn't a problem and things are so much tastier.  I have a terrible craving for sweets which I didn't have before tx, but refrain as I don't want THAT kind of weight gain! I don't drink ANYTHING but water and LOTS of it all day long. Doctor told me I should start drinking Ensure to help keep my weight up. I seem to not notice any difference how my stomach/reflux feels based on what I'm eating (except for those rare times I suffer after attempting a Mexican meal "treat"....very very bad idea!...certainly NOT a treat afterwards.)  So that is a generalized list ....so what do you think? I appreciate your input and suggestions.  Maybe I need more yogurt, keifer, buttermilk, cottage cheese etc?...I do eat these but only about 2-3 days a week. Thanks again..you are very kind as always! This is the worst side I'm facing right now and until you go through it one wouldn't know how bad it is!
Scott
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Avatar universal
Scott, you've really gotten me going with that arugula sandwich bit.   I want you to know that there's an apron waiting for you in my kitchen any time.   (Italian, screenprinted with hyperrealist neon colored fruit--think you might like it.)   It's a wonderful diet you've got going there, and it's just not fair that you're STILL having trouble.   Heck, I consumed a moderately sized walnut, apple, spinach and goat cheese salad for lunch yesterday and a half hour later became completely nauseous--was adequately hydrated, the whole works, and still the riba gleefully pounced.   Queen of the Quease, I am, in spite of my organic habits and lovely little kitchen garden and the whole works.   Some people just have all the fun, you know.  

Ina,  you could dangle those latex gloves from your back pocket, either as enticement or warning...on the left for the former, right for the, uh, latter.....

And a random thought:  Is it possible that this tx could especially vex the gallbladder?

Jm:  Eeeeeerrrrrrrrrp.   And thanks for the many good laughs today.
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Ina:  Thank you so much for your interest and support.  I appreciate it so much espeicailly since my docotr seems to be dismissing my issue and just telling me to pop Zantac as needed.  First to clarify....I don't mean to be completely ignorant about these stomach issues but I have not been diagnosed with any of the specific problems you all have mentioned....as this is all new and has crept up on me during tx.  My description of the problem is after eating..usually about 2 hours I feel nauseated, churning in my stomach, and kind of an acidic taste in my mouth with a constant pressure pushing 'UP' from my stomach which can last for hours on end.  It isn't a burning pain as I suspect an ulcer would produce...more of a constant pressure and churning that makes me feel very sick.  I usually try if possible to nap as it takes my mind off the discomfort...although this is difficult when I'm busy working. (self employed textile designer...LOTS OF FABRIC everywhere!)  Regarding other questions:  I don't use canned/jars of tomato sauce.  I'm obsessed with preparing my own foods from scratch so I make my own....easy to do...tomato's, garlic, basil, onion, and simmer away...toss with pasta and voila!  Salad dressings are the same...I whip it up on my own....olive oil, vinegar of some sort and usually herbs mixed in like french Herbs de Provence or something similar. I hope this info helps.  Please take your time in getting back to me...I understand you are very busy right now as well!  Once again your kindness is so overwhelming...Thank you.
jmjm: Thanks for your advice!  Yes, I've thought it may be an ulcer but the symptoms have not seemed right to me by the reading I've done.  My partner has had an ulcer and the symptoms are different from mine.  I WILL however pursue this matter with a different doctor if I don't get relief soon as it is getting to be a BIG problem....my most stressful side effect at the moment:  but as you ALL know....they change like the weather!  I'm hoping this will phase it's way out like other challenging sides I've gotten through on tx.....Thank you again jmjm....always helpful to MANY here on the forum.  
In the meantime I'm going to try Califia's recomendation:  Peppermint oil and if that doesn't help I'll try Ina's and Scruffy's advice on the cabbage juice....I love veggies so this could be a treat(although dread the extrator clean up!!)
Thanks to all and I hope this tues. finds you all well with few sides and beating this virus down or keeping it at bay!
Scott
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nanniega; how long are you treating for? as Jm suggeste, extending treatment beyond the norm might ensure SVR and some damage reversal. keep us posted.

rearfang: many things do cause elevated rheumatoid factor,  a web search might give you other reasons for its elevation. I had high factor for a few years before tx and it was not checked during tx so I have no idea if it was high or not. I am definetely getting it checked this week to see if it went back to normal after all these years. Did you get tested prior to tx? what made them test you during tx? my GI never suggested it, it might not be significant while on tx if it goes up.
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Without pressure we would have no diamonds.
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Ha!  I'm learning from you, babe.   But having those mittel /  eastern european genetics myself, I'd have to say that when I'm feeling bunk, my instincts always lead me back to rye bread and cabbage and cultured milk--and a nice sour borscht, of course.  I have also learned from this treatment that you can do everything "right" and still get clobbered.   I do know that it took my body about six months to adjust to the ribavirin assault, but it finally has.   Well, not completely--but at least the more painful aspects seem to have passed.  I'm glad you mentioned the internal landscape, something that we're all too polite to talk about around here, myself included.   I mean, what self-respecting femme fatale is going to go on public record about  vagxxxx itchxxx and chronxx conxxxxxxxxx and really painful hemxxxxxxxx?

Ah, treatment is a thing of beauty....
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Thank you all for your responses to my question.  I apprecaite your input as this stomach issue is getting to be my biggest challenge on this tx at this point.  
Ina:  I found your cabbage juice idea inspiring.  You mentioned cabbage tx takes 2-3 months and the added benefit may also be less anemia!  Wow, sounds great.  I have to look into investing in that extractor.  Thank you for that tip.  Sorry you too were in such stomach discomfort for nearly 6 months of your tx.....just like myself.

jmjm: Your question regarding if I had started taking Zantac for stomach problems or for acid reflux made me stop and look at my problem.  I have never been diagnosed with GERD or any acid reflux problems as I haven't seen a doctor for it as of yet.  I now assume it is from Hep C and the tx.  Now I am thinking I may seek professional help (not my own doctor however as he dismissed it when I discussed it and told me his other patients hadn't experienced it on tx! You all have confirmed I'm not alone with this problem!  I have gotten to the point I'll take other sides over this anyday.  Your words also put my mind at ease that I am not interfering with riba absorption as it is an H2 blocker.  I should have put my "brain cells together" and realized this as at week 12 I learned I was undetectable!  Obviously the Zantac has not interfered with the progress I'm making.  Thank you for your input...I really appreciated how thorough your note was.  As for your challenges I hope your idea of a Xanax will work for you.  I know how challenging this HEPCFLUX issue can be!!!  awful!

Ben:  Thank you for your informative note:  So glad you too confirmed that the H2 blockers are o.k. to take. Next time I see the doctor I'll pin him down on why I shouldn't be taking cimetidine as this doesn't make sense to me either...and it WORKED for me better than Zantac!  I believe this GERD/reflux issue is Hep C related but not too much talk is out there about it. Why? I now know I'm not alone with this issue which at times is horrendous!  I have to force myself to eat at times as I'm loosing too much weight on tx but it can be hard when you feel like your stomach is in your throat! If this continues I will look into Omeprezole you were on.  This sounds encouraging.  Thanks for your information.
  I hope this finds everyone well this Sunday night...or at least less sides than normal!  I'm going to do shot 23/48 right now....it feels great to be getting to that 1/2 point!
Best to all,
Scott
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Avatar universal
Thanks Dutch, but reflux/gerd/LPR comes in many strengths and flavors. I think (and please correct me) Ina had mostly stomach problems. Sometimes a different approach will work down there.

I have what is called LPR or silent reflux. No hearburn but just about everything from the throat upwards is all messed up.

First I tried the H2 blockers and PPI's and while they helped marginally, I had a lot of side effects from the drugs.

Then I stopped all meds and tried about every natural cure I could find including yogurt and fermented foods like Miso soup, and a daily umbeoshi plum. For the past month I lived on nothing but white rice porridge, boiled chicken, applesauce and white toast. Not fun. LOL.

Finally couldn't take it any more and went back on H2 blockers and some antacids. I've already had a battery of tests including an endosophy. Monday I'm supposed to have what is called a dual prope 24-hour PH monitoring plus Manomentry.

But like I said earlier, I've had the feeling all along that the stress from treatment (physical and emotional) has been a big factor.

It may be coincidence, but today I took two Xanax's and have had no symptons. If things keep working out for the next couple of days I'll probably cancel/delay the PH test which is not fun.

If my Xanax approach doesn't work out, I'll probably have to go back on a double daily dose (possibly triple) of PPI's for at least 4-6 months. They have an operation, but there can be complications, plus it really doesn't make sense to have it while I'm on treatment. I'm sure I can lick this thing once I get off treatment. But that won't be for a while.

We really should start a reflux/Hep C forum. LOL. Maybe we can call it HepCFlux. LOL.
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Thanks for the kind words. I am so sorry to hear you are having troubles. I can't answer your questions but am sure there are others who can. I will say a prayer the test is wrong and if it isn't, will say a prayer that your body deals with it well. Good luck to you and may God Bless.
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Lexapro is a SSRI class of antidepressant. It doesn't counteract or oppose the actions of Xanax but works by inhibiting the reuptake of serotonin by brain neurons. Thus, Lexapro increases serotonin levels in the brain which in turn counteracts the symptoms of depression.
I hope I was clear.....

Best wishes,
Ben
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BTW.....SSRI=Selective Seretonin Reuptake Inhibitor
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Nanniegea,
That is great news!!! Congratulations to you.

Okay, once again I apologize for jumping in here, but I suddenly seem to be facing one thing after another. I have done #9 (should have been #10) of 48. First 7 weeks were a relative breeze. Next a fever that would not go away, blood tests x-rays, more blood tests, docs wouldn't let me continue tx, missed a full week of peg, 4-5 doses of riba. Finall y got a friend (ER Dr) to prescribe antibiotics (Doxycycline), fever gone w/in 24 hours, back to tx. ANYWAY, just got a call from gastro yesterday. Results from the 2nd round of bloodwork showed somewhat elevated RA factor. They've got me seeing a Rheumatologist Tuesday. Now am scared to death about having yet another chronic illness. Questions: Could the test be wrong? Could whatever bacteria caused the fever have affected the RA factor? Anyone else experience this? Have RA from tx? Know what to expect? (Interestingly, when I had the fever, my wbc count was "up" as in normal, now is back down to 3.9, closer to wahat it had been during tx. Still waiting on PCR results but liver enzymes were normal.) I do have joint pains, like many of us, but none of the other symptoms I read that are associated with Rheumatoid arthritis. Any feedback would be much appreciated. I am discouraged and worried. Miss talking to you all daily--am w/o computer for now.
Lauren
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Avatar universal

I think in your current state of mind you could use a healthy dose of Provigil to counter the effects of Xanax.....hahaaha. Are your walls padded, in case you should stagger the wrong way? Well at least you should have no problems in sleeping well tonight!
Keep on smiling while you're stumbling,
Ben
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Avatar universal
You're not alone w/ these digestive fun and games.  I have to second Ina's comments about the effects of early treatment on the Gi tract.....the horror, the horror.

I had such severe acid stomach from the riba that I started having sharp pains behind my collarbones (!)  from the very first week.  That was certainly a new experience.  My doc, who was used to hearing about this complaint, prescribed Prilosec.  I took it for a few days, decided that it was making a negligible difference, and promptly discontinued it.   For the next few weeks, I medicated myself with peppermint oil--a few drops in a small glass of water.  Worked much better for me.

There is a lot to be said for Ina's recommendation, too.  You might also find fermented foods very helpful right now--yogurt, kefir, sauerkraut, etc.

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Avatar universal
I thought Lexapro would do the opposite of the Xanax, which is to calm you and your system down. Did you use one to counteract the other? I'm using the Xanax very specifically to counteract the stress effects of the riba while I eat.
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How do I know if I have a sustanined release tablet? The .5 mg tabs I have are oblong and orange with a score down the middle. So i just assumed they could be cut in half. Actually, I'm taking the generic xanax called Alprazolam but I'm not sure that makes a difference
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