Triple TX length. Anti-nausea/ rash

[Cory255]

Got the dreaded rash on elbows, knees, & feet wk 7 on Incivek, Pegasus (alfa-2a), & Copegus.  

I've tried the following, any interactions with these and incivek?

Hydrocortisone Anti-Itch Cream - Cortaid Brand
Maximum Strength Cortisone Hydrocortisone Anti-Itch Cream
Diphenhydramine HCI 25 mg Anthihistamine

Geno 1, starting viral load 2,230,643.  Wk 4 VL not-detected.  I need advisement on # of wks I need to do?  

Previous TX - 09' - 44 wks w/ Peg-interferon alfa-2b & Ribavirin.  Cleared ( UND ) @ wk 12 - relapsed 1 month post TX.

Also, I was prescribed Promethazine 25 mg, generic for Phenergan for anti-nausea.  Any interactions w/ incivek?

[Cory255]

Great idea about the ice packs, I haven't tried that yet.

[Cory255]

Nice to see ya, Dee.  The atarax and icing worked for you, that's helpful.  

[Cory255]

The zofran worked out well.  That's awesome.  The benadryl didn't make much of a difference for me either.

[Cory255]

Now I'm just kind of itching all over, like I'm on an opiate or something.  I didn't want other people around to think I hade lice or something, heh

Nice, Props for that.....Things seemed to go well at my last follow up, I'm sure if I brought it up they'll prescribe something for the rash.

[BoceprevirGal]

Aha, these were exactly the three ladies (up there^^) that I was hoping would come by, to advise you : )
   The Atarax being mentioned is another name for the Hydroxyzine, that I mentioned, and I got the idea to take it, from pooh, who is very knowledgable.
   I should start taking it again, probably, because I am still itchy, and it is making me irritable. I get pretty stubborn about not taking pills though.
  This is the first time I have ever had to take all these pills, so I'm just not at all used to it. But yeah, the Atarax is good, because it treats it systemically, and it wont dehydrate you, like the Benadryl does

[LookingForward12]

For my rash, which turned into a major major deal, I found  relief from the itching Atarax (hydroxide 25mg X 2 four times a day). It also helped me a lot to apply cold paks (used for sprains and things) that I kept In The freezer to the worst areas- especially before bedtime. I actually have one that is about 14 inches square....almost big enough to cover my whole back. It felt heavenly and really helped with my prickling, burning, and itching.

The topical steroids did not help my rash at all because it was so severe. Even the heavy hitting clobetasol didn't touch ot.

For nausea, I started with the Phenergan and then switched to Compazine.

Hope you will feel better soon.

[Dee1956]

Hi Cory, so happy to hear you are treating.  I am sure you have received lots of great information I just wanted to say hello.
Also I used Atarax and also iced the itchy skin with frozen wascloths until the Atarax started working, best to you.  Godd to see you
Dee

[pooh55811]

I got the nausea and the rash, lol.

I take Zofran 8 mg every 8 hours and it works very well. I was very ill before starting it and within a day or two felt so much better.

For the rash and itching, I take Hydroxyzine 25 to 50 mg every 6 hours. Currently I am taking 7 tabs a day, 50 mg in the am, 25 mg about 11, 50 mg at 5p, and 50 mg at 10:30 p. I also have a prescription for clobetesol soln. and 1 for fluocinonide ointment. For me, the fluocinonide cleared up the rash that I put the ointment on (but it took a long time to do it, weeks), but then the rash just moverd next door. It did help the itching. I found tthat he Hydroxyzine was not nearly as effective at a low dose. I started at 20 mg every night. That was not anywhere near what I needed. Once I got on the correct does, I felt so much better. The rash cleared up pretty well, and the itching pretty much ceased. If the rash is a drug reaction it is systemic. That is why the pills (at the correct dose) work better. They suppress it systemically. The yopical ointments and creams will work for the area you put it on, but they do nothing about the cause of the rash, the systemic drug reaction.

I found the over the counter meds to be worthless. I may as well have been taking sugar. They are just not strong enough for a true systemic drug reaction.

The drugs I use are all safe and I ran them by my pharmacist to be double sure that there would be no reactions with the Hep C meds.

[BoceprevirGal]

Yeah..it helped alot, but I went off of it, once my rash was no longer visible.
Now I'm just kind of itching all over, like I'm on an opiate or something. I was just at the store, trying not to scratch my head, because I didn't want other people around to think I hade lice or something, heh
   My rash is just from the ribavirin though, I know the incivek rash can be more serious though, so make sure you mentionit to your Doctor, at your next visit (hopefully it's soon?) and get him to prescribe the anti-itch pills, and a prescription cream.
   Some people on here have had better luck going to a Dermatologist, but I hate making appts, and going to Specialists, and there is always a long wait, etc
  That Gold Bond lotion sounds good also, though. I might try some of that

[Cory255]

For now...the promethezine works for my nausea, I may ask about zofran if it gets any worse, it sure does sound potent with the headaches.

[Cory255]

Changing to Zofrans not a bad idea, and I appreciate the idea.  The promethazine I believe seems safe when not on an AD, since so many others were on it as well.

[Cory255]

The itching is crazy, so the hydroxyzine's helped a little bit?  I try to stay outta the sun, if I wear a hat or shades it's not so bad.

[Cory255]

You told your Dr. about the Fluocininide.  How'd you find about that?  At next meeting, I'm gonna try to get a rash prescription.

[Cory255]

Thanks for the trustworthy info.

[Ironpony]

I have both.. zofran was no longer covered (but I got a huge bottle to start with, so they prescribed promethezine. The promethezine does not touch my nausea. I am hoping I have enough zofran to get me through. I occasionally get a headache but it is worth it to not be nauseated all of the time!

[ceanothus]

That's right. They were both being extremely conservative about what medications they would allow me to use while on the Incivek. They said that Ondansetron (generic for Zofran) was the safest anti-nausea pill to take with Incivek. They also insisted that prior to starting tx I had to change my AD from Zoloft to Cymbalta (though in this case Cymbalta was not the only AD I could use, just their first choice in my particular situation). I really was extremely impressed with how well the Ondansetron worked - it took effect in about 15-20 minutes, had no discernable sx at all, and took me from vomiting to actually feeling good enough that I had a little bit of an appetite. When I had tried Promethazine in a previous round of 2-drug tx, I had not found it nearly as effective and it really knocked me out every time - I never did acclimate to it. I'm really glad it works well for you, but you might want to ask about the other drug just to be on the safe side.

[BoceprevirGal]

Hmmm, I am on Victrelis, and so I think the Incivek rash is different from the common riba-rash~
   I got a rash last week, and at first I did try Benadryl, but read that it was dehydrating, and since I'm never able to drink the gallon of water we are supposed to drink (I drink maybe half of that, I think), then I went to my Doctor, and had her prescribe me some anti-itch pills called Hydroxyzine.
The Doc looked it up on her pom-pad and there was no interactions with my three meds, so you could check, to see if it is safe with, Incivek. I took the pills every 6 hours, and they did help a bit. But I have to stay out of the sun, or the rash comes back~

[Dawn703]

First time I got the rash, Eucerin calming cream worked. Benadryl, hydrochortosone did not. No drug interactions there. I currently have rash again, and NOTHING worked. I finally TOLD my Dr. To prescribe Fluocininide. Again no interactions there. It has worked great. It is not completely gone, but is subsiding and itch is so much better. Don't know about drug interactions for your antinausea, but Zofran works great, it causes annoying headache occasionaly but no drowsiness.

[hrsepwrguy]

In an earlier, dose-finding clinical trial, 78% (52/67) of prior relapsers achieved an eRVR and were treated with 24 weeks of peginterferon alfa and ribavirin (T12/PR24); of those 94% (49/52) achieved an SVR.

http://pi.vrtx.com/files/uspi_telaprevir.pdf

The not knowing for sure if you have cirrhosis kind of throws a wrench in things and it is always best to follow the advice of a knowledgable doctor who has expirience treating HCV

[hrsepwrguy]

Treatment-Naïve and Prior Relapse Patients

HCV-RNA Undetectable (Target Not Detected) at Weeks 4 and 12
Action
Triple Therapy INCIVEK, peginterferon alfa and ribavirin first 12 weeks
Dual Therapy peginterferon alfa and ribavirin additional 12 weeks
Total Treatment Duration 24 weeks

HCV-RNA Detectable (1000 IU/mL or less) at Weeks 4 and/or 12
Action
Triple Therapy INCIVEK, peginterferon alfa and ribavirin first 12 weeks
Dual Therapy peginterferon alfa and ribavirin additional 36 weeks
Total Treatment Duration 48 weeks

Patients with cirrhosis who have undetectable HCV-RNA (Target Not Detected) at weeks 4 and 12 of INCIVEK combination treatment may benefit from an additional 36 weeks of peginterferon alfa and ribavirin (48 weeks total)

http://pi.vrtx.com/files/uspi_telaprevir.pdf

I was also on promethazine for 11 1/2 wks of 12 on incivek with out any problems (no ad's though) and had the same expirience as you, it made me tired at first and then I got used to it

[Cory255]

You used gold Bond lotion for the rash, right on....

[belle19]

i used gold bond lotion, green bottle with red cap.  it really worked for me.  and, of course, lots of water.  good luck to you.  belle

[Cory255]

The first day of Promethazine I was extremely drowsy.  After a few days I got used to it & can take it without sides.  Your Dr.s thought Promethazine might interact with your AD?

[Cory255]

At my wk 2 consultation, they told me I should do 48 because past failures could benefit by doing this.  They also thought that I may have cirrhosis, although I've never had a biopsy.