Blood Count: Nupagin(?)

[RichCM]

Hello, I started Hep C treatments (pegasys & ribo)one month ago. As far as side effects, it has been one day good next bad. Dr. office just called me with my latest blood results. They said my red and white combo was off and to decrease my injection from 180 to 135 and want to start me on Nupagin. I read in some of the forums different views on treatment.One said not to decrease the interferon but take the Nupagin and see if the blood levels off. Does anyone have the same problem or went through this also?
My Dr. also said if the Nupagin does not work I would have to stop with the interferon, what happens then? I know I should be asking my Dr. these questions but I feel like I'll deal with it when the time comes. Thanks! Rich

[Dale_Ray]

Hey Goof:
My doctor instructed me to take the Nupogen 24 hours after the Pegasys. So Friday night is Pegasys and Saturday night is Nupogen. Once my nutrophils came up he cut me back to half doses. Now he has me back on the full 300m dose because they have dropped again. He let mine go down to the 300 level the last time but this time he increased dosage at 600. He is a hemotogolgist and keeps up with my blood work well. I am not sure why the difference in when to administer the nupogen though. Dale

[GoofyDad]

I think it's most important not to do it concurrent with Peg. Before helps prepare for the crash the peg will cause, after helps recover from the crash. I was doing both - a Neup shot on either side of the Peg - 24 before and 48 after.

[RichCM]

Iam new to this whole tx thing, sorry if I did not explain it right. My Dr. is worried about the white count, worried that my count is low to fight off infections. The only reason I'm lowering my Friday injection from 180mg to 135 is because I might not be able to get the Nupogen by then. But the Dr. also said to take both injections on Fridays, should I ask about taking on different days? Also in your experiences with doctors, do they get insulted when told about something that was suggested in a forum like this? Thanks for youe help...Rich

[susan400]

I just started the Neupogen, but I can't do the staggering that you suggest because I'm on daily Infergen.  I try to take my Neup and my Procrit in the afternoon and (different days) and then, take the Infergen at around 9:30.

Susan

[Dale_Ray]

Doctors are funny creatures. NYgirl (Debbie) warned me about not using terms with my doctor like internet forum. Didn't listen to her and it seemed to insult his intelligence. Now I always say "I've read" and he is cool with that. Can't explain it.

When my counts dropped the mail order drug company couldn't respond as quickly as my doctor wanted and he sent a nurse out twice to pick the Nupogen up at a local medical supply house and then I picked it up at his office.

If your doctor wants to reduce the dosage I am sure he has medical reasons that are for your own good. Remember no a medical diploma in here. Good luck to you and let us know how it works out.

[Dale_Ray]

Similar situation here with whites (nutorphils low) and doctor started me on Nupogen and they improved over a three week period. He never recommended me decreasing dosage of Pegasys. However, with your reds off that may be the decision making issue with your doctor. I hope this works out for you. Dale

[FlGuy]

If the solution is Neupogen the problem is probably low ANC (absolute neutrophil count). Neup is fast and effective (a couple of days or quicker) in bringing up the ANCs whcih you body needs to ward off infections. Low ANC's would be less than about 500.  Since low anc are quickly remedied with either neupogen or neulasta a reduction of dose should not be the sole reason to reduce the doses.  Is it your treatment doc who also monitors your blood work?  Many people here for to hemotologists on a regular basis for bloodwork.  These docs are usually up to speed on drugs that can bolster the various blood components, including hemoglobin.  It's imprtant to avoid dose reductions, especially early in treatment.  You should talk to the doc again.

[GoofyDad]

As FLguy says, Nuep works fast. I've never heard of it not working, though some need more than others. If your WBC/ANC counts are really low and you're due for a Peg shot right away, reducing dose might be warranted until you get the Neup.

The sooner you can get the Neup in you, the sooner your counts will rise. Generally, you want to inject it 24 hrs before Peg, and it will take 24-48 hours to increase your counts.

Many progressive Docs will let your ANC drop to about 350 without concern, but if you have cirrhosis 500 or higher is often the limit.

Good luck.

[friole]

I am on the neupogen train too.  My hemotologist told me 48 hours after or before the Peg - but I think 24 hours is fine too.  They counteract each other - that is why you stagger (if you have the luxury to do so, which Susan does not). If you are doing your shots yourself, just do them of differnet nights and don't tell your doc if you don't want to offend him and they do get offended.  I haven't actually seen the hemotologist since my white counts went down to about .8.  SHe wanted my to start Neup right then and I begged off, and wrote her a letter and sent her some studies (I did end up starting a month later).  Since then I have only seen the hemo nurse and I have always wondered if that was why.  

Goof - I like your doc's method.  A couple of weeks ago my hemo nurse wanted me to start doing them more and I  couldn't figure out how to stagger the doses.  If I drop again, I am going to suggest your method - 24 before and 48 after.