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Week 5 - lowering peg and adding rescue drugs
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Week 5 - lowering peg and adding rescue drugs

I am in week 5 of the BI 201335 Trial. Got a call from the clinic with the news that my WBC is 2.7 and the trial requires  lowering the peg from 190 to 135.  I asked if I could use the rescue drug(s) instead of reducing but was told I had to reduce and could add Neupogen (rescue drug) beginning tomorrow.  I picked up the neupogen tonight and didn't realize I'd have to inject it.  Should I inject in the fatty part of my stomach or does it matter where I inject.  I won't be able to talk to anyone at the clinic until Monday and need to inject tomorrow.  Going for repeat labs Tuesday and will be able to talk with the Dr at that time.
I don't feel bad physically and trust the medical staff but would appreciate any advice or questions you think I should pose to the Dr. next week
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789911_tn?1368640383
I dont know about Neupogen but I am on Procrit which is a sub-cutaneous injectable and I was told to do it in the same area in the stomach that I do my interferon shots.  You could probably look on line on how to give those shots.  Call the pharmacy even find a 24 hour one and see if the pharmacist can give you any information.  make sure you do it right!  Im sure if you can wait someone will chime in that has actually done it if you can get the info else where.  also check search conditions,treatments symptoms above the posts and see if someone has already asked the question
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1467213_tn?1304217905
Thanks for the feedback; I called the pharmacy and was given the same info.
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Avatar_f_tn
What is your absolute neutrophil count (ANC)?  2.7 isn't low enough yet for rescue, unless ANC is lower than .5
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87972_tn?1322664839
Hi Fullmoon,

The Neupogen should be injected much the same as the interferon; inject subcutaneously under the skin in the tummy or thigh.

Absolute neutrophil counts should be roughly 0.50 for intervention with Neupogen, as ‘Believer’ mentioned above, by the way.

Good luck with everything; I remember you from months ago (last year?) and glad to see you got in trial and have all this going on. Take care,

-Bill
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1467213_tn?1304217905
Thanks for responding.  Do you think I should hold off on taking the neupogen until I get in to see the dr. on Tuesday?  I don't know what my neutrophil count is at this time, my previous lab on June 2nd reported 37.1.  I don't have my numbers from this week and I'm wondering if it could drop to 0.50 (or lower) in two weeks???  I'll post again when I get the neu count from this week.
Thanks again everyone, glad I don't have to go through this alone.
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Avatar_f_tn
Hi fullmoon1,

Your trial will likely have a protocol cutoff for your hgb (hemoglobin) or ANC or whatever blood component they're monitoring - my trial monitored lymphocytes - and when it drops below that, it's a dosage reduction and / or if the trial allows, a rescue drug.  The level a trial uses is generally higher than if you were in general treatment.  There isn't much choice in this, a trial protocol is a trial protocol.  The rescue drug is to bring you back above the trial protocol so your levels can get back above where the trial cutoff is that requires a dosage reduction.  Neupogen acts fast so hopefully by taking the neupogen you'll be back to full INF dose by your next injection.

Not all trials allow rescue drugs so this is good you're able to take them.  If it's unclear where the cutoffs are for your trial, ask your treatment team so you know for all your blood counts and which counts they're watching and can monitor yourself.  My trial (and many trials) mandated a ribavirin reduction if hgb dropped below 10.0 - my trial allowed rescue drugs and even when my hgb went back up over 10.0, my doc allowed me procrit to keep the hgb above 10.0 and prevent dosage reductions.  On regular treatment perhaps an hgb over 10.0 wouldn't require procrit but we were using it to keep it away from dropping below that and forcing a dosage reduction.  Usage of rescue drugs on a trial, if they allow it, is to prevent dosage reductions as well as to keep your levels out of caution zones.  

I'd take the neupogen as your doctor has suggested to get your white counts above trial mandates and get your INF dosage back to full.  

Wondering also what your ANC is ?  Are they telling you your viral load results as they're testing?

Good luck with your trial.

Trish
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1467213_tn?1304217905
Thanks for the advice, I will take the neupogen tonight and hope this helps get me back to the full dosage of rib. asap.   I won't have the viral load results until week 8.  I have three weeks to go before I know if this is working...
Thanks again, I really appreciate the knowledge shared on this site.
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1669790_tn?1333666195
I had my 2nd neupogen shot on Thursday and each time the nurse injected on the back of my arm.  As Bill mentioned, the injection site isn't critical.

Hope you respond well to the rescue drug and your ANC responds with vigor.  I hope mine responds with vigor.    Maybe a trip to Hooters for some good chicken wings would help.  lol

Best of luck.
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1467213_tn?1304217905
My prescription for the neupogen is 2 times per week (Sat & Thurs).  Are you taking it twice a week?  Have you had any side effects?
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