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Weight based Ribavirin with low HB level?
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Weight based Ribavirin with low HB level?

Hi everyone,
I was wondering IF weight based Ribavirin is given considering a heavy weight body contains more quantity of blood than a body with average weight; than a heavy person with low HB level might be OK with the standard dose. Please put me right if this is not correct. Thanks
Tags: Weight based Ribavirin
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568322_tn?1370169040
This is important...

There's a paper called "Vitamin D improves viral response in hepatitis C genotype 2-3 naïve patients"  that showed that supplementing Vitamin D increased the SVR to 95% in genotype 2/3.

Since you are having a blood test soon, ask your doctor to check your vitamin D and if it's low he can prescribe Vit D.  Just to be on the safe side.

Co
7 Comments Post a Comment
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Avatar_m_tn
The reason you are on standard dose of Ribavirin is because of your genotype, no other reason. And sense you had a RVR the dosage is working. You have had a second opinion confirming this...

http://www.medhelp.org/posts/Hepatitis-C/Switching-from-Pegasys-to-Pegintron-after-weak-4/show/2018182#post_9560543
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Avatar_m_tn
Yes I got a second opinion but forgot to ask this particular question from the doc. My question is not exactly pertaining to me. Its just for general knowledge with regard to weight based Ribavirin dose involving HB level. Thanks  
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Avatar_m_tn
Ribavirin is prescribed as part of a packaged protocol with the other drugs, and the amount of mgs you take is based on weight but prescribing info does show minimum requirements for your bloodwork in order to start treatment, your doc on his own may bypass prescribing info based on your cmp/cbc and start you on a lower dose and monitor you a little more closely to see how you respond, but as far as I remember your mg's are not charted/determined based on your lab work only adjusted or discontinued based on labs during tx.
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568322_tn?1370169040
So what you're asking is if a person who starts off with a low hemoglobin needs a lower dose of Ribavirin even if they're heavy.

That would be nice but it's not how it works.  The experts decided that since Genotype 2 and 3 were easier to kill than genotype 1, they only needed 800mg of Ribavirin.  But later on they saw that genotype 3 was not as easy as genotype 2 to kill and decided that if you had any treatment negatives (like cirrhosis, high viral load, obesity) then perhaps weight based dose was better.

Do you know whether you have cirrhosis?  Because you started with a hemoglobin of 12 and a platelet count of 124 and usually cirrhosis causes low hemoglobin and low platelets.

So if you do have cirrhosis and you're obese and started with a high viral load then perhaps a higher dose of Ribavirin would be better.  BIUT...some of the studies have proven that when you decrease your hemoglobin by 2 grams (like you went from 12 to 10 hemoglobin) then that means that your level of Ribavirin is good.

One thing I would recommend is not taking the omeprazole at the same time as the Ribavirin because it might interfere with absorption (yes, I peeked at your previous posts).

Also, get the blood tests done right before you take the next Peg injection, not right after the shot when your levels will be lower.

The thing I can't understand is why your doctor changed from Pegasys to PegIntron.  Why didn't he just cut the dose of Pegasys?  Tell him he's not supposed to switch products back and forth because PegIntron stays in the system 1 week and Pegasys stays several weeks.

Another thing.  Whenever they decrease your dose of either Riba or Peg, don't let them wait two weeks or longer to check the llabwork.  You need to see before then whether you can resume your previous dose.  I would have checked after 1 week.

I would ask for the viral load test to be checked at 8 weeks to see if you're still undetected.  I think it will give you peace of mind.  Best of luck to you and keep asking questions.

Co
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568322_tn?1370169040
This is important...

There's a paper called "Vitamin D improves viral response in hepatitis C genotype 2-3 naïve patients"  that showed that supplementing Vitamin D increased the SVR to 95% in genotype 2/3.

Since you are having a blood test soon, ask your doctor to check your vitamin D and if it's low he can prescribe Vit D.  Just to be on the safe side.

Co
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Avatar_m_tn
Thanks Co for a detailed response.
It really feels good when you are able to express your concerns about the disease/treatment and even better when you get an excellent response like this one.

As far as treatment negatives are concerned, I don't think I have cirrhosis as I have this virus only since two years (tested negative for antibodies in 2003, 2004, 2008 &2011). Also had couple of ultrasounds and both showed nothing except a bit fatty liver (may be due to drinking and bad eating habits?). Biopsy is not very common here.
I had VL of 4,500,000 copies/ml (not IU/ml), which is medium i think (not sure though) and I'm not exactly obese, but overweight by 6 kgs (BMI 27), wear a 34 waist jeans. Need your comments on that :)

I already had my 9th shot yesterday so I think now I should do next PCR after week-12. I'm NOT reducing the dose again and will do every measure to keep the figures in an acceptable range.

I already stopped Omeprazole and taking Paracetamol only when needed.

Sure will have a Vitamin D test on my next visit to lab.

Once again thanks for your help. regards
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568322_tn?1370169040
You have several things in your favor.  Your age, the fact that you've only had hep c for two years and obtaining an RVR.

Just be very careful not to miss taking any of the Ribas.

Co
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