blocking Ribavirin absorbtion

This is my first post. I am into week #2 and am experiencing some intestinal upset. Normally, I would take psyllium in the morning to offset this, but I'm wondering if that or the calcium that I also take in the am might keep the Ribavirin from being absorbed? This is an extremely helpful forum, and I'm glad I found it! I'm female, 64, 1b, Stage 1 and on treatment now mainly because of age and my insurance running out in June.

[Bill1954]

I'm not personaly well informed about this issue; however, it was discussed in depth in the post below -
Ribaviron/antacids/drug interactions  Jmjm530  7/8/05.

Scroll down and see if this gives you some answers. Someone will be along shortly with some more thoughts.

Best,  Bill

[jmjm530]

I take psyllium and follow the directions on the bottle. That means I space my ribavirin doses two hours apart from the psyllium.

As far as antacids like calcium, tums, etc., I space my ribavirin doses 3 hours away from the antacids.

I may be a bit cautious on all this -- there are really no definititive studies -- but as much as I hate ribavirin, I want to make sure I get every last horrible bit of the drug gets in my system every day. LOL.

As far as your upset stomach is concerned, try taking the riba with your largest meals of the day. They do not have to be 12 hours apart. You can even break it into three doses if you want. It's also preferable that your meals have a decent fat content. This not only should help your stomach but will actually more effectively deliver ribavirin into your system.

[giddyup]

The most important thing to remember is to take the riba with food, preferably with some fat content. Try a muffin or one of those breakfast bars if you aren't that hungry. Unfortunately stomach/ intestinal distress isn't uncommon on treatment, I would check with your doctor for additional guidance. I hope you feel well..Su (whoaisme)

[dutch_boy]

I had the same experience as chellski just above.  For the first 3 -4 weeks I experienced cramping and diarrhea and then it stopped. (I had diarrhea before tx due to the hep C itself I assume but it worsened greatly the first weeks of tx). I now only get boughts of this on occassion but nothing like in the beginning.  Jmjm's comment above should be helpful to you regarding the psyllium powder but I would also have a talk with your doctor about this to be sure nothing else may be the problem like infection. (how is your blood work so far or have you not gotten the first blood draw done yet at week #2?)
I hope someone else comes along and answers your question regarding Calcium and it's possible interference with Riba?....I don't know the answer but it is a very good question.  Hope you are doing well and welcome to the forum....lots of wonderful people and helpful insight on many issues....it is the best support. One thing to keep in mind as you go through the tx is that things change all the time.  I try not to get too worried about some sides unless they just don't go away for a couple weeks as many cycle in and then leave....except for fatigue which has been fairly constant.  Best to you carpedi.  
Scott

[ASmile4U]

Had doc appt this afternoon...to say the least...it didn't go as I had anticipated. Genotype 1, completed week 16/48 with PegIntron/Riba.  Did not clear nor did I have 2 log drop at 12 weeks.  VL went from 1.9 to 44,000.  Doc had me continue with same tx for what I initially understood would be another 12 weeks...taking me to 24 and hopefully undetectable at that time. And tx for 72 weeks.  Surprise, surprise, surprise...he stopped tx today. Made it very clear I was a non-responder not a slow responder.  I am angry and PO (riba doesn't help either!)  because I had no idea he was going to do this, I was unprepared and  shocked.  He has suggested I take 4-6 weeks to build up platelet count, which is finally somewhat stable at between 60-70...wants it near 200...then will start me on Infergen/riba tx.  He also tried to assure me the sx are not near as bad as what PegIntron/riba are. Although my current sx are quite doable. Hmmmmmmm not sure that makes any logical sense to me right now.  I know nothing about Infergen...is there anyone here who is or has done this tx who can offer a little insight.  I will be prepared when I return for my next appointment.  I just hope it's not too late since I'll have been off tx for approx 4 weeks...4 months basically wasted.

[chellski]

a positive thought - i experienced that week 1 thru 5 then the symptoms went away....maybe you'll be lucky...some side come and go...
chelle

[poolcue]

ASmile4U
I'm so sorry to hear that.  I just had almost the same thing happen to me.  I'm 1a,0-1 damage, start tx 7mil vl.drop to 100,000 in 12/48wk. miss 2-log drop by 30,000.  I'm going to wait awhile for a new tx to come out.  I'm still having lots of sides.  Just take care of your self what ever you decide to do.........
Smiles,
Diana
p/s I haven't look today, did you do a profile? ck it out.

[jmjm530]

Sorry you didn't clear but I wouldn't consider it wasted time.

Considering that you haven't been responding, your doc may actually be saving you time by switching to infergen/riba now, rather than waiting for week 24 on weaker meds.

The only question I have is whether or not you have to wait four weeks with your platelet numbers. My docs will allow anything over 50, but that's on Pegasys.

If you don't feel like you physically/mentally need the break, I'd quickly research out the platelet thing, and if it's not a critical concern, I'd push your doc to start the infergen/riba right away.

[ASmile4U]

Thanks everyone for your kind words and support.  I definitely have a lot to consider in the few weeks ahead.  At the moment I am just devastated, wondering why he didn't tell me this 4 weeks ago when I didn't clear at 12 weeks.  Poolcue, I may just wait too.  However, in 5 years, I will be real close to 50...:) I have twins who will be 16 soon...lots going on and lots to enjoy.  I've learned a few things since being dx...I don't take much for granted any more.  If I choose to wait, I would insist on a bx though because I have never had one.  Rather confident that I am a recent infection, ya just never know.  Not sure I could do nothing either, decisions.
jmjm, my doc has drawn labs weekly watching platelets, concerned only when they dropped to 50 as well.  When they dropped to 53 in the first 2 weeks of tx, we had a discussion as to how low he'd let me go.  He was willing to take me a little below 50 as long as I was doing ok and they showed an increase the following week.  Although I'd like to think I am mentally/physically up for the new challenge, perhaps he saw otherwise today.  He knows it's difficult for me not being able to hang out at the pool and hit the lake on the weekends.  Maybe he thought he'd let me enjoy the rest of the summer!  The only 2 questions I even thought of to ask today were if waiting 4-6 weeks and a possible increase in VL would affect future tx...he says no.  And what % was I now looking at for SVR on Infergen/Riba...41-61%...still not the best odds, but worth a shot....On a happier note...family doc called right after we left GI and hubby is negative!!!

[honey1616]

ASmile and Poolcue,,,,I'm so sorry that you did the time and was taken off the drugs.  These rounds weren't wasted amunition,,,You weakened the little devil and now you will come in full impact for the final round.  Hang in there both of you!


Awwww Califia,,,That is so awful about your friend,,,The nurse right?  I'm so sorry and know its just as difficult for you as you both were doing the time together!  Give her a hug for me and I know with her having a friend like you,,,She will do just fine!

[Califia]

Jm's right.   TG you have a viable backup plan in place and don't have to scramble to find another MD or a clinical trial that would allow you access to a stronger drug combo.    When the shock wears off you'll see that your doc has actually done you a  big favor.   Here's a  classic worst case scenario about not clearing:  for 18 months now a dear friend of mine has been on full dose peg and riba and found out today that she's _still_ RNA+.    Her doctor refused to change protocol,  in spite of her many requests.  She was p.o.'d, but also very grateful not to be cut loose altogether.  A terrible situation, and one I'm glad you don't have to repeat.  Hang in there.

[ASmile4U]

Ooooooooooops I just read your profile down below and I was mistaken!  For some reason I thought you were one of the 27 year olds!  I am as young as you!  :)

[cuteus]

I would have been just as angry as you to be surprised in such an "underhanded" manner! It might not have been a 2 log drop but it was significant and I would not call you a non responder. I understand the latter to be a non significant drop in VL or a viral breakthrough. A lot of replicating can go on in 4 wks, plus who knows what variant has been created from the 4 months on meds? I have a few friends that have treated several times, but the common denominator was that the GI did not treat aggresively the first time; did not use Procrit, did not change dosages or meds to see if they could trigger a different response, lower dosages, etc. After that initial round, the subsequent rounds showed no significant drops. It could be that had they change the protocol in the first round, the virus might not have mutated to a more "resistant" variant impervious to subsequent rounds.  You are a special case, and you are not part of a trial, are you? if you are not, insist on customizing your war against hcv.
GL to you

[jmjm530]

Getting a biopsy would be an excellent next step and in my opinion more important than going right back on treatment. If it shows very little damage (stage 0 or 1) I'd seriously consider waiting for newer treatments. If it shows stage 3 or 4, I'd get right back on the program. Stage 2 is a coin toss.

I had the feeling your doc was pretty sophisticated with his infergen strategy, but having a few more dots to connect -- the fact that he started tx without a biopsy and the way he "surprised" you gives me pause. Is he a heptologist that specializes in hep c patients? If not, this might be a good time for a second opinion.

[Califia]

Yes,  the RN who felt she didn't deserve special treatment and put up with what has to be one of the most inept medical staffs in the continental U.S.  I'm going to pass on your kind words, Honey, for which many, many thanks.   (Thinking 'bout you lots as I near that finish line and mentally prepare for life on the Other Side!)

[ASmile4U]

Well, I made it through the day.  Actually haven't given much thought to the situation today, just trying to come to terms with the realization of it all.
jmjm - my doc is not a hepatologist, he's a GI, however he is very knowledgeable and active in the latest tx.  I have been pleased with his approach to my tx thus far.  I seriously think he has pondered my case for the past 4 weeks after not clearing and decided that changing tx now would give me the best shot at SVR.  I also think he opted to surprise me face to face because he knows I have educated myself since being dx and question and give my opinion on everything.  I have asked all the "what if" questions and so forth. And I always have a friend or hubby with me, yesterday my hubby was with me...maybe he thought I'd be stronger with him there...who knows.  When I started tx, he made it clear then that if I didn't have a 2 log drop he would simply call me, stop tx, I wasn't to "freak out", just make an appt in a year.  He is optimistic that new tx is near.  So I was encouraged when he allowed me to continue after not meeting the 2 log drop.  A biopsy was not done because more than likely it is a very recent infection.  Lab work from a few years ago are all neg...I work in the medical field and came into contact with HCV.  I didn't argue not doing one because until I found this forum, I didn't realize just how important it was and by then I had begun tx.  Only a month had passed from being dx to starting tx...I was "freaking out" with the devasting news...my bad.
cuteous - I can only hope that stopping Peg/Riba tx and trying something a little tougher is the best option for me at the moment.  I am not participating in any trials.  My PCP referred me to this particular GI because she had studied with him prior to and knew he was very involved with HCV tx.  I do have an appt with an infectious disease doctor on the 28th.  Have had this scheduled for 3 months now...not sure what will come of that visit...it was scheduled by my atty as I fight worker's comp denial.  Yet, another battle.   Even though I have battled low #'s since week 2, dose reducing was not an option for him...he has just monitored me weekly and taken it a week at a time. So, for now, I guess I have to trust my GI is doing what is best for me. I really wish there was someone here who has been through the Infergen/Riba tx.  Doc did say that he wished I had my appt the day before, he had 2 other patients there that day who are on Infergen...I'm hoping he can get us together...that would be helpful.
Thanks again for all the support...Often times, I think I'd be lost without this place!  :)

[jmjm530]

Your doctor sounds thoughtful and caring, but the idea of putting you through a year or more of Infergen/Ribavirin without the benefit of a biopsy raises questions.

If the biopsy shows little or no liver damage, I'm not sure an agressive treatment approach like he suggests is warranted. In fact, that seemed to be his original concept -- that if you didn't EVR in 12 weeks, you should wait for newer, better treatments. Personally, I agree with that approach, but I'm not in your skin.

For many other reasons, you may have already decided to beat this virus down regardless of your liver damage. If this is the case, the infergen approach seems like a good next step. And perhaps here a biopsy now is less important although it would give you a pre-treatment baseline for future reference.

[ASmile4U]

My doctor is very thoughtful, not sure about the caring aspect...LOL...he's not one to pat me on the back and tell me everything is going to be ok.  Quite the opposite...he's very direct and to the point; one quality that initially helped make my decision to tx with him.  In the beginning, I needed his approach to pull myself together...he told me to get a grip and get tough...I did exactly that.  
I agree with you in regards to the biopsy.  I regret not insisting on one 4 months ago. Given this new challenge and opportunity, may very well do so.  However, for various reasons, regardless of my liver damage, I would still probably choose to treat. I'm not as young as you...LOL  Sides that initially got me dx with HCV were taking a toll on my daily routine.  Although I had different sx with treatment, I felt a lot better most days.  Also, because I continue to work in the healthcare field, without direct contact, I feel it somewhat necessary to do what I can to rid myself of HCV.  May sound crazy, but...I will have a lot of questions at my next visit!  I've already started my list.
Thank you for all your input...I read daily and find your posts very interesting and informative.  
:)

[carpedi]

Thanks everyone for the good advice on absorption. I did go to the post for 7/8 and by the time I got to the bottom, I had experienced 90% of the symptoms described there. (A little knowledge is a dangerous thing with me!)So, to test my new info on the importance of fat, I ate almost a complete half an avocado for dinner and topped it off with homemade lemon yoghurt ice cream constructed with genuine, organic, hi-fat, heavy whipping cream. It was wonderful! I just KNEW there had to be an upside to this stuff. Now I may have to call roto-rooter for my arteries, but I'm sure the ribaviron is putting in a stellar performance and I will be the willing recipient of every one its nasty sides. Thanks also for the directions for psyllium - mine says only "take with meals or in between". I guess that suggests that taking it or not might be optional?:)
Asmile and poolcue - I sure am sorry to hear that you are having such a hard time. Being new to this whole thing, I'm afraid I have little to offer except my heartfelt hope that you will find acceptable solutions for the moment and permanent cures in the future. Good luck!

[jmjm530]

"For some reason I thought you were one of the 27 year olds!"
-----------------

If only. :)

Given your situation, I can see why you want to treat now. Let us know how it goes with your doc.

-- Jim

[cuteus]

Infergen side effects - Dank Wizard: 06/30/2005

[cuteus]

there are a few people on infergen here, southernboy is on it, and I don't know who else(texasgal?). some have said it is harder than pegylated interferon

[ASmile4U]

Thanks...I'll check it out.  It's looking like not too many out here on Infergen...wonder why that is?  I really don't know anything about it and it scares me a bit.   My doc is trying to convince me that the sx will be easier than PegIntron...I just don't buy it at 3 shots a week...it would have to be a little stronger or why the change in tx.  If I would get up the nerve to call his office...I am still very angry at the way he went about everything...and don't want to say anything I will regret.  I would like to ask him to give my # to the other 2 patients that are on Infergen and ask them to call me...Meanwhile...I hit the pool for a while today...I've decided to enjoy the rest of summer with my kids before making a decision... :)

[ASmile4U]

Hey, did you notice I spelled your name correctly this time!  Sorry.  I just read thru the 6/30 post...Looks like there's 3 currently on Infergen and 1 who has completed.  Haven't seen the 3 post recently.  Think I will try to post a question to them one day it is slow and see if I can get their attention.  I really need to learn a little before jumping in unaware.  Thanks again. :)