Aa
incivek & acidity
I am in week 8 and Rash has gotten pretty bad. I just saw a dermatologist and am waiting for biopsy results.
Has anyone tried an alkiline to reduce body acidity? I posed this question to Dermatologist and he seemed
to disregard acidity as being a factor. If anyone has had severe rash and ulcerations, please let me know if you found anything that works. My viral loads two weeks ago were at 49. I am hoping to be undetectable after next weeks visit. I am so close, I hope that I am able to continue treatment. Any help would be greatly appreciated.
Has anyone tried an alkiline to reduce body acidity? I posed this question to Dermatologist and he seemed
to disregard acidity as being a factor. If anyone has had severe rash and ulcerations, please let me know if you found anything that works. My viral loads two weeks ago were at 49. I am hoping to be undetectable after next weeks visit. I am so close, I hope that I am able to continue treatment. Any help would be greatly appreciated.
pooh is correct, the prednisone is the drug of last resort after topicals and incivek discontinuation.. i was pulled off of the incivek one week before starting the prednisone.
my rash started the first week of treatment. i was told to use moisturizers and over the counter topical hydrocortisone which had very if any effect. at week 4 the PA put me on the hydroxizine. at week 8 the rash exploded and at week 9 i went to the dermatologist who prescribed clobetasol. at week 10 the liver doc discontinued the incevik and also reduced the interferon. at week 11, i was running a fever and the doc reduced the ribavirin. at week 11 i was placed on prednisone 80mg/day. the prednisone was gradually reduced over the following 5 weeks. i was undetected at week 4, and am now at week 44 still have small patches of rash.
my rash started the first week of treatment. i was told to use moisturizers and over the counter topical hydrocortisone which had very if any effect. at week 4 the PA put me on the hydroxizine. at week 8 the rash exploded and at week 9 i went to the dermatologist who prescribed clobetasol. at week 10 the liver doc discontinued the incevik and also reduced the interferon. at week 11, i was running a fever and the doc reduced the ribavirin. at week 11 i was placed on prednisone 80mg/day. the prednisone was gradually reduced over the following 5 weeks. i was undetected at week 4, and am now at week 44 still have small patches of rash.
Depending on the severity of your rash, the doctor may want to try the Hydroxyzine first before the systemic steroid (such as prednisone). Topical steroids are okay, but Teleprevir interacts with systemic steroids such as Prednisone so normally they don't like to give you a systemic steroid while still on Teleprevir. The derm doc needs to determine exactly how severe your rash is (see photos and description). Obviously for treatment it is better to stay on the Incivek for the full 12 weeks. But if the rash is very severe, then the Incivek would be stopped and a person would be placed on systemic steroids.
This is why it is imperative to get on top of the rash immediately before it snowballs out of control. Some rashes will still become severe, but if the rash is treated immediately and appropriately, many people can stay on the Incivek for the full or most of the full 12 weeks.
Of course, if your rash is as severe as coerics or looking forwards, then you may have no choice but to go with predinisone.My rash was a generalized rash but in the moderate category (according to the photos and descriptions). I think coeric and lookingforward had the severe rash and had to sop the Incivek early. Then they went on systemic steroids.
Here are links to photos of the rash and the categorization of Incivek rash:
http://www.incivek.com/hcp/assess-and-manage-rash
and here is a link to drugs.com about co-administration of Teleprevir and systemic (oral) steroids:
http://www.drugs.com/interactions-check.php?drug_list=1936-0,2009-0,3328-15346,1806-1159
Interactions between your selected drugs
prednisone ↔ telaprevir
Applies to: prednisone, Incivek (telaprevir)
GENERALLY AVOID: Coadministration with telaprevir may increase the plasma concentrations of systemic corticosteroids. The mechanism involves telaprevir inhibition of CYP450 3A4, the isoenzyme primarily responsible for the metabolic clearance of most steroids. No pharmacokinetic data are currently available, although telaprevir is a potent CYP450 3A4 inhibitor and may interact significantly.
MANAGEMENT: The use of systemic corticosteroids in combination with telaprevir is not recommended. Systemic corticosteroids should not be used to treat telaprevir-induced rash.
This is why it is imperative to get on top of the rash immediately before it snowballs out of control. Some rashes will still become severe, but if the rash is treated immediately and appropriately, many people can stay on the Incivek for the full or most of the full 12 weeks.
Of course, if your rash is as severe as coerics or looking forwards, then you may have no choice but to go with predinisone.My rash was a generalized rash but in the moderate category (according to the photos and descriptions). I think coeric and lookingforward had the severe rash and had to sop the Incivek early. Then they went on systemic steroids.
Here are links to photos of the rash and the categorization of Incivek rash:
http://www.incivek.com/hcp/assess-and-manage-rash
and here is a link to drugs.com about co-administration of Teleprevir and systemic (oral) steroids:
http://www.drugs.com/interactions-check.php?drug_list=1936-0,2009-0,3328-15346,1806-1159
Interactions between your selected drugs
prednisone ↔ telaprevir
Applies to: prednisone, Incivek (telaprevir)
GENERALLY AVOID: Coadministration with telaprevir may increase the plasma concentrations of systemic corticosteroids. The mechanism involves telaprevir inhibition of CYP450 3A4, the isoenzyme primarily responsible for the metabolic clearance of most steroids. No pharmacokinetic data are currently available, although telaprevir is a potent CYP450 3A4 inhibitor and may interact significantly.
MANAGEMENT: The use of systemic corticosteroids in combination with telaprevir is not recommended. Systemic corticosteroids should not be used to treat telaprevir-induced rash.
I had blood work done last Thursday and yesterday. Results from thursday
showed that red, white blood cell & Platelets(39) where very low. They
reduced rib dosage and have ordered Procrit to increase red blood cell count and platelets. Hopefully this will build immune system and reduce inflammation and anemia. I will ask about eosinophil levels and prednisone, still waiting for call back. I wish I would have found this site sooner. I feel
more impowered and eduacted listening to people that have or are going through the same treatment & side efects that I am currently experiencing.
Appreciate all the information. Thanks again! Ray
showed that red, white blood cell & Platelets(39) where very low. They
reduced rib dosage and have ordered Procrit to increase red blood cell count and platelets. Hopefully this will build immune system and reduce inflammation and anemia. I will ask about eosinophil levels and prednisone, still waiting for call back. I wish I would have found this site sooner. I feel
more impowered and eduacted listening to people that have or are going through the same treatment & side efects that I am currently experiencing.
Appreciate all the information. Thanks again! Ray
looking forward has a good point about the eosinophils which can be an indicator of a much more serious condition than the rash. these are listed on a CBC. mine when from .1 at the start of tx to .5 at week 8. the prednisone knocked it down in a hurry.
Just a note of caution ... don't get overly concerned if your skin biopsy reports shows several different possibilities.
Mine showed a drug reaction as the most likely cause but then it listed other possibilities too (like autoimmune disorders, lupus, and other skin and connective tissue disorders. I had an ANA drawn and that was positive, which did make me a bit apprehensive, but I knew that the Interferon can make the ANA show positive. Then I had an ENA panel to diagnose for specific autoimmune disorders. Luckily all of those specific tests were negative.
Mine showed a drug reaction as the most likely cause but then it listed other possibilities too (like autoimmune disorders, lupus, and other skin and connective tissue disorders. I had an ANA drawn and that was positive, which did make me a bit apprehensive, but I knew that the Interferon can make the ANA show positive. Then I had an ENA panel to diagnose for specific autoimmune disorders. Luckily all of those specific tests were negative.
I am so so sorry you have a bad rash. I had it too. It was The Rash from he!!. Mine started around week 4 but at week 8, it just exploded! Every day it just continued to gore and spread. By week 10 it covered 90%od my body, I was swollen, red all over, bumps, hives....scalp problems you name it.
I had to quit Incivek 5 days early. I, too, saw a dermatologist. We tried Clobetasol first (right after i quit incivek) - two weeks later, a Kenalog shot and continued with another strong topical. Four weeks after quitting the Incivek, the rash continued to progress over my lower extremities and he started me on Prednisone for two weeks. That finally interrupted the cycle so that The Rash finally began to clear. and the itch finally began to go away.
All of the suggestions given to you are spot on. Try them all, but be aware too that 1-4% of patients taking the telaprevir get the severe rash. You cannot take the prednisone while taking the telaprevir. I begged to stop the telaprevir at week 10, but struggled on for another 10 days. I was UND at week 8 and just felt that there came a tipping point where the medicine was almost poisoning me, hence the severe reaction.
Oh,also have your doctor check your eosinophil levels. They are one indicator of a strong allergic reaction to the drug. Mine were highly elevated and I also had facial edema (swelling). My treating doctor now believes I actually had DRESS.
Good luck with your efforts to get this under control!
I had to quit Incivek 5 days early. I, too, saw a dermatologist. We tried Clobetasol first (right after i quit incivek) - two weeks later, a Kenalog shot and continued with another strong topical. Four weeks after quitting the Incivek, the rash continued to progress over my lower extremities and he started me on Prednisone for two weeks. That finally interrupted the cycle so that The Rash finally began to clear. and the itch finally began to go away.
All of the suggestions given to you are spot on. Try them all, but be aware too that 1-4% of patients taking the telaprevir get the severe rash. You cannot take the prednisone while taking the telaprevir. I begged to stop the telaprevir at week 10, but struggled on for another 10 days. I was UND at week 8 and just felt that there came a tipping point where the medicine was almost poisoning me, hence the severe reaction.
Oh,also have your doctor check your eosinophil levels. They are one indicator of a strong allergic reaction to the drug. Mine were highly elevated and I also had facial edema (swelling). My treating doctor now believes I actually had DRESS.
Good luck with your efforts to get this under control!
Thanks for the information! I am currently taking Triamcinolone Acetonide
cream and benedryl. I will request Hydroxyzine and I should have an answer tommorow from biopsy results.
Thanks! Ray
cream and benedryl. I will request Hydroxyzine and I should have an answer tommorow from biopsy results.
Thanks! Ray
I appreciate the information and will have ph levels tested.
I also appreciate all the other posts and suggestions.This is my second time around with Interferon and Rib and had no problem dealing with the two
after the 1st two weeks. Taking Incivek in conjunction with peg and rib is a complete different animal. Results are much better, most side affects are tolerable, except for the Rash. As soon as I have biopsy results and recommendations I will post all Information. Again I sincerely appreciate all posts and information. Thanks! Ray
I also appreciate all the other posts and suggestions.This is my second time around with Interferon and Rib and had no problem dealing with the two
after the 1st two weeks. Taking Incivek in conjunction with peg and rib is a complete different animal. Results are much better, most side affects are tolerable, except for the Rash. As soon as I have biopsy results and recommendations I will post all Information. Again I sincerely appreciate all posts and information. Thanks! Ray
great tips everyone. become a vampire and by all means stay out of the sun.
"sleeping in snot" LOL. thank you pooh the derm also prescribed triamcinolone by the one pound tub. i would smear that vasoline concoction over my entire body. i would then get in some nice cotton PJs and do everything i could to keep from scratching. i am glad i invested in a new washing machine before treatment.
eric
"sleeping in snot" LOL. thank you pooh the derm also prescribed triamcinolone by the one pound tub. i would smear that vasoline concoction over my entire body. i would then get in some nice cotton PJs and do everything i could to keep from scratching. i am glad i invested in a new washing machine before treatment.
eric
I tried a smaller dose of Hydroxyzine. It helped a little but I still had to slather head to toe in Fluicinonide ointment. Then I had to lie on my back with my knees up and no covers for awhile so the ointment would not all rub off before it stopped the itching. The sheets were covered in ointment. It was like sleeping in snot, LOL. I gradually increased the Hydroxyzine up to the 50 mg every 6 hours and now, unless I get hot or forget to take the Hydroxyzine, I really have almost no problem (at least annoying or irritating problem).
Tips to add to crossroad's tips:
Don't get hot
No scratchy clothing
No heavy clothing with thick seams (like denim jeans)
No sox if they make your feet itch (sox made mine hot and they scratched)
Keep the house cool (mine is at 66)
Light sheets if any sheets at all
Fans (box or overhead)
Tips to add to crossroad's tips:
Don't get hot
No scratchy clothing
No heavy clothing with thick seams (like denim jeans)
No sox if they make your feet itch (sox made mine hot and they scratched)
Keep the house cool (mine is at 66)
Light sheets if any sheets at all
Fans (box or overhead)
The rash is the pits. Try searching this site. I believe the high alkaline diet does help your health in general and have used it for years. It's not easy while on tx, but maybe give it a try.
Many of us used natural products. I still use Dr. Bonners soap and olive oil only on my skin. During tx, ice packs, topical steriods, and occasional Visteral and Benedry helped. Not much. Good news is that it goes away. I remember reading others post that reassured me of that and LOVING the thought.
Some people have had to quit due to rash, so I agree that you should stay on top of it.
Uh remembering: cool short showers - no hot water. Mild shampoo washing hair in kitchen so shampoo wouldn't run down my skin. (I had scabs on my scalp) Ew. But wig covered em.
Good luck, Karen :)
Many of us used natural products. I still use Dr. Bonners soap and olive oil only on my skin. During tx, ice packs, topical steriods, and occasional Visteral and Benedry helped. Not much. Good news is that it goes away. I remember reading others post that reassured me of that and LOVING the thought.
Some people have had to quit due to rash, so I agree that you should stay on top of it.
Uh remembering: cool short showers - no hot water. Mild shampoo washing hair in kitchen so shampoo wouldn't run down my skin. (I had scabs on my scalp) Ew. But wig covered em.
Good luck, Karen :)
pooh has a great point about getting the rash under control as soon as possible so you can continue treatment. i seemed like mine really exploded at week 8. i hope the derm prescribed meds for you.
the PA put me on 100mg/day hydroxyzine at week 4. maybe i needed a higher dose because the rash really took off a week 8. i went to the derm and he prescribed the steroids. i asked him about the hydroxyzine, and he said that it would not help with my rash and that i needed topical and oral steroids. i am continuing to have small areas of rash and the derm says to keep on using the chlobetasol otherwise the rash could spread.
blessings
eric
the PA put me on 100mg/day hydroxyzine at week 4. maybe i needed a higher dose because the rash really took off a week 8. i went to the derm and he prescribed the steroids. i asked him about the hydroxyzine, and he said that it would not help with my rash and that i needed topical and oral steroids. i am continuing to have small areas of rash and the derm says to keep on using the chlobetasol otherwise the rash could spread.
blessings
eric
I am not trying to be argumentative, but the Hydroxyzine acts as an antihistamine and is used to reduce the natural chemical histamine in the body (and thus reduces both itching and rash/hives). For me, the topicals helped the itching and after about 3 weeks of using it in the same spot it cleared the rash (but only where I put the topical). It was temporary and the rash came back or moved next door or both. Also, the systemic drug reaction was going full force until I got on the Hydroxyzine. The Hydroxyzine worked extremely well. I rarely have to use the topicals now.
"What is hydroxyzine?"
"Hydroxyzine reduces activity in the central nervous system. It also acts as an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing and runny nose, or hives on the skin. .....
Hydroxyzine is also used to treat allergic skin reactions such as hives or contact dermatitis. ....."
http://www.drugs.com/hydroxyzine.html
"What is hydroxyzine?"
"Hydroxyzine reduces activity in the central nervous system. It also acts as an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing and runny nose, or hives on the skin. .....
Hydroxyzine is also used to treat allergic skin reactions such as hives or contact dermatitis. ....."
http://www.drugs.com/hydroxyzine.html
my derm told my the hydroxyzine was for the itch. and the steroids were for the rash. i still use the hydroxyzine.
from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000796/
Hydroxyzine is used to relieve the itching caused by allergies and to control the nausea and vomiting caused by various conditions, including motion sickness. It is also used for anxiety and to treat the symptoms of alcohol withdrawal.
from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000796/
Hydroxyzine is used to relieve the itching caused by allergies and to control the nausea and vomiting caused by various conditions, including motion sickness. It is also used for anxiety and to treat the symptoms of alcohol withdrawal.
I have not heard anything about rash and acidity.
My main advice would be to get that rash under control now, before it gets so bad it jeopardizes treatment. These are systemic drug rashes and they snowball out of control rapidly. Hopefully the dermatologist has already ordered some prescription Hydroxyzine tabs and prescription steroid ointments and/or solutions. (the over the counter creams and antihistamines are useless for these rashes) If not, perhaps give the dermatologist a call and suggest them to him/her.
My rash took off on about week 10 (hives, all sizes of red bumps, flat red patches, red skin). What finally got it under control was Hydroxyzine 50 mg every 6 hours, clobetesol soln., and Fluocinonide ointment. The rash is systemic which is why Hydroxyzine tabs help so much. The steroid ointments and solutions do help locally with the itching, but they won't get rid of the cause of the rash or prevent it from moving next door because the rash is systemic. (I am in week 45 and I am still on Hydroxyzine 50 mg every 6 hours and I occasionally use the clobetesol soln and/or the fluocinonide ointment.)
Glad to hear you have dropped to 49 and hopefully the next VL wil be UND.
My main advice would be to get that rash under control now, before it gets so bad it jeopardizes treatment. These are systemic drug rashes and they snowball out of control rapidly. Hopefully the dermatologist has already ordered some prescription Hydroxyzine tabs and prescription steroid ointments and/or solutions. (the over the counter creams and antihistamines are useless for these rashes) If not, perhaps give the dermatologist a call and suggest them to him/her.
My rash took off on about week 10 (hives, all sizes of red bumps, flat red patches, red skin). What finally got it under control was Hydroxyzine 50 mg every 6 hours, clobetesol soln., and Fluocinonide ointment. The rash is systemic which is why Hydroxyzine tabs help so much. The steroid ointments and solutions do help locally with the itching, but they won't get rid of the cause of the rash or prevent it from moving next door because the rash is systemic. (I am in week 45 and I am still on Hydroxyzine 50 mg every 6 hours and I occasionally use the clobetesol soln and/or the fluocinonide ointment.)
Glad to hear you have dropped to 49 and hopefully the next VL wil be UND.
here is a link to a thread that a brilliant doctor wrote on this site about pH. he no longer visits this site. i learned much from his wisdom.
eric
http://www.medhelp.org/posts/Hepatitis-C/TO-HEPATITIS-RESEACHER--others/show/96449
eric
http://www.medhelp.org/posts/Hepatitis-C/TO-HEPATITIS-RESEACHER--others/show/96449
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