missed a dose of Riba what do I do?

[AmeliaFufu]

My husband is in week 2 of treatment and accidently forgot to take his am dose of Riba this morning.  He also just told me that he took the am dose instead of the pm dose for tonight.  Has anyone else done this and what were you told to do?  And I will give an advanced great big thank you for everyones help.  You all are blessings to me.
Ameliafufu

[Rockerforlife]

http://www.medhelp.org/forums/hepatitis/messages/45791.html

[Rockerforlife]

Just some interesting facts on RIBA



Physically ribavirin is similar to the sugar D-ribose from which it is derived. It is freely soluble in water, and is re-crystallized as fine silvery needles from boiling methanol


http://en.wikipedia.org/wiki/Ribavirin

[Rockerforlife]

Ribavirin is absorbed from the GI tract probably by nucleoside transporters. Absorption is about 45%, and this is modestly increased (to about 75%) by a fatty meal. Once in the plasma, ribavirin is transported through the cell membrane also by nucleoside transporters.

Ribavirin is widely distributed in all tissues, including the CSF and brain. The pharmacokinetics of ribavirin is dominated by trapping of the phosphated form inside cells, particularly red blood cells (RBCs) which lack the enzyme to remove the phosphate once it has been added by kinases, and therefore attain high concentrations of the drug. Most of the kinase activity which converts the drug to active nucleotide form, is provided by adenine kinase. This enzyme is more active in virally infected cells.

The volume of distribution of ribavirin is large (2000 L/kg) and the length of time the drug is trapped varies greatly from tissue to tissue. The mean half-life for multiple doses in the body is about 12 days, but very long-term kinetics are dominated by the kinetics of RBCs (half-life 40 days). RBCs store ribavirin for the lifetime of the cells, releasing it into the body's systems when old cells are degraded in the spleen.

About a third of absorbed ribavirin is excreted into the urine unchanged, and the rest is excreted into urine as the de-ribosylated base 1,2,4-triazole 3-carboxamide, and the oxidation product of this, 1,2,4- triazole 3-carboxylic acid.

[Tippyclubb]

My rx states:

If you miss a dose Copegus and remember the same day, take the missed dose as soon as you remember.  If the whole day has passed, ask your health care provider what to do.  Do not take two doses at the same time.

Hope that helps.

[copyman]

Don't worry. The short answer is Riba has such a long half life that it really don't matter. Pick up with the next scheduled dose.

[Rockerforlife]

i had a medical card issued to me that said if my missed dose was less than 2 hours before my next one...it was ok to take the mising dose..so if your dose was at 6 am....and your next one is at 6 pm....skip the dose if its after 4pm

[Rockerforlife]

i my self would even sneak the on pill in along the way.....just dont take 2 dosed all in one shot

[Rockerforlife]

What happens if I miss a dose?

--------------------------------------------------------------------------------

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. If you have not taken the medication for longer than 24 hours, call your doctor for instructions. Do not take extra medicine to make up the missed dose.

http://www.aolhealth.com/drugs/ribavirin-oral/what-happens-if-i-miss-a-dose

[Rockerforlife]

i cant find that card about the missed dose info.....i know it said to take the missing dose if its less than 2 hours before the next schelued dose...but that was for the Boceprevir...im not sure if it was 2 hours for the riba ...so you may want to check it out more...soory bout that

[copyman]

rock, thanks for going the extra mile as usual but trust me it really don't matter about missing a dose. Have you ever heard of the 80/80 rule with HCV treatment? What it means is the importance of taking 80% of the meds 80% of the time to achieve SVR.  Missing one dose is far from 80% of the meds this refers to. So NO need for someone to worry.

[Rockerforlife]

BTW...so i guess i can stop worrying my self about not taking my RIBA on the exact time either?....ive been taking my first dose at 6 am in the mornings...and usally at 6 pm when i got home from work....but sometimes id be workn OT and end up taking the evening dose at 730 pm....so i guess this is ok?

[nygirl7]

If you have completely forgotten a dose just take the next dose when you realize. It is especially important in the first twelve weeks NOT to miss ANY doses, but it does happen and you can't undo the past.  Don't double up or anything though just take the next dose and get back on the every 12 hour schedule.

Buying one of those little am/pm containers helped me alot when I was new. Also taking the doses with breakfast and dinner (also because you want to take it with fat and food) but heck even if I wasn't hungry I KNEW it was a meal time cause everybody else was around me.

Don't let him miss one again but you can't do anything about it now so just try harder next time - in the course of all the pills he will be taking if those are the only ones he misses he'll be doing fine.

[can-do-man]

I hope people don't get the ideal that 80-80-80 rule is something they should follow. Your GOOD hepatologist does not recommend this. Not much difference then dose reducing to me. And that is also something not recommended unless its that or stopping tx. Thats why they put us on rescue drugs so we can stay on FULL dose all the time.

Rocker, ever wonder on them palms why they worry about the excact times we take the boceprevir but only ask how many riba we take for the day? As long as we take the full dose of riba in a day it does not need to be 12 hours apart. It has been suggested to me at least 6 to 8 hours apart is fine.

[Isobella]

Definately easier to remember taking the Riba when you do it with meals.  Breakfast and dinner....or where ever the most fat is as long as the doses are 6-8 hrs apart like can-do said.

The study meds are the ones you have to take at precise times, according to my trial anyway.

Me personally, if I miss a Riba dose-I'm doubling up on the next one, or making it up someway.  

[copyman]

I did not want to make people think the 80% rule is acceptable. IT IS NOT! If you want the best chance of SVR don't miss any. I believe the 80% rule is old school anyway. I was just trying to make a point that it is not that critical.

Rock, like someone else posted, it is not important to take your riba at exact times once it has built up in your body (few weeks). As long as you take the prescribed daily mg's. As for the Bocep this is much more critical to take as close to 8 hrs as possible. Unlike the riba PI's don't have a long half life.

[Rockerforlife]

it wasnt me who said anything bout 80% rule....you need goggles?....;)

[Rockerforlife]

The boceprevir i always take on time...i was 3 hours late in my week  with one does,but still got UN ...so guess im ok...its almost impossible to take BOC exaclty on the hour tho...im off by maybe 5 min at the most...but id do hit the exact time too

[can-do-man]

Im with you, i don't set and watch the clock to take right on the minute, and they do give a 2 hour lead-way. I do try and be within 15 minutes either way because the times work best for me.

My point on the riba was they don't ask us the times we take it because they really don't care, just as long as we take our regular dose each day.

Also we MIGHT get to find out what arm we are in soon, the 36 week or 48 week arm. Now this came from my trial nurse and not kwo. But until i hear it from the doctor i don't put alot of stock in it. Would be nice though.

[Rockerforlife]

I was told the same thing by my nurse friday..some of us WILL be stopping at wk 36.........id be happy with that...i think the SVR rates between 36 wks and 48 will be small...inother trials the SVR diff was 10%...82% for 24 wks and 92% for 48 wks...but that was in the naive trials...i still think if we get UN by week 4 with the BOC our odds are way in high numbers...

[R Glass]

Do stress to your husband that the first few weeks of treatment is crucial to obtain RVR and to be more careful. The Brain Fog may be kicking in and he may need your help to stay on top of it. R. Glass

[copyman]

yes i need goggles but that is beside the point. perhaps you need them as well because you missed something :-)

if you read the "To" line on my post it is titiled to rock / "all"

the message about the 80% was on my prior post and I wanted to tell  "ALL" that this was not acceptable.

I addressed you seperately.

The vertex study gave us timers because with Telaprevir they want it taken exactly 8 hrs apart. I took the Riba and telap together mornings (6am) & afternoon(2pm) then just telap (10pm) I hated getting up at 6am with the alarm to take horse pills but it paid off. Just got back my 16 week pcr and still UNDE, since 3 weeks!

[Rockerforlife]

I have some extra fames if you need them....do you some coke bottles .you use the bottoms of the bottle....now you know im only serious...LOL