ribavarin concentration

Good morning all.  Was wondering , after starting the peg. and the riba, how long does it take for the riba to reach maximum concentration in our plasma . I really didn't start to notice any sx's from the riba until I'd taken it for a couple days. Maybe it would be better to start the riba a few days ahead of the 1st. peg. shot. Any imput would be appreciated.

Dyce

[jmjm530]

This is something I've thought about for some time. In fact, someone posted maybe a month ago that they're in a trial where the riba starts like 10 ? days before the Peg.

If you think about -- especially with all the positive riba/SVR data plus the importance of EVR/RVR in the process-- it makes a lot of sense since it takes (not sure of exact time ) but maybe a couple of weeks for serum riba levels to peak in the blood.

And while it's true that riba alone doesn't kill the virus -- it appears to be critical in some sort of mutant process that softens the virus for the Peg. So why not "rough" up the virus as much as possible before the first shot, which btw in most cases results in the biggest virus drop, as opposed to having one or two measely riba doses in our system at that time.

One strategy therefore might be to start high-dose riba and Procrit simultaneouly 14-days prior to treatment.

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

Just to be clear, especially to new people, all the above is a simply this layman's opinion/speculation and to my knowledge no trial data has been developed on taking riba prior to Peg. Hopefully, the trial data I spoke about will be out in the not too distance future.

-- Jim

[HCA]

I believe that the 'mad mutation'action of Riba is only partly understood.
I think it plays it's part when the virus rallys and rebuilds after being being blasted by the T-Cell attack triggered by the Peg.
I believe that the kinetic performance of Riba is very efficient i.e that it is quickly and easily absorbed.
As it is an adjucnt to the treatment I can't visualise how introducing it prior to interferon would improve results i.e what would it be doing?
I know of one Hep doc who builds it in gradually from week two.
Naturally any treatment innovation is worth testing tho.
Riba had decimated my hgb in two weeks.
I just finished treatment (geno 1a/1b),last shot monday.
Started 1.3m
606 at 12 weeks
N/D at 24 and 36
Total 48 weeks
I was up to extend but Doc.said not needed and undesirable.
I rather expect to relapse-if I don't it will be a new lease of life.

[jmjm530]

I think it' normal to fear relapse, especially if you have a difficult genotype like 1. I'm going through the same doubts now as treatment ends. The doctors say it's enough but I still wonder. Truth is, however long I treated, I'd probably have the same doubts prior to my 3-month post tx PCR. Curious, how old are you and how much liver damage. Male or female and what drug doses? Thanks.

All the best with your SVR! Doubts aside, no one really knows and as many have stated, in the very end it becomes a calculated cr*p shoot.

-- Jim

[dyce]

I too , being 1-a geno. wonder about relapes down the pike. I guess it's about a 50 /50 chance . I've been eating well , drinking alot of water and I have no liver damage yet, I'm trying to up my odds here a little. I too would like to see a study with partisipants starting the riba a couple weeks a head of the 1st. peg. shot. From my understanding the riba slows down the virus's replication ability thus giving the peg. a good shot at helping the t-cells do alot more of the virus in. Hopfully a future trial will sum this question up! Ha I'm with you guys on the svr thing, I pray svr for you both, you guys deserve it.

Dyce

[dyce]

No riba bumps yet but that was a ? in the back of my mind. Guess it comes with the turf. Thanks ,you wre reading my mind on that one ( ya sure your not telepathic )LOL. Ha thanks and congrats again on the undetectable.

Dyce  ps. hope all goes well with your thyroid!

[HCA]

Jim,
We have exchanged some info previously,but my log in name is so unmemorable I'm going to change to Godzilla or something.
Male age 56
Stage 3 of 6 by biopsy-occasional bridging.
Fibroscan recently inconclusive but appeared to show progression.
Took max epo (procrit) but average intake of riba 600mg,although took 1200mg for first critical 10 weeks.
At one point my HGB was down to 7.6 and was always below 10.
I have followed your treatment story and know you had RVR.
I will be very surprised if you don't clear based on that fact alone.
Rgds
Laurence

[jmjm530]

I kinda like "Godzilla" but more just havin' trouble keeping stats in my head these days.

Our pre-tx stats are similar. I'm 59, 1B, stage 3 of 4.

Some studies suggest that your lower hgb levels on treatment are positive in the sense they correlate with higher levels of serum ribavirin. Yes, I did have an RVR and am guardedly optimistic but my hgb never has gone below 11.2.  Also, your biopsy looks better. At this point all we can do is cross our fingers. How about we make a pact to both SVR !!!

-- Jim

[HCA]

Pact accepted!!!!!!!!!
L.

[NYgirl]

it took a while for the riba bumps to come and for the hemoglobin to go south - so I know usually the anemia can come at around 3 weeks so I figure we are TOTALLY saturated by then.

I started having a bump or two at around week 2 I think.

Now...can tell my serum level is through the roof after that time because between the hemo, anemia, rash, etc etc it's very obvious.

So I would agree that within ten days is a good number honestly but have no real data.

FYI Just because you don't feel it doesn't mean it's not there...

[Mister beagle bailey]

HCA--Congrat on your last shot.
I believe both you and Jim will be SVR.

Jim am I understanding this right that if the hgb goes low the riba is working  well?

Bob

[Mister beagle bailey]

Man,I hope your right and it's hard to believe i'm at the half way mark.

hope those buggers are gone for good, it's been a h**l of a month and it's not over yet.

How are you doing?  You sound in good spirit.

Bob

[jmjm530]

A Sweedish study suggests there's a relationship between the degree of anemia (hgb drop) and serum riba levels as measured by HPLC (high performance liquid chromatography) a test unfortunately not available in this country. What exactly that relationship is and how it relates to one's individualized treatment is another thing. So in a sense, anemia might be considered a double-edged sword with HCV treatment.  

Regarding "normal" AST and ALT. Different labs give different ranges but there're usually close. With Quest Diagnositics the normal range is : AST 3-50; ALT 3-60. That said, falling within the "normal" range when infected with Hepatitis C doesn't mean that those values are normal for you.

For example, it's possible to have an ALT of 55 and be considered "normal" by lab standards. However, it may turn out that you actual "normal" -- after you clear the virus -- is really 20. What's more, with some folks Interferon can temporarily raise liver enzymes during treatment further complicating the picture.

-- Jim

[Bill1954]

In support of Jim's theory of an early ribavirin start to Tx, I've included a link to an article from Schering-plough that discusses the clinical pharmacology of ribaviron.

http://www.medscape.com/viewarticle/416602_1

Much of this material is over my head, so we

[jmjm530]

The long half life and slow absorption is why many of us feel OK early-on with anemia then seeming to "creep" up on us after a few weeks. Combine this with the slow-acting Procrit (plus of course individual response based on factors such as weight,renal function, etc)  and it's very difficult to time Procrit dose/frequency for best results. Building up serum riba levels prior to the first peg shot with several weeks of riba (and perhaps Procrit) is very intriguing. Surprised that I've only heard of one trial looking into this.

-- Jim

[beamishboy]

good seeing your post;glad the transfusion helped & you are still able to focus on trx...
beagle,i know yu r gonna be 'CLEAR" on that 12 wk pcr...no doubt in my mind,brother..
You are cruising into losin all them nsty lil bugs & slaying dragons on your backswing!!

[Mister beagle bailey]

That is what I thought but just couldn't remember.  After the transfusion my AST and ALT was within range.  Keep in mind that the day before I had a fever from shot on Sun. night and was taking tylenol which always made my AST and ALT go up in the past.

Sun. will be #12 and will get the PCR on Thurs. or Fri. after shot.

Thanks,

Bob

[jmjm530]

You're a real trooper with a great attitude, always thinking ahead and focused on the prize, no matter what you're going through.  Best of luck with your PCR!

-- Jim

[dyce]

Your gonna be undetectable!!


Dyce

[Mister beagle bailey]

Jim,

What is the norm for AST and ALT?  can't remember, brain fog.....

Bob

[GoofyDad]

As stated elsewhere in this thread, max concentration is at 4 weeks. We had a graph showing the build up levels somewhere - I think frole provided the link, but I can't find it now - anyway, IIRC, there were twice daily spikes initially, gradually leveling as steady state was acheived at 4 weeks.

My unscientific conclusion was to be more dilligent about the 12 hour interval initially, being less concerned as I approached week four. From then on, I had basically a 2 hour window in the AM and the same in the PM. The good meals with balanced fat are also a good idea throughout, and again, I feel especially so early on.

[FlGuy]

ribavirin concentration.  Now there's a contradiction in terms.