ribavirin amounts and times

[marty59]

I am starting tx this week with the 3 meds. I had to buy them via my insurance co. mail order. I just noticed the label on the ribavirin bottle says to take 3 pills 2x daily.
The incivek says to take 2 pills 3x daily, but in the instructions it says to take 7-9 hours apart.

First question is, does everyone else take the riba 3 caps at a time twice a day?
If I take riba twice a day, how far apart, and can I take it at the same time I take the incivek?

I knew there would be 6 caps of the riba to take and 6 of the incivek, I just assumed they would be equal amounts taken at the same time.

[marty59]

I started this thread almost a year ago when I started triple tx.
Since then I did the 24 weeks and have been und since.
My last labs at 6 months post tx. confirmed that the virus was gone.
Good luck with your treatment.

[TeaCea]

I am glad to hear that, because I have been taking the pills then eating within the 15 to 30 min. I'm on day 4 of the triple therapy. I have done therapy 4 times before, this is the first with all three, I have always made it a year on the diffident interferon's,  this is my 3rd time on Pegasys Pro Click, My problem has always been the ribaviran  Or I should say the worst problems, and I'm already having some of the same intestinal issues as in the past, So will see if I can make this, I know if there isn't something to help those issues I will not make it on the ribaviran for a year, having prob. after 4 days.  Hope you do well and this is a cure for you!  

[Lifenet62]

Riba also must be taken w food. :). Best of luck!!!  We are with you!

[Lifenet62]

All foods consumed (not liquids) must be eaten WITHIN 30 minutes prior to taking INCIVEK at each dosage time.   I generally prep 1/2 hr to 15 minutes before and est then take pills. Am is real bkfst (sometimes it is a honey bun tho)  2:30 is cheetos cookie snak or crackers and cheese hummas n pita or avocado w lemon and sour cream.  I  eat dinner. 10:30 usually pie or cookies, ice cream w melted almond butter and hershey dyrup on top yummmmmy

[Advocate1955]

My husband's liver specialist said Incivek 3x/day (8 hrs apart, eat 20 grams of fat 30 min. before); Ribavirin, 2x/day (10 hours apart, with food), and Peg Interferon (once a week).  She was pretty clear that the timing of the doses were important, but that being an hour or so late on something occasionally she didn't think was too big of a problem. (He was late with Riba one day due to dr. appt. and forgot to bring it with him, she wasn't worried).  It sounds like you are taking your Riba with 8 hours in between.  I would suggest that you give your NP a call and ask if you should change it to the 10 hours in between for the Riba.
Advocate 1955

[Livinontheedge]

I am just reading this thread and wonder how much I have screwed up my treatment.   I could of sworn my NP told me it was ok to take my meds the way I have been taking them.   I am on my 8th week of triple tx w/ INC  Here is my schedule
9AM  INC & Riba
5PM  INC & Riba
1AM INC  

Am I off here.   I dont store my Riba in the frig either I have it in a thermal bag with all my meds, so they stay pretty cool and are out of the light .  

[ceanothus]

Thanks for all the answers! I've also searched more on the pharmacy website and it does seem to confirm that I need to eat first. I'm glad I found that out within the first week. I think I only had one or two doses where I may have swallowed the pills while I was preparing the snack instead of waiting until after I had eaten it. I'm amazed at how many things that seem high-fat are really only half what we need, unless we can manage to eat huge amounts of it, such as two whole cups of whole-fat yogurt. I couldn't eat that much at once even without the nausea and even if I was truly hungry. My morning dose is the hardest, but I seem to be doing much better with it since I gave up on the large chunks of cream cheese, peanut butter or cheese and went to a breakfast pastry instead. The relative dryness of croissants or morning rolls seems easier to tolerate with my nausea. I got a little tired of ice cream every night, especially now that the nights are getting colder, and I rediscovered the Nestle Toll House ready to bake cookies. Two "ultimate chocolate" cookies and a glass of milk do the job. I suspect that the constant nausea I'm having will tend to add some kind of taint to almost any sort of goodie over time though, so I'll have to keep looking for new ones all the time.

[FrontRangeMom]

Hagen Dazs -20 grams of fat per half cup, or for one of the ice cream bars. Easy pre-measured serving. Still, don't think I want one for breakfast.

Two days of peanut butter was enough for me. I can't even look at it now. Brown Cow whole milk yogurt over bananas is perfect, while providing 9 grams of fat per cup

[hostalavistababy]

The 20 grams of fat should be consumed within 30 minutes of taking the Incivek.  You can eat and then take the Incivek immediately afterwards or you can wait up to 30 minutes before taking the Incivek.  

[marty59]

I'm in my 9th week now and I have found just toast butter and peanut butter is working for my morning snack, with a cup of coffee, it makes it seem normal.
I eat first, then take the meds when my stomach is ready for them.

I eat a normal late lunch, usually a cheese burger type luch. Plenty of fat there.
Then for the evening snack, I started with cheese and crackers, then went to  a combo of cheese/crackers and small ice cream bar.
Now I'm doing a warm large blueberry muffin or apple cinnimon muffin with a tbsp of butter.

[Advocate1955]

My husband is on the triple therapy with Incivek too.  He works swing shift so he gets home from work at 11:45 PM.  His medication schedule is 7:30 AM fat snack, 8 AM 2 tab. Incivek, 10 AM 3 tab. Rivavirin, 3:30 PM fat snack, 4 PM 2 tab. Incivek, 8 PM 3 tab. Ribavirin, 11:45 fat snack, 12:15 AM 2 tab. Incivek.  Plus of course the weekly injection of Peg. His nurse practioner was very clear that the fat snack must be eaten 30 min. before taking the Incivek. Hope this helps.

[ceanothus]

I just started triple tx with Incivek on Sunday, and am having a very hard time with the required fat intake, particularly since I'm feeling pretty nauseated. There is absolutely nothing that sounds good when I wake up, and I've been shocked to discover how little fat is actually in all the foods I'm used to eating. I like butter, cream cheese and peanut butter, but the quantity required to provide 20g of fat, is way more than I'd ever choose to eat at once, especially when it's only a "snack" and not my normal mealtime. Do most of you manage to do this as a snack, or have you mostly moved your mealtimes to coincide with your Incivek? I wonder if they ever studied the possibility of getting the plasma concentration up by letting people eat normal little snacks but giving them larger doses of Incivek. I'd sure rather swallow twice as many pills than all that fat, particularly first thing in the morning.

Okay, now I've ranted, but I do have a question too. I've been under the impression that I just have to get my 20g of fat in within 30 min. one way or the other of taking the pill, so sometimes I eat first and sometimes I take the pill first. Is this wrong? Many comments here make it sound like one should eat first and then take the pills. If I'm going to suffer through all this I sure don't want to screw it up with a silly mistake. Thanks!

[crossroadsec]

I'm a 6 2 10 girl w/ Incivik.  Both RIBA doses at 6 pm. I did find myself hitting snooze button n have moved off about 30 min gradually w Incivik. But I moved all 3 dosages. good luck!! Karen :)

[lynda607]

If you are starting Incivek tomorrow it is very important you take it 3 x day every 7-9 hrs with 20 g of fat and some fat is also required for the absorption of ribavirin.  You don't have to eat high fat meals 3 x a day but will need to adhere to the required fat grams for maximum absorption of the Incivek.  Food that is taken with Incivek should be ingested within 30 minutes prior to each Incivek dose. Examples of some foods that could be taken with Incivek include: a bagel with cream cheese, ½ cup nuts, 3 tablespoons peanut butter, 1 cup ice cream, 2 ounces American or cheddar cheese, 2 ounces potato chips, or ½ cup trail mix.

High iron does mean you will not experience hemolytic anemia which can be caused by both the Incivek and ribavirin.  Tylenol is recommended by most hepatologists, up to 2000 mg per 24 hr period.

20 g of fat is not required with Victrelis but it must be taken with food for maximum absorption benefit.

Here is the info from the Vertex medication guide:

Effects of Food on Oral Absorption with Incivek
The systemic exposure (AUC) to telaprevir was increased by 237% when telaprevir was administered with a standard fat meal (containing 533 kcal and 21 g fat) compared to when telaprevir was administered under fasting conditions. In addition, the type of meal significantly affects exposure to telaprevir.
Relative to fasting, when telaprevir was administered with a low-fat meal (249 kcal, 3.6 g fat) and a high-fat meal (928 kcal, 56 g fat), the systemic exposure (AUC) to telaprevir was increased by approximately 117% and 330%, respectively. Doses of INCIVEK were administered within 30 minutes of completing a meal or snack containing approximately 20 grams of fat in the Phase 3 trials. Therefore, INCIVEK should always be taken with food (not low fat).

[Blondebl59]

This is the first I knew about eating Fat with the meds? I start tomorrow, hopefully the nurse will explain all this tomm...My Dr. had actually told me to go on low fat diet?  red meat on occassion as I have high Iron so I guess this means I will not have any anemic problems? I am stocked up with Advil, itching creams etc...I thought Advil was better for the liver than than tylenol?? Now I wonder what will I eat tomm...

[marty59]

Tell me more about the Nioxin - shampoo.

[marty59]

Thank-you for the good news on the sides.
At the moment I am not working and plan to stay off for atleast a couple weeks. But I really need to get back to work and you give me a hope I can soon.

[elpasolady]

HI...Good luck with starting. I am starting my 4th week tomorrow.  I want to tell you that I was told it was okay for me to take my Incivek and Riba together, and that is exactly what I have done since day one.  I take my first pills at about 6:30 am and my second dose at about 2:30. My last dose of Incivek is at 10:30, so I am only taking pills three times a day. I was told that as long as the  Riba doses are at least 8  hours apart, that would be fine!  So...I eat my 20 gr of fats just before, and that covers both pills needing food for better absorption.
And, just to give you some encouragement....I have had no side effects that I was so worried about, with one exception.  I developed a rash from the Riba starting on day 3.  It became annoying, but it was tolerable.  It went away after about 10 days.  Right now, I would not even know I am treating, I feel so normal.  The only thing is when I bend down and come up again, I get a bit dizzy for a few seconds.  I also get a bit winded easier, but that is all, thus far.
I eat greek yogurt, full fat in the mornings.   A 6oz container has 17 gr of fat.  Hummus and Avocadoes are also good forms of fat. Pecans have 21 grs of fat per serving.
Keep us posted.....Hugs, Debbie

[marty59]

Pegasys.

I'm going to stock up on the Klondike bars and some vanilla ice cream for the night time snack.

I also saw the the Jimmy Dean suasage, and cheese microwave biscuits are like 28 grams, plus there are several other microwave breakfast bowls that will make it easy for someone like me that doesn't like to cook in the morning

[frijole]

Yes, Marty, I have been reading here that a lot of people are getting mighty sick of peanut butter.  I don't have to worry about those 20g fat with the VIC but I had already checked the labeling on KLondike Bars and they are 17g -- which I thought was nearly perfect for the late night snack!

I stocked up on Medicated Gold Bond -- it helps with the ribavirin itching (probably not the Incevik rash) and Tylenol - the pain med of choice with liver disease.  I still need to get some Nioxin - shampoo for hair loss. My scalp has been itching quite a bit so I think those folicles may be releasing some hari pretty soon (darm).

I will be thinking about you Friday.  Hope it goes smooth -- which interferon are you using - PegIntron or Pegasys?

frijojle

[marty59]

Yes this is going to be my first.
I'm starting on Friday.
I have already gone down to the grocery store and looked at all the different snack type foods I think I will be able to eat to get that 20grams. Looks like alot of people rely alot on peanut butter, which is ok, but not long term.
Just getting some sort of schedule planned in advance and trying to make a plan B if plan A doesn't work.

[frijole]

marty
good luck on getting started.  Is this your first time treating?

I think it is fine for you to take the first doses of both at the same time.  I will be taking the Victrelis instead of the INcivek, but it is the same timing.  I am taking the riba now, during the lead in at 7 & 7.  I may adjust that to 6 & 6 since I must do the VIC exactly 8 hours apart and will probably do 6,2, and 10.  You will find your rythym.

Have the doctors told you to take the INcivek with about 20 grams of fat each time?  That may impact how you dose too as you may want to line up your meals and snacks with dosing times.  You are supposed to take the ribavivin with "some" fat for absorption but for the Incevik to achieve maximum absorption, the 20 grams of fat is suggested.  

Welcome to the mad house  (oh, I mean forum)

frijole (I am on week 2)

[marty59]

Thanks everyone

[lynda607]

Yes, you can take the ribavirin and Incivek at the same time in the am.  The 20 fat g requirement required with Incivek will also assist in the absorption of the ribavirin.