ribavirin dose & anemia

[stg088]

I'm on 1200 mg of ribavirin daily (along with interferon), at 17 weeks of treatment.  When I started treatment, my Hgb was well over 13, then fell into the 12s, then 11s, then 10s, back into the 11s, back down to the 10s.  The labs I had drawn yesterday show Hgb at 9.8.

I weigh about 115 lbs (52 kg).  According to weight-based guidelines, only 1000 mg (or even 800) of ribavirin would be recommended for someone my size. My question is this: If I reduce my dose to 1000 mg, would this be likely to stop this gradual hgb slide, without decreasing my chances of SVR?  (I'm genotype 1.  Viral load was 100 at 4 weeks and UND at 12 weeks.)

[jepperone]

Maybe, maybe not, the only way to find out is to reduce by 200 just after your next draw until the next draw, with the doc’s permission of course. But at 17 weeks and 1200mg mg a day most of the killing is over given your being und at week 12 and to a lesser extent a vl of 100 at week 4 which is a pretty good indication you are well on your way to svr.


Here is a copy and past from a prior post and former member; zazza, that may help you in making a decision whether to reduce the riba or at least present it to the doctor for consideration. Just a little encouragement I am a 1b, UND at week8 and was taking 1200mg a day up till week 20 and then dropped back to 1000mg daily because of the sx and working and still went on to SVR.

At week 4 you had a vl of 100 and UND by week 12 and now at 17 weeks still UND.

106 lbs equals 48 kg. That is 20.75 mg ribavirin per kilo if you take 1000 mg a day; 16.6 mg per kilo with 800 mg riba; 12.45 mg per kilo with 600 mg riba.

For geno 1's a dose of 13-15 mg per kilo is often recommended. So it seems to me you can safely reduce your riba with one pill a day down to 800 mg, perhaps even with 2 pills down to 600 mg.

Normal dose below 65 kg (143 lbs) is 800 mg, so you seem to have been heavily dosed from start. Any special reason for that?

With Copegus you get 1000 mg riba up to 75 kg, so if that is the brand of riba you are taking, that would explain your dose. Copegus and Rebetol are just different brand names of the same drug though, so I figure you can safely follow the more detailed weight based dosing of Rebetol, which is as stated above 800 mg riba below 65 kg.

[jusjames]

you are well over dosed!!  
75kg= 1200mg

[stg088]

Thanks, guys. Your answers are helpful.
(I am a first time treater, so I don't think there's any good reason to take more than the recommended amount of riba.)
I am planning to ask my doctor about this (but often I get the nurse practitioner instead of the doc, so I try to find out as much as I can on my own - not sure the NP knows as much as I do....)

[Alek07]

Hi

You are at week 17 and you cleared by week 12. At this point in tx I wouldn't worry about lowering your riba dose to 1000 mgs. According to some studies at your weight even 800 mgs would be sufficient. ...BUT

talk to your dr first. We don't know whether you are a first time treater or a previous tx failure or what...that would affect the decision you make about dose reduction.

btw my hb went from baseline 15 to 10s to 9s and has been fluctuating between 9-10 ever since. I'm at week 24. I australia they don't give us rescue drugs at all.

alex

[nygirl7]

You are seriously dosed on the riba for your weight - I did the same sort of thing myself (only I took even more - I was crazy) and when the doc wanted me to cut back I was too afraid it would do something........and while I think it would not be a problem I cant really guarantee anything.  What does your doctor say?

Boy not much of an answere here or there huh? But at least you know others have struggled with the problem even if I cant give you any definitive answer.

Have you asked your doc for Procrit - with a hemo in the 9s you should be able to get it no problem at all?