Aa
water consumption/riba concentration
i read that early riba concentration might possibly effect success rate of tx. I wonder if drinking the quantity of water recommended (half body weight) might dilute or wash through the riba faster and lesson the positive effect. i have been eating cheese with riba as i have heard that it will keep the concentration longer. any thoughts?
congratulations on being clear. I hope I'm as lucky. I hadn't heard anyone say they were clear so it's nice to know. Had you been on this treatment before or was this the first time?
Did not know you were in a trial.
Can`t really comment on that since I don`t know the rules of that trial plus
most data I base my decisions on stems from just straight SOC.
My personl view is to take as much Riba as you can safely get away with including
rescues before dose reduction.
Also I would run the most sensitive PCR available such as LabCorps NGI QuantaSure by PCR .#140639 <2 IU
Can`t really comment on that since I don`t know the rules of that trial plus
most data I base my decisions on stems from just straight SOC.
My personl view is to take as much Riba as you can safely get away with including
rescues before dose reduction.
Also I would run the most sensitive PCR available such as LabCorps NGI QuantaSure by PCR .#140639 <2 IU
I became UND at week 8.
Original riba was 6 pills per day 2 @ 185 lbs. but that was cut to 5 pills at week 4 just as the Boc was added. I am now down to 155 lbs.
Geno type 1
Gee~whiz
Original riba was 6 pills per day 2 @ 185 lbs. but that was cut to 5 pills at week 4 just as the Boc was added. I am now down to 155 lbs.
Geno type 1
Gee~whiz
I started in the Boc anemia trial. At 10 weeks I stopped the Boc and remained on SOC. Prior to stopping the Boc, I had been randomized into the riba reduction arm. They have never offered rescue drugs and now with the Epo recall, I am unaware if it is even available. I was <25 at week 6 and UND at week 8.
Of course, I am concerned with remaining UND and even more concerned about my success rate for SVR.
Gee~whiz
Of course, I am concerned with remaining UND and even more concerned about my success rate for SVR.
Gee~whiz
When did you become UND ?
What was your original Riba dose ?
What is your weight and geno ?
What was your original Riba dose ?
What is your weight and geno ?
Why no rescue drugs are you in a trial? I had a six point drop in ten days, yes I thought I was dying too. Without Procrit I never could have continued.
Thanks for responding Bali!
I was down to 10.2 at week 4 and hovered between 9.6 and 10.3 until week 32 when I dropped further to 9.1. I almost felt like I was going to die. They cut my riba to 3 pills per day last Monday. To say the least, today is the best day since.
No rescue drugs and on SOC at week 34. 14 to go!
Gee~whiz
I was down to 10.2 at week 4 and hovered between 9.6 and 10.3 until week 32 when I dropped further to 9.1. I almost felt like I was going to die. They cut my riba to 3 pills per day last Monday. To say the least, today is the best day since.
No rescue drugs and on SOC at week 34. 14 to go!
Gee~whiz
good stuff from CoWriter. Thanks for digging that back up.
Gee704: Yes that is a 5.9g drop. How long did it take you to get there ?
At what week did you start being anemic ?
How long do you have to go ?
Are you going to get rescue drugs ?
Gee704: Yes that is a 5.9g drop. How long did it take you to get there ?
At what week did you start being anemic ?
How long do you have to go ?
Are you going to get rescue drugs ?
Could you tell how to figure out what a 3 gram drop in hemoglobin is?
I started at 15 and am down to 9.1. Is this a 6 gram drop?
Thanks ~
I started at 15 and am down to 9.1. Is this a 6 gram drop?
Thanks ~
Hepatitis C linked to fat enzyme in liver cells
Gladstone scientists link hepatitis C virus infection to fat enzyme in liver cells
Discovery points to a potential new strategy for treating the disease
SAN FRANCISCO, CA—October 10, 2010—Scientists at the Gladstone Institute of Virology and Immunology (GIVI) have found that an enzyme associated with the storage of fat in the liver is required for the infectious activity of the hepatitis C virus (HCV). This discovery may offer a new strategy for treating the infection.
More than 160 million people are infected throughout the world, and no vaccine is available to prevent further spread of the disease. Current treatments are not effective against the most common strains in the US and Europe. The study, published in the journal Nature Medicine, shows that the enzyme DGAT1 is a key factor in HCV infection. With several potential DGAT1 inhibitors already in the drug-development pipeline, a treatment for HCV may be possible in the near future.
"Our results reveal a potential 'Achilles heel' for HCV infection," said Melanie Ott, MD, PhD, senior author on the study. "Several DGAT1 inhibitors are already in early clinical trials to treat obesity-associated diseases. They might also work against HCV."
At first glance, the HCV lifecycle is fairly simple. The virus enters the cell. One large protein is produced and cut into several smaller viral enzymes and proteins that build the virus. The RNA genome is copied, and the new RNAs and structural proteins are used to make new virus particles that are released into the blood stream for to infect more cells. These processes were thought to occur at specialized membranes inside the cell. However, recently it has been shown that fat droplets are critically involved.
Fat droplets, which store fat in cells, have become a hot new topic in biology. DGAT1 is one of the enzymes that help to form fat droplets. The Gladstone team, led by Eva Herker, PhD, discovered that HCV infection and viral particle production are severely impaired in liver cells that lack DGAT1 activity.
"DGAT enzymes produce the fat that is stored in the droplets that are important for HCV replication, so we wondered if inhibiting those enzymes might disrupt the viral life cycle," said Dr. Herker. "We found that HCV specifically relies on one DGAT enzymes, DGAT1. When we inhibit DGAT1 with a drug, the liver still produces fat droplets through another DGAT enzyme but these droplets cannot be used by HCV."
The team sought to identify which step in the HCV lifecycle requires DGAT1. They found that DGAT1 interacts with one viral protein, the viral nucleocapsid core protein, required for viral particle assembly. The core protein normally associates with the surface of fat droplets but cannot do so when DGAT1 is inhibited or missing in infected cells.
Gladstone scientists link hepatitis C virus infection to fat enzyme in liver cells
Discovery points to a potential new strategy for treating the disease
SAN FRANCISCO, CA—October 10, 2010—Scientists at the Gladstone Institute of Virology and Immunology (GIVI) have found that an enzyme associated with the storage of fat in the liver is required for the infectious activity of the hepatitis C virus (HCV). This discovery may offer a new strategy for treating the infection.
More than 160 million people are infected throughout the world, and no vaccine is available to prevent further spread of the disease. Current treatments are not effective against the most common strains in the US and Europe. The study, published in the journal Nature Medicine, shows that the enzyme DGAT1 is a key factor in HCV infection. With several potential DGAT1 inhibitors already in the drug-development pipeline, a treatment for HCV may be possible in the near future.
"Our results reveal a potential 'Achilles heel' for HCV infection," said Melanie Ott, MD, PhD, senior author on the study. "Several DGAT1 inhibitors are already in early clinical trials to treat obesity-associated diseases. They might also work against HCV."
At first glance, the HCV lifecycle is fairly simple. The virus enters the cell. One large protein is produced and cut into several smaller viral enzymes and proteins that build the virus. The RNA genome is copied, and the new RNAs and structural proteins are used to make new virus particles that are released into the blood stream for to infect more cells. These processes were thought to occur at specialized membranes inside the cell. However, recently it has been shown that fat droplets are critically involved.
Fat droplets, which store fat in cells, have become a hot new topic in biology. DGAT1 is one of the enzymes that help to form fat droplets. The Gladstone team, led by Eva Herker, PhD, discovered that HCV infection and viral particle production are severely impaired in liver cells that lack DGAT1 activity.
"DGAT enzymes produce the fat that is stored in the droplets that are important for HCV replication, so we wondered if inhibiting those enzymes might disrupt the viral life cycle," said Dr. Herker. "We found that HCV specifically relies on one DGAT enzymes, DGAT1. When we inhibit DGAT1 with a drug, the liver still produces fat droplets through another DGAT enzyme but these droplets cannot be used by HCV."
The team sought to identify which step in the HCV lifecycle requires DGAT1. They found that DGAT1 interacts with one viral protein, the viral nucleocapsid core protein, required for viral particle assembly. The core protein normally associates with the surface of fat droplets but cannot do so when DGAT1 is inhibited or missing in infected cells.
This is a very interesting post written by CoWriter a while back on the subject of high fat meals with ribavirin and we all know she's a very smart lady who does her homework. An article about Hepatitis C linked to fat enzyme in liver cells will follow this post. It's common knowledge if you maintain a 3 gram drop in hemoglobin you will have the right concentration of Riba. I
________________________________________________________________________
Should you take the Ribavirin with a high fat meal to increase the concentration????
Every time I hear people tell a newbie to take the Riba with a HIGH FAT MEAL or to eat all the ice cream they want, I cringe. So I decided to look into it. Please feel free to jump in. All comments welcome even if you don't agree with me.
First of all, let's see what the drug company means by "a high-fat meal"....( 53.8 grams of FAT, 31.6 grams of Protein, and 57.4 grams of Carbohydrate. A total of 841 calories per meal).
53.8 grams FAT = 482 calories. If you have 2 high fat meals a day to take your Riba, that would give you a total of 1682 calories.....and 964 calories would be from fat. That means that over 50% of the total calories would come from fat. Considering that only 30% of a person's total calories each day should come from fat, that would be a very unhealthy diet.
Diabetics are usually allowed a total of 1800 calories a day. So that means that after eating the two high fat meals, they'll have 118 calories left to cover one more meal and two snacks....which may cause their blood sugar to be out of control.
What are you guys going to eat to make your meal "high fat"? Did you say TWO tablespoons of peanut butter? Hmmm.....that's only 16 grams of fat.....so you'll have to eat at least 6 tablespoons. Or a Big Mac, fries and 2 tablespoons of peanut butter.....Twice a day!
What they're suggesting is ridiculous and unhealthy. Having some fat with your meal is fine, but do you really need 54 grams????
To help you decide, I did a little research on the effects of food on Riba bioavailability.....
(The quotes come from published data on Riba pharmacokinetics. Sources listed below)
"Bioavailability" means the portion of the dose that reaches the systemic circulation. When a medication is administered intravenously, its bioavailability is 100%. However, when a medication is administered orally, its bioavailability decreases because not all of it is absorbed. So 70% bioavailability means that, from the dose you took, 70% of it reached systemic circulation.
"Two studies have been carried out to assess the effect of food (ie, a high-fat breakfast) on the bioavailability of a SINGLE oral dose of ribavirin. An initial study by ICN Pharmaceuticals, Inc. showed MINOR EFFECTS on bioavailability, but a 33% increase in Tmax (Time to Maximum Concentration)"
In other words, a high-fat breakfast (54 grams of fat) slowed the absorption of Ribavirin by 33%. It took 33% longer to reach the maximum concentration and had only a minor effect on bioavailability. So according to that study, eating a high fat meal had no benefit.
"A subsequent study by Schering-Plough demonstrated more substantial increases in bioavailability: food increased the AUC (Area Under the Curve) and Cmax (Maximum Concentration) by 70% compared to the FASTING population, and Tmax (Mean Time to Maximum Concentration) which is usually 1.5 hours was more than doubled."
So that means that compared to people who were fasting, eating a high fat meal (54 grams of fat), increased the maximum concentration of Riba by 70% but it took twice as long to do it. Ribavirin is rapidly absorbed following oral administration. The time to reach the Maximum Concentration of Riba after taking a single oral dose is usually 1.5 hours. After a high fat meal, it took over 3 hours to reach the maximum concentration.....but bioavailability is more important than absorption time.
"Although both studies consistently showed that food slowed the absorption of ribavirin, the extent to which food affected ribavirin bioavailability differed widely between the studies."
That's right, one study showed that a high fat meal had no effect on bioavailability and the other one showed that it did.....if you ate 54 grams of fat.....as compared to people who ate nothing. That means that we don't know whether bioavailability would be 69% or 71% or whatever if people eat a regular, non high-fat meal because they didn't look at that. They compared people who ate a high fat meal to people who ate nothing.
"It is also UNKNOWN whether any food effect might be altered by the type of meal consumed (eg, high versus low fat), IF A FOOD EFFECT WOULD STILL BE EVIDENT UPON MULTIPLE DOSING OF RIBAVIRIN, and, finally, what clinical implications the food effect might have. It should be noted that in the pivotal Schering-Plough clinical efficacy studies, ribavirin was administered without regard to food. Because of the uncertainty about the effects of food, it may be prudent for patients to TAKE RIBAVIRIN WITH FOOD."
Notice how it DOES NOT say HIGH FAT food.....just food.
But 70% concentration sounds so impressive, doesn't it? But remember....that was after taking ONE SINGLE DOSE of Riba. Taking multiple doses is totally different. You cannot predict what the bioavailability will be after taking multiple doses from looking at what happened after taking ONE DOSE.
"The fact that the multiple-dose ribavirin half-life (298 hours) is considerably longer than the single-dose half-life (79 hours) MEANS THAT IT IS NOT POSSIBLE TO PREDICT MULTIPLE-DOSE RIBAVIRIN PHARMACOKINETIC PARAMETERS BASED ON SINGLE-DOSE PARAMETERS. This has implications for interpretation of food effect pharmacokinetic data."
In other words, the data from the two high fat meal studies pertains to those of you who are planning on taking ONLY ONE Ribavirin dose....
Fat is a good source of energy and we all need some fat in our diet. For somebody on treatment who has lost lots of weight and can't afford to loose any more, the recommendation is certainly to eat whatever they can tolerate and that includes fat. If it means survival, it's better to eat junk than to eat nothing at all. At that point, getting calories is the important thing, doesn't matter where they come from.
I have no problem with people having some fat with their Riba. But I can't agree with suggesting people starting treatment eat 54 grams of fat twice a day as suggested by the study (especially if they're already obese) to MAYBE increase Riba bioavailability. Not when multiple dosing may already be doing that. Not when up to two thirds of them may have insulin resistance and many of them have fatty liver.
A high fat diet promotes oxidative stress, fatty liver, high blood sugar, an increase in CYP2E1, cytokine-induced beta-cell death, hepatic insulin resistance and hyperinsulinemia. All the things that lower SVR.
When you become insensitive to insulin (Insulin Resistance), the pancreas increases its production of insulin....so you end up with too much insulin (hyperinsulinemia).....And large levels of insulin, MAKE INTERFERON INEFFECTIVE....and at that point, Riba bioavailability will no longer matter.
As always, the choice is yours.
________________________________________________________________________
Should you take the Ribavirin with a high fat meal to increase the concentration????
Every time I hear people tell a newbie to take the Riba with a HIGH FAT MEAL or to eat all the ice cream they want, I cringe. So I decided to look into it. Please feel free to jump in. All comments welcome even if you don't agree with me.
First of all, let's see what the drug company means by "a high-fat meal"....( 53.8 grams of FAT, 31.6 grams of Protein, and 57.4 grams of Carbohydrate. A total of 841 calories per meal).
53.8 grams FAT = 482 calories. If you have 2 high fat meals a day to take your Riba, that would give you a total of 1682 calories.....and 964 calories would be from fat. That means that over 50% of the total calories would come from fat. Considering that only 30% of a person's total calories each day should come from fat, that would be a very unhealthy diet.
Diabetics are usually allowed a total of 1800 calories a day. So that means that after eating the two high fat meals, they'll have 118 calories left to cover one more meal and two snacks....which may cause their blood sugar to be out of control.
What are you guys going to eat to make your meal "high fat"? Did you say TWO tablespoons of peanut butter? Hmmm.....that's only 16 grams of fat.....so you'll have to eat at least 6 tablespoons. Or a Big Mac, fries and 2 tablespoons of peanut butter.....Twice a day!
What they're suggesting is ridiculous and unhealthy. Having some fat with your meal is fine, but do you really need 54 grams????
To help you decide, I did a little research on the effects of food on Riba bioavailability.....
(The quotes come from published data on Riba pharmacokinetics. Sources listed below)
"Bioavailability" means the portion of the dose that reaches the systemic circulation. When a medication is administered intravenously, its bioavailability is 100%. However, when a medication is administered orally, its bioavailability decreases because not all of it is absorbed. So 70% bioavailability means that, from the dose you took, 70% of it reached systemic circulation.
"Two studies have been carried out to assess the effect of food (ie, a high-fat breakfast) on the bioavailability of a SINGLE oral dose of ribavirin. An initial study by ICN Pharmaceuticals, Inc. showed MINOR EFFECTS on bioavailability, but a 33% increase in Tmax (Time to Maximum Concentration)"
In other words, a high-fat breakfast (54 grams of fat) slowed the absorption of Ribavirin by 33%. It took 33% longer to reach the maximum concentration and had only a minor effect on bioavailability. So according to that study, eating a high fat meal had no benefit.
"A subsequent study by Schering-Plough demonstrated more substantial increases in bioavailability: food increased the AUC (Area Under the Curve) and Cmax (Maximum Concentration) by 70% compared to the FASTING population, and Tmax (Mean Time to Maximum Concentration) which is usually 1.5 hours was more than doubled."
So that means that compared to people who were fasting, eating a high fat meal (54 grams of fat), increased the maximum concentration of Riba by 70% but it took twice as long to do it. Ribavirin is rapidly absorbed following oral administration. The time to reach the Maximum Concentration of Riba after taking a single oral dose is usually 1.5 hours. After a high fat meal, it took over 3 hours to reach the maximum concentration.....but bioavailability is more important than absorption time.
"Although both studies consistently showed that food slowed the absorption of ribavirin, the extent to which food affected ribavirin bioavailability differed widely between the studies."
That's right, one study showed that a high fat meal had no effect on bioavailability and the other one showed that it did.....if you ate 54 grams of fat.....as compared to people who ate nothing. That means that we don't know whether bioavailability would be 69% or 71% or whatever if people eat a regular, non high-fat meal because they didn't look at that. They compared people who ate a high fat meal to people who ate nothing.
"It is also UNKNOWN whether any food effect might be altered by the type of meal consumed (eg, high versus low fat), IF A FOOD EFFECT WOULD STILL BE EVIDENT UPON MULTIPLE DOSING OF RIBAVIRIN, and, finally, what clinical implications the food effect might have. It should be noted that in the pivotal Schering-Plough clinical efficacy studies, ribavirin was administered without regard to food. Because of the uncertainty about the effects of food, it may be prudent for patients to TAKE RIBAVIRIN WITH FOOD."
Notice how it DOES NOT say HIGH FAT food.....just food.
But 70% concentration sounds so impressive, doesn't it? But remember....that was after taking ONE SINGLE DOSE of Riba. Taking multiple doses is totally different. You cannot predict what the bioavailability will be after taking multiple doses from looking at what happened after taking ONE DOSE.
"The fact that the multiple-dose ribavirin half-life (298 hours) is considerably longer than the single-dose half-life (79 hours) MEANS THAT IT IS NOT POSSIBLE TO PREDICT MULTIPLE-DOSE RIBAVIRIN PHARMACOKINETIC PARAMETERS BASED ON SINGLE-DOSE PARAMETERS. This has implications for interpretation of food effect pharmacokinetic data."
In other words, the data from the two high fat meal studies pertains to those of you who are planning on taking ONLY ONE Ribavirin dose....
Fat is a good source of energy and we all need some fat in our diet. For somebody on treatment who has lost lots of weight and can't afford to loose any more, the recommendation is certainly to eat whatever they can tolerate and that includes fat. If it means survival, it's better to eat junk than to eat nothing at all. At that point, getting calories is the important thing, doesn't matter where they come from.
I have no problem with people having some fat with their Riba. But I can't agree with suggesting people starting treatment eat 54 grams of fat twice a day as suggested by the study (especially if they're already obese) to MAYBE increase Riba bioavailability. Not when multiple dosing may already be doing that. Not when up to two thirds of them may have insulin resistance and many of them have fatty liver.
A high fat diet promotes oxidative stress, fatty liver, high blood sugar, an increase in CYP2E1, cytokine-induced beta-cell death, hepatic insulin resistance and hyperinsulinemia. All the things that lower SVR.
When you become insensitive to insulin (Insulin Resistance), the pancreas increases its production of insulin....so you end up with too much insulin (hyperinsulinemia).....And large levels of insulin, MAKE INTERFERON INEFFECTIVE....and at that point, Riba bioavailability will no longer matter.
As always, the choice is yours.
This is a very good question. I am in the riba dose reduction Arm of a Trial. My first impression is that impeding riba uptake isn't going to help w/ tx unless you're facing a non-medical administrative "rule" that will force you to drop out of tx.
Hey Babs! For a while during my tx I had a craving for buttered toast w/ cinnamon sugar - so there's your sugar coated fat (I gained 3 lbs that month while on tx) LOL
Hey Babs! For a while during my tx I had a craving for buttered toast w/ cinnamon sugar - so there's your sugar coated fat (I gained 3 lbs that month while on tx) LOL
The boss just brought in an apple strudel from the German bakery they had leftover from their big Oktoberfest soiree at their home. Of course, I wasn't invited but I'll sure eat his apple strudel. Enough fat grams in that to last me for the rest of the month.
Trin
Trin
Jez this thread just made me starving and now somebody here is toasting a bagel......it's enough to make me drool. Screw the apples pass me the butter.
Or a chocodile.
Or a chocodile.
Sugar coated fat, eh. Several years ago, I think it was test marketing a new product - Hostess came out with a chocolate covered Twinkie called a "Chocodile"
"God didn't intend us earthlings to go around eating fries all day long I don't think but rather apples"
Hmmm.. I'm not one for the scriptures, but I'm pretty sure that it was the apple what was what we weren't supposed to eat.
Hmmm.. I'm not one for the scriptures, but I'm pretty sure that it was the apple what was what we weren't supposed to eat.
Some more food (fat) for thought
Would someone with a very low HgB with no available rescues and facing dose reduction
from tx team be able to raise HgB by going fat free ?
Would someone with a very low HgB with no available rescues and facing dose reduction
from tx team be able to raise HgB by going fat free ?
just because it is from germany does`nt make it any better , most of the stuff they print i usually
already know and is based on US research but it is always nice to see a different angle on the
same issues and once in a while you find something unexpected.
i don`t think drinking more or less water will influence your riba concentration. Once it is absorbed
into your body and cells it will stay there up to 6 months in certain areas.
It`s not like water soluable vitamins that can get flushed out of your system within hours like Vit C.
already know and is based on US research but it is always nice to see a different angle on the
same issues and once in a while you find something unexpected.
i don`t think drinking more or less water will influence your riba concentration. Once it is absorbed
into your body and cells it will stay there up to 6 months in certain areas.
It`s not like water soluable vitamins that can get flushed out of your system within hours like Vit C.
GSDgirl,
I made potato soup with butter. milk and cream all through treatment. If my stomach was upset which happened a lot during treatment it was one of the few things I could eat that would actually settle it. My god if I ate as much of it now as I did then, I'd blow up for sure. Same thing with the cream cheese.
I made potato soup with butter. milk and cream all through treatment. If my stomach was upset which happened a lot during treatment it was one of the few things I could eat that would actually settle it. My god if I ate as much of it now as I did then, I'd blow up for sure. Same thing with the cream cheese.
Never thought of that combo but a bagel and tons of cream cheese....yummm
Bali, I have German dogs but that is about as far as my German goes. Jagers-Tal (Hunters Valley) is my kennel name.
Bali, I have German dogs but that is about as far as my German goes. Jagers-Tal (Hunters Valley) is my kennel name.
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