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20gm meal or snacks/ incivek dosing
Does any one else have any menu items containing 20 gm fat? Chooosing to eat fat is new to me.
As far as my opinion on incivek dosing: I believe getting as close to every 8 hours is important because of the duration of action of the drug. If there are periods when the blood drug levels are below effective treatment drug resistance can result as well as subptimal viral killing. So, thus we are harming our chances as well as those in the future. Not a good scenerio. And of course taking with fat is essential for complete absorption thru the gut. The controlling factor is what's absorbed in getting results which over rides how much you put into the gut.
Ribaviron has a longer (half-life) duration of action as therefore can be taken every 12 hours. As the half-life of a drug reduces the importance of keeping on schedule increases.
We all want the best results from our therapy. I hate the idea of going thru this regimen and getting suboptimal results so... for me I am going to be as strict as any human being can be following protocol. Varying 1/2-1 hour is not a deal buster but still opens the door to possible sub-optimal therapy.
I agree each MD has different personal protocol they like. As a drug is on the market longer, new ways of administration become evident--but this is all new so who is to say what is best? My MD was part of the Univ of Cincinnati that participated in the incivek trials. My MD stands by a 5X dosing day with 6am incevik with meal and 8am ribaviron. this was what this study followed, and with great results--so of course my MD believes in following what has been proven. that is not to say that we will find other protocol just as effective.
As a fellow Hep C therapy patient and pharmacist my basic advice is: Make sure you eat the 20GM of fat with incivek and get as close to every 8 hours as humanly reasonable, don't miss doses. Get as close to every 12 hours for the ribaviron as possible. I will choose to separate incivek and ribaviron.
Another pharmacy 'pearl of information' is that some drugs can be given (for instance a 3 dosing/day drug) three times broken up while awake such as 8-2-8 but some require strict every 8 hour dosing. Some examples of the ones requiring strict every 8 hours are antibiotics, antivirals (incivek) and antifungals. This is due to the importance of keeping a minimum level of the med in the blood(kill level and kill time) at all times. Blood levels below 'kill levels' allows for the virus to replicate as well as 'morph' and produce resistance strains. It is possible these strains could be produced during a 3month therapy. So be as ridgid as possible-respect your MD advice (unless evidence to the contrary) and allow yourself to be human and not sweat 'the small stuff'. Allow yourself to be human if you gett off timing or meals. STRESS IN NOT A FRIEND to those on or off therapy.
Hope this helps.
Any 20GM
As far as my opinion on incivek dosing: I believe getting as close to every 8 hours is important because of the duration of action of the drug. If there are periods when the blood drug levels are below effective treatment drug resistance can result as well as subptimal viral killing. So, thus we are harming our chances as well as those in the future. Not a good scenerio. And of course taking with fat is essential for complete absorption thru the gut. The controlling factor is what's absorbed in getting results which over rides how much you put into the gut.
Ribaviron has a longer (half-life) duration of action as therefore can be taken every 12 hours. As the half-life of a drug reduces the importance of keeping on schedule increases.
We all want the best results from our therapy. I hate the idea of going thru this regimen and getting suboptimal results so... for me I am going to be as strict as any human being can be following protocol. Varying 1/2-1 hour is not a deal buster but still opens the door to possible sub-optimal therapy.
I agree each MD has different personal protocol they like. As a drug is on the market longer, new ways of administration become evident--but this is all new so who is to say what is best? My MD was part of the Univ of Cincinnati that participated in the incivek trials. My MD stands by a 5X dosing day with 6am incevik with meal and 8am ribaviron. this was what this study followed, and with great results--so of course my MD believes in following what has been proven. that is not to say that we will find other protocol just as effective.
As a fellow Hep C therapy patient and pharmacist my basic advice is: Make sure you eat the 20GM of fat with incivek and get as close to every 8 hours as humanly reasonable, don't miss doses. Get as close to every 12 hours for the ribaviron as possible. I will choose to separate incivek and ribaviron.
Another pharmacy 'pearl of information' is that some drugs can be given (for instance a 3 dosing/day drug) three times broken up while awake such as 8-2-8 but some require strict every 8 hour dosing. Some examples of the ones requiring strict every 8 hours are antibiotics, antivirals (incivek) and antifungals. This is due to the importance of keeping a minimum level of the med in the blood(kill level and kill time) at all times. Blood levels below 'kill levels' allows for the virus to replicate as well as 'morph' and produce resistance strains. It is possible these strains could be produced during a 3month therapy. So be as ridgid as possible-respect your MD advice (unless evidence to the contrary) and allow yourself to be human and not sweat 'the small stuff'. Allow yourself to be human if you gett off timing or meals. STRESS IN NOT A FRIEND to those on or off therapy.
Hope this helps.
Any 20GM
Just wanted to add in a few bits of information that may help someone in their quest to finish the program with some eating tips.
I am finding that to stay balanced in this program that i have to go into the store at least once a week to seek different foods so my taste buds are not locked into a bland taste. These are some of the things I have learned.
It helps to plan meals in advance and sometimes there are a few things one can do in times of a crunch. Now from what I have read one can fall behind no more than 4 hours on their dosages and after that just move on to the next one. If one falls behind four hours then best to re-balance dosages again until getting back on track. last minute catch up meals I can think of are:
1. 2 Tablespoons of peanut butter are equivalent to at least 30 grams of
fat of course depending on brand...well known brands are the ticket
2. 2 Pecan Sandies cookies are 15 grams of fat X 2= 30 grams of fat for
a night snack....add or without milk
3. Those instant lunches...noodles....Maruchan...are 18% grams of
fat...in a cup...so one and 1/2 times those are 27 grams of fat
4. 1/2 cup of walnuts...are equivalent to 16 grams of fat...so X 2= 32
grams of fat
5. 1/2 cup of ice cream = 17 grams of fat...so 1 whole cup equals 34
grams of fat
6. Ice cream drumsticks are 25% fat...so one of those as a snack works
7. In sandwiches...1 tablespoon of mayonnaise equal 18 grams of fat...for
me it almost takes one tablespoon of mayo foe each slice of bread..
for me it about takes 1 tablespoon for each slice of bread....so egg
sandwiches in the morning with turkey bacon....or those who eat
regular bacon are safe with a bacon and egg sandwich with or without
cheese for breakfast....cup of coffee with or without cream and sugar
8. Hersey's kisses...have 18% fat...if 7 of them are eaten......
9. 16 potato chips are 17% grams of fat....you'd be surprised to know that
eating 24 chips is nothing....
10. Then there are certain soups...like Progresso...broccoli, potatoes and
cheese have 18% grams of fat....soup and sandwich.....
11. Hershey's chocolate bars...the small ones....5 will get you 17%
grams of fat...and a glass of milk...Hershey's chocolate in milk?
Just some ideas to help. Breads are important....eating salads with
meats such as chicken and fish. The salad dressing brings the fat. Then the chicken....and whatever else prepared. salad dressing depending on the brand can bring about 17% or higher grams of fat.
Fried foods, mashed potatoes and gravy are good. Properly mixed shakes are good.
Strawberries, marinated in sugar and water to go over ice cream...or strawberries and whipped cream.
These are just some ideas to help with the other examples above. Hope they help. May add to the list later as I learn more. This was a problem for me when I first started. then I became a label reader and started going into grocery stores more often, and planning my meals at times. I am making very good progress as my doctor states and I wish the same for everyone else in their recovery.
For those that have iron issues, Geritol
I am finding that to stay balanced in this program that i have to go into the store at least once a week to seek different foods so my taste buds are not locked into a bland taste. These are some of the things I have learned.
It helps to plan meals in advance and sometimes there are a few things one can do in times of a crunch. Now from what I have read one can fall behind no more than 4 hours on their dosages and after that just move on to the next one. If one falls behind four hours then best to re-balance dosages again until getting back on track. last minute catch up meals I can think of are:
1. 2 Tablespoons of peanut butter are equivalent to at least 30 grams of
fat of course depending on brand...well known brands are the ticket
2. 2 Pecan Sandies cookies are 15 grams of fat X 2= 30 grams of fat for
a night snack....add or without milk
3. Those instant lunches...noodles....Maruchan...are 18% grams of
fat...in a cup...so one and 1/2 times those are 27 grams of fat
4. 1/2 cup of walnuts...are equivalent to 16 grams of fat...so X 2= 32
grams of fat
5. 1/2 cup of ice cream = 17 grams of fat...so 1 whole cup equals 34
grams of fat
6. Ice cream drumsticks are 25% fat...so one of those as a snack works
7. In sandwiches...1 tablespoon of mayonnaise equal 18 grams of fat...for
me it almost takes one tablespoon of mayo foe each slice of bread..
for me it about takes 1 tablespoon for each slice of bread....so egg
sandwiches in the morning with turkey bacon....or those who eat
regular bacon are safe with a bacon and egg sandwich with or without
cheese for breakfast....cup of coffee with or without cream and sugar
8. Hersey's kisses...have 18% fat...if 7 of them are eaten......
9. 16 potato chips are 17% grams of fat....you'd be surprised to know that
eating 24 chips is nothing....
10. Then there are certain soups...like Progresso...broccoli, potatoes and
cheese have 18% grams of fat....soup and sandwich.....
11. Hershey's chocolate bars...the small ones....5 will get you 17%
grams of fat...and a glass of milk...Hershey's chocolate in milk?
Just some ideas to help. Breads are important....eating salads with
meats such as chicken and fish. The salad dressing brings the fat. Then the chicken....and whatever else prepared. salad dressing depending on the brand can bring about 17% or higher grams of fat.
Fried foods, mashed potatoes and gravy are good. Properly mixed shakes are good.
Strawberries, marinated in sugar and water to go over ice cream...or strawberries and whipped cream.
These are just some ideas to help with the other examples above. Hope they help. May add to the list later as I learn more. This was a problem for me when I first started. then I became a label reader and started going into grocery stores more often, and planning my meals at times. I am making very good progress as my doctor states and I wish the same for everyone else in their recovery.
For those that have iron issues, Geritol
Sorry, but you absolutely need that 20 g. It's definitely tricky. We buy the bars at the healthfood store, they're sold in the refrigerator case next to the probiotics, and Udo's oil. They really are delicious and travel well.
According to the literature, your doctor is mistaken. You need that 20 grams of fat with every dose of Incivek. The fat is critical for getting the most from your Incivek.
"The usual dose of Incivek is 2 tablets taken 3 times per day, every 7 to 9 hours."
"Take Incivek within 30 minutes after eating a meal or snack that contains about 20 grams of fat. Always take Incivek with food. Examples of snacks that contain about 20 grams of fat include: A bagel and cream cheese, 3 tablespoons of peanut butter, 2 ounces of American or cheddar cheese, 2 ounces of potato chips, a half-cup of nuts or trail mix, or 1 cup of ice cream."
http://www.drugs.com/incivek.html
And this:
"Effects of Food on Oral Absorption
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)."
http://www.rxlist.com/incivek-drug/clinical-pharmacology.htm
"The usual dose of Incivek is 2 tablets taken 3 times per day, every 7 to 9 hours."
"Take Incivek within 30 minutes after eating a meal or snack that contains about 20 grams of fat. Always take Incivek with food. Examples of snacks that contain about 20 grams of fat include: A bagel and cream cheese, 3 tablespoons of peanut butter, 2 ounces of American or cheddar cheese, 2 ounces of potato chips, a half-cup of nuts or trail mix, or 1 cup of ice cream."
http://www.drugs.com/incivek.html
And this:
"Effects of Food on Oral Absorption
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)."
http://www.rxlist.com/incivek-drug/clinical-pharmacology.htm
Where do you get those Flora truffle bars? Whole Foods? About to start treatment on Tuesday and getting really scared. My Dr. said I didn't need 20 Grams of fat??? with the incivek
Wow an old post but great info.Called incivek and debated with them on the 20 grams.Well it looks like I will be doing about 15-20 grams of fatty food,which the body likes to absorb.I already gained 5 lbs in 5t week.I lost 33 the 1st tx,gained about15 the next 6 months,and now gained another 5.I found bagels and peanut butter hard to digest,especially before bed.I changed to high fat ice cream(no problem for an ice cream lover),doughnuts,fatty pudding,home made baked mac+cheese,dropped egg on toast,ritz crackers+peanut butter(not just peanut butter alone),waffles loaded with maple syrup,pop corn,hot chocolate,tuna,pizza,croissants,etc.There is no getting around the fatty foods,so if you have any strength left,exercize.MIKE
Hi- Best (and healthiest) thing we've found are Flora Truffle bars infused with Udo's oil (Omega 3-6-9) 3 small squares is 21 g and it's good for you. The Hazelnut ones are particularly yummy. Easy to take when nothing sounds good. My husband has a bunch of ideas on his blog under the "Feed Me Seymour" posting - www. hep-free.com. I think he lays out his entire day with meal ideas. Seems to be working for him - although at this point (6 weeks) eating anything is a bit of a chore :(
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