Anemia and Procrit ? ??

[beckland]

Hi , its me again with another question. The treatment nurse was going over rescue drugs with me in case I decide to do it, so she said if my hgb gpes to low they would give me the option of procrit or blood transfusion.  My decision cause she said that something has come out about procrit being bad for the heart.  Does anyone know what it is?  Thanks

[pauloz57]

In 2003 I took m first Riba/Interferon therapy, as a 1a I was a non responder. 3 years later, i took the therapy again, this time a 2 week hospital stay, fever of unknown origin.

I am in the end  stage of the Incivik program and have become anemic. Dr. is giving me Prokrit, My labs are better (ALt etc) but I'm scared that my liver spasms and pain are  harbingers of the inevitable. An similar patients who want to weigh in?

[pauloz57]

In 2003 I took m first Riba/Interferon therapy, as a 1a I was a non responder. 3 years later, i took the therapy again, this time a 2 week hospital stay, fever of unknown origin.

I am in the end  stage of the Incivik program and have become anemic. Dr. is giving me Prokrit, My labs are better (ALt etc) but I'm scared that my liver spasms and pain are  harbingers of the inevitable. An similar patients who want to weigh in?

[beckland]

Thank you. One minute I think I want to do treatment and then I'm not sure.  So confused

[Bill1954]

If you’re interested, Wikipedia has a pretty decent article on anemia; more info here than you probably care to absorb :o)

http://en.wikipedia.org/wiki/Anemia

Good luck with everything,

--Bill

[beckland]

Wow..thanks for all the information. Bill thank you for explaining the difference in anemia.

[HectorSF]

If you doc reads the ribavirin package insert directions it says that for anemia the standard protocol is to reduce ribavirin to 600 mg per day if hemoglobin <10 g/dl, first. If < 8.5 g/dL interrupt dose. Then see if hemoglobin level rise. In the clinical trial most patients did rise. Only 4% stopped treatment owing to anemia.

1. The proper protocol is to reduce ribavirin to 600 mg when hemoglobin is less than <10 g/dl. (* One 200 mg tablet in the morning and two 200 mg tablets in the evening).
2. Discontinue Ribavirin Tablets if: <8.5 g/dL.
Once Ribavirin tablets  have been withheld due to either a laboratory abnormality or clinical manifestation, an attempt may be made to restart Ribavirin tablets at 600 mg daily and further increase the dose to 800 mg daily. However, it is not recommended that Ribavirin tablets be increased to the original assigned dose (1000 mg to 1200 mg).

Only after this doesn't work would you need to take procrit or have a transfusion.
---------------------------------------------------------------------------------------------------------
You can read the Ribavirin package insert yourself
http://www.drugs.com/pro/ribavirin.html
Look at the section "Dose Modifications"

Hector

[Bill1954]

No, the anemia from HCV therapy is distinct from say, iron-deficient anemia. Ribavirin causes ‘hemolytic anemia’; red blood cells are destroyed more rapidly than they can be replaced by your body. This occurs naturally anyway; normally they have a lifespan of roughly 100 days, but the HCV drugs hasten this process.

Other forms of anemia occur on the other end of spectrum; red cells aren’t produced rapidly enough, for instance.

If you do decide to undergo HCV therapy and have issues with iron stores make sure the doctor orders an ‘iron studies’ panel to assess your individual needs. HCV patients as a group tend to have issues with elevated iron; however, sufficient iron stores need to be present for Procrit to work.

Best to you,

--Bill

[Bill1954]

You’ll want to discuss this with her further and ask her for specifics. She might have been referencing the FDA’s actions to place Procrit into a ‘black box warning’, but this occurred back in 2007:

http://www.medpagetoday.com/ProductAlert/Prescriptions/5231

“...Avoid serious cardiovascular and arterial and venous thromboembolic events by using the lowest dose of Aranesp, Epogen, or Procrit that will gradually raise the hemoglobin concentration to the lowest level sufficient to avoid the need for blood transfusion.
Aranesp, Epogen, and Procrit and other erythropoiesis-stimulating agents increased the risk for death and for serious cardiovascular events when dosed to achieve a target a hemoglobin of greater than 12 g/dL...”

(much more in the article...)

Many of the drugs used to manage HCV are strong and some involve significant risk. Your doctor should be in a position to analyze the risk vs. benefit equation and help you determine the best course of action.

Good luck with your decisions--

Bill

[willbb]

Procrit is usually considered if HGB. gets to <10 ,however  if your VL is UND.  and you are well in to tx..according to  some treating doctors slight reduction in Riba is considered also. Transfusions are usually only considered if someone"s HGB gets into the danger zone ...8.5 can be considerd such by some doctors.

The use of procrit was recently found to be a problem in those that had  a previous heart attack.

Best..
Will

http://hepatitiscnewdrugs.blogspot.com/2011/05/procrit-and-epogen-anemia-drugs-may.html

[beckland]

I meant to say that I already get low iron about every 4 months due to a heavy menstrual cycle.  Is the low iron i get the same as the hgb from treatment? ?

[beckland]

Thanks for the information.  I don't know how low, only that my choice of procrit or blood transfusion. Is procrit bad for the heart? The treatment nurse said something about it.

[working dog]

hgb low???how low??  i would keep cbcs every week..are you doing triple?t also depends on how fast your hgb goes down....i would say in the high 9s...takes a couple weeks to work...also you can maybe lower the riba...especially if you are und....maybe try to avoid a transfusion...its good for you to be talking about this now....good luck....billy