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264121 tn?1313033056

Comparing Meds

Finally! My nurse hates me, but she did finally fax my medication request over to the pharmacy today and they are fed-exing my meds to me tomorrow for Friday.  She is annoyed because I was anxious to get them and kept calling her (hey, she's had two and a half weeks two do it).  Anyway, apparently I don't get to start them on Friday unless I can get the nurse to come by then because they have to teach me how to give myself the pegasys.  They were unmoved by the fact that I already give myself procrit.  They want to show me.  So anyway, but.

I was going to ask about the meds.  I weigh 125 lbs and I am on 1000 mg of the riba with the pegasys.  Does that sound average or the same or different from everyone else who starts the combo in terms of the riba amount?  Also, like someone else (can't remember who) I'm also being instructed to take part of the riba in the morning and the other part of it at night.  I can't remember if it's two pills in the morning and three at night or the other way around (I'll see when I get the meds), but I thought most people just took it once a day?  I mean, I'll do whatever works better, but I'm on a lot of other meds and I just take everything at the same time, so I'll have to do an extra deal or whatever.  She said that the pegasys is the alpha-2a.  Anyway, my family is a lot more upbeat about this than I am.  I am very very hopeful that I have everything going for me, except my genotype of course, which is 1b (you know, I'm low viral load at 182,000 and I'm starting within four months of my exposure/infection), but they are just not even open to discussing that this might not clear me.  They are just looking at it like it's 100% that it will work, and I feel my chances are better than worse, but I guess I don't want them to have false hope given that it's not 100%, and that I already have some medical issues, like my weird anemia which may well be auto-immune, which may mean I'll respond differently.  It's like I'm the patient but I'm more worried about how upset they're going to be if it doesn't work.

Anyway, is my combo therapy basically similar in terms of dosage and everything to anyone else with my weight?  Oh yeah, any other helpful tips you can give me as I plunge into the treatment?  They said to drink a log of water, but I think I actually had read that here first.
27 Responses
186606 tn?1263513790
you have to space your riba about, morning and evening. i take three am and four pm.  

i'm no expert but it seems right in there, in terms of dosing.

drink a LOT of water. i drink about five  or six one liter bottles every day and then some.
264121 tn?1313033056
lol did I actually type a "log" of water?  My mind is already gone and I haven't even started the tx yet...
151263 tn?1243377877
Sounds like you're on weight based ribavirin, which is good. 1000mg should be sufficient for someone of your weight. And yes technically you should take the riba twice a day, and yes usually the pills are 200mg (mine were at least), so you'll need five a day. However, don't get too hung up on when you take the riba, it has a very long half-life so it's not like it'll drop to unefficacious levels in the afternoon if you happen to forget to take it one morning. Bottomline is that in reality, you could get away with taking it all at once a day, but it's less than ideal so just split the daily dose between morning and evening. Also make sure you take the pills with a fat rich meal or snack everytime. Ribavirin's bioavailability increases dramatically with fat, and you really want to get this nasty drug into your system as well as you can. Also, you have a very low starting VL which is good, that makes it more likely you'll go UND sooner rather than later. Based on your stats, you probably have a better chance of clearing the virus than most others with type 1 (although the pre-existing anemia problem you mention may pose a challenge for you, keep your procrit handy). Pam (pln) here had type 1a and 1b and had a starting VL similar to yours and also had borderline anemia when she started. She's SVR now and with only 24 weeks of reatment, although she was in the VX950 trial.

Best of luck...
85135 tn?1227293372

As far as the Pegasus, it’s a one size fits all. Your Riba dose sounds like you are on the high end for your weight but many on this board think that’s a good thing. It may make your HGB tank, so watch your CBC’s closely.
It’s best to take 3 Riba in the am and the 2 early Riba in the pm as it makes some folks a bit speedy and you DO want to sleep at night. Take the Riba with a bit of fatty food for better absorption. Yogurt or milk or the like.
BTW, I live 50 miles south of B’ham. May I ask what area you live in Alabama. Are you treating at UAB? They have a liver center there.
Best to you.
Avatar universal
why not go to the pegasys website and watch the video on how to give yourself the injection and start tomorrow anyway. sounds like the right amount of RX. best of luck and may the tx make you SVR
Avatar universal
Sometimes you have to trade popularity for advocacy in your doctor's office to get things done right. Good that you pushed your nurse to do her job.

Yes, usual protocol is to split the riba. It could be 3 in the morning and 2 in the evening or vice versa. If breakfast is bigger than dinner, I'd say take the 3 riba with breakfast and the 2 with dinner. If dinner is your big meal, then reverse it. Reason being that taking riba with food is both kinder on your stomach and it also helps it to absorb better. Meals with riba should have at least a moderate amount of fat in them.
That said, some people take the larger riba dose in the morning, regardless, because they feel they sleep better with the smaller dose in the evening. Lots of ways to do it. Also, don't get hung up on taking the riba 12 hours apart. Riba has a very long half life, so the timing isn't as crucial as getting the full dose down the hatch every day. My usual  breakfast on treatment was at 10-11AM and my dinner  4-5PM. So that's when I took my two riba doses.

As to treatment suggestions. Make sure you get a senstive 4-week viral load test (50 IU/ml or less) which should be taken the day before your fifth injection. Discuss this upfront so there will be no misunderstandings.

Also, if you havent' had a viral load test in a few months, try and get one right before starting treatment. That and at least a complete blood count. Also, make sure they do a thyroid panel periodically during treatment.

You mention only your nurse. Do you have a way to communicate with your doctor if need be? Don't be afraid to ask to speak to him directly. If he has email, ask him if you can use it.

I agree, no reason you have to wait for shot instructions if you're already injecting Procrit. Maybe talk to the doctor direct on this ask for another nurse if there's a choice.

Be well,

-- Jim
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