Comparing Meds

[alagirl]

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.

[alagirl]

I would dearly dearly love to do that.  And.  I asked for that.  But.  Both the pharm co. and the doc's office are adamant that I wait for this nurse person and I have already annoyed the nurse once...  However, I may just say, which is true so far, that the nurse never called so I gave myself the dosage and call in for my lab schedule.  

[Sheri1966]

CHARM27

lol... why 6:55pm?... because it's 5 mins before my pills are due... lol

WILLING

With everything I've read.... seems like UNDER is worse than OVER... !?!

[willing]

at the other end of the  spectrum, the following dosing regime, used during the Toronto SARS outbreak, makes even the Lindahl patients, with their paltry 2.5g/day, look like wimps:

"A regimen consisting of a 2-g intravenous loading dose followed by 1 g intravenously every 8 hours for 4 days, followed by 500 mg intravenously every 6 hours for 3 days was considered very high–dose treatment."


from "Adverse Events Associated with High-Dose Ribavirin: Evidence from the Toronto Outbreak of Severe Acute Respiratory Syndrome", Muller et al Pharmacotherapy , April 07.

[willing]

those angle brackets are giving the posting software gas, let's try again:
" a WBD of 800 mg for patients weighing  less than 65 kg;
1000 mg for patients weighing 65 to 85 kg; 1200 mg for patients weighing  85 to 105 kg; and 1400 mg for patients weighing more than 105 kg but <125 kg (Fig. 1)"

[willing]

sorry that was a bit cryptic; anyway, Sept. issue of hepatology reports a recent analysis of riba dosing.

http://tinyurl.com/2bop6t

Not surprisingly WBD weight-based-dosing outperforms flat dosing. However the definition of WBD is "a WBD of 800 mg for patients weighing  85 to 105 kg; and 1400 mg for patients weighing >105 kg but <125 kg ". The older definition of 1000 for under 75Kg 1200 for everybody resulted in  fairly extreme dosing for those on the low end of the weight scale. For example, in Shiffmann's AASLD'05 study of "high dosage ribavirin"

http://www.hivandhepatitis.com/2005icr/aasld/docs/112305_a.html

the high-dosage group was given 15.2mg/Kg/day whereas if you weigh 125 and are taking 1000mg day (5 pills) you're doing a whopping 17.60. All good, but if the anemia gets out of hand it's good to know a dosage reduction would actually put you in the recommended range.

[willing]

you gals weighing less than 143lb might want to take a look at last month's
Jacobson'07