Has anyone tried to or had to split ribavarin tabs when their dose was reduced?

[yodennis]

The form is the Ribasphere RiboPak 600 mg tabs which are not split and have a film coating: My dilemma: Triple (Incivek) tx times 7 weeks today with a a worsening hgb each week (from pre-tx 13 to 9.5 this week) The trajectory of progressive dropping forecasts a definite continuing lowering. 2 alterations have been made: My Ribo has been reduced from 600 twice a day+ 1200 mg to 400 twice a day+800 and Procrit ordered. However! Since I just received a monthly supply of  600 mg Ribo tablets 2 days ago the pharmacy is having a hard time with my insurance company approving the new 400 mg prescription plus I am being asked by the pharmacy (a large NYC pharmacy) to wait until monday (for both availability and insurance approval) reasons. As I cannot become more anemic because of my unambiguous need to work m-f and the weekend making it difficult regarding a dialogue with my hematologist: Has anyone carefully (I'm in healthcare so not entirely naive) split their existing coated non-scored tabs when their Ribo was reduced secondary to anemia?

[yodennis]

Original problem resolved. 400 mg tabs procured. Thank you all. d

[hrsepwrguy]

Yes it has been my understanding that only 2 persons in group 2 have actually needed dose adjustments, and yes knowing I am on target makes me feel much better even if I was still detectable at week 4 and 6. I go for week 8 bloods and PCR on teusday and am really hoping to be UND by week 8. They changed there PCR protocol for me because I was dectable at week 4 and want to know when I go UND just for the record I guess, they are going to treat me for 48 weeks regardless though.

[coeric]

it seems to me that given the ranges of serum ribavirin concentration that the study is seeking, most in group 2 will end up with the standard dose.  but it is cool that you know you are getting an adequate level.  Too much - kidney damage, Too little - less chance of SVR. plus you are receiving care that is far above the clinic standard.
eric

[yodennis]

Thanks a lot guys. i'll try an sort out the insurance delay then call my pharmacist to try to clarify what my best intermediate choice would be. Then if necessary my hepatologist.

[hrsepwrguy]

I am in group 2 and still getting standard wt based dosing of 1000 mg per day, JK said no need to adjust me my body was hitting right on target with standard dose.

[coeric]

i am receiving triple therapy in a ribavirin concentration study. i am in the control arm and am prescribed a standard weight based dose.  however in the dose adjusted arm patients may need to split the copegus tablets.  the following is from the study plan, written by a Pham.D. professor.

Only ribavirin tablets (not capsules) will be used during the course of the study because of the potential need to split tablets based on drug levels in Group 2 patients.  

of course i would follow the advice of my pharmacist.
blessings
eric

[JasmineT]

I accidentally broke one taking it out of the pack. The instructions said do not split so I called the pharmacy 24 hour number. They said throw it away. It would not absorb and maintain at the right rate essentially. Your predicament may be different but I would call the pharmacy.

[indy531]

I have Accredo and the customer service and pharm assistance have been outstanding; I think the pharm has given me more and better info than my hep doc.

[dreamcat]

The pharmacy where I get my meds is Accredo -- they have been absolutely wonderful with me... I can get a pharmacist on the phone any time (during business hours, of course), and they answer any questions I have... at the beginning, I think I was on the phone with them for close to an hour.  

I feel very taken care of between the specialty pharmacy and my doctor's office.  It makes a big difference, I think.  

[scoleman]

I have a phone number from the pharmacy that provides my meds where I can reach a pharmacist.  Does your pharmacy have a customer service rep or pharmacist you could call.  When I signed up for treatment, this pharmacy offered to have a nurse call and check on me once a month.  I declined but it was nice to be offered this.

Sherry

[dreamcat]

I don't think they should be split without a doctor's or the pharmacy's direction, but for future reference for other medications, they have pill splitters that work perfectly.  You can find one at any supermarket or pharmacy.  

[can-do-man]

A toll-free telephone number to talk to nurses—24 hours a day, 7 days a week—who will provide guidance throughout your treatment with PEGASYS alone or in combination with COPEGUS. Call 1-877-PEGASYS (1-877-734-2797; Prompt #2)

[pooh55811]

The hematologist should either be on call or have some other doctor covering for him/her. I would try to give him/her a call and state it is urgent that you speak with the doctor or whomever is on call for the doctor.

[pooh55811]

I would NOT split the tabs. They are coated for a reason. I am sure in this case it is so they absorb at the appropriate time, for the appropriate amount of time, in the appropriate part of the GI tract.

Here is a link:

Quote:

"How should this medicine be used?"
.
"Ribavirin comes as a tablet, a capsule and an oral solution (liquid) to take by mouth. It is usually taken with food twice a day, in the morning and the evening, for 24 to 48 weeks or longer. Take ribavirin at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ribavirin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor."

"Swallow the capsules whole; do not split, chew, or crush them."

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a605018.html

[yodennis]

I meant to report my Ribo was reduced from 2 600 mg tabs each day for a total of 1200 mg to 2 400 mg tabs each day for a total of 800 mg each day. p.s. I was undetectable at 4 weeks