How long to stay on lowered Riba dose?

Question

Dear All
I am on my 10th week of triple therapy treatment. UND since week 4.  
On my 6th week  my HMG dropped to 8.5.. Doctor lowered my Riba dose to 600mg from 1000 mg and put me on Procrit once a week. 
According to my CBC today, my HMG is 9.8. Doctor told me to continue with Procrit and 600MG Riba and check my HMG again next week. 
My question is: Since I am on Procrit and my HMG is going up slowly every week, why can't I go back to regular dose of Riba? I really don't want to jeopardize to achieve SVR, because I am taking lowered dose Ribavirin. I am 125 pounds. 
How your doctor managed similar situation and what was the outcome?

LookingForward12 · Accepted Answer

My riba was reduced to 400 mg from 1000mg around week 10 of treatment, after being taken off of it for four days due to hgb problems. I also had a very bad rash experience. My doctor kept me at 400mg through my EOT at week 24. I was undetected at week 4, 12, and 24.
From what I have read, reduced ribavirin after you are UND doesn't seem to affect SVR.

Diamando6 · Answer

Hi, my Doc. also reduced me Rebetol from 1000 to 400, after my hgb, dropped from 107 to 91, so for the last 10 days I am on that dose. I am on week 10 of treatment.As I can see, more or less hgb starts to fall more serious, around week 10. I have not been yet on Procrit, but I am thinking of it. It is not easy to find that medicaton in a free marked easy , where I live. It is important that I am UND at week 4, YEAAAAAH!

pcds · Answer

Those who started triple tx when the new stuff came out were very afraid of the reduced dosing.  However results are showing SVR in those with reduced riba and interferon.  I am one example.  You have to trust your doctor.  Hopefully well experienced with meds.  After the incevik was over and about the last 5 weeks I went to full dose of both meds, needed neupogin and procrit throughout.

orphanedhawk · Answer

My riba was dropped from 800 to 600 and it stayed that way the rest of tx.
Try to be patient. The meds affect your wbc and/or rbc. They probably aren't going to be normal until after tx.
I'm 100lbs and right from the get go they were willing to drop it down to 800. I waited to lower it until the cough and shortness of breath kicked in, It is weight based dosing although I recall someone posting research claiming it wasn't as vital with the triple tx.

skiyaltr · Answer

I am on week 30; incivek UND at 4, 8, 12, 24 weeks; prior partial responder and doing 48. Reduced riba from 1200 to 600 at 6 weeks. Still at 600, no procrit. Hgb has gone up to 12. Data is available that indicates reduced riba after UND at 4 does not impact SVR. There are others with more details and other study information on reduced riba.

Pepela · Answer

Every doctor have their own ways. It also depends on Genotype. 
My HMG went up to 10.4 from 9.8 this week. Procrit definitely worked for me. Finally, today my doctor increased my Riba dose to 800 mg from 600mg and reduced dosage of Procrit to 20000 units from 40000 units once a week. 
  Since I weight 125lb, 800 mg Riba is full dosage for some people. My doctor told me that since I am Genotype 1B, my full dosage should be 1000mg. 
Anyway, I am happy with this progress. Also happy that I have 7 more days left before I finish Incevik. Fat eating is killing me. I hope we all achieve SVR. That matters most.

Dee1956 · Answer

Hi Id's answer was very good.  I am surprised that they did not just drop it by 200.  But...I don't know your entire story.  The 6th week is pretty early to reduce the riba.  Maybe the procrit is not helping as he had
I am sure your doctor knows what he is doing and as ID said you do have a way to go.  My doctor would not give me anything for my low HGB, started 14.8 dropped to 9.7.  I could hardly breathe.  He kept my dose of Riba right where it was and said once I finished the Incivek it would start to stabilize.  It was hard.  I would think you are lucky to have a doc who will give you the rescue drugs and reduce riba.  Though I do understand your concern before the 12 weeks of Incivek are up.
I think you will be fine.

Pepela · Answer

Thank you for detailed answer. My doctor thinks that once I am off Incevik on August 10, my HMG should go up more. My doctor also feels to keep me on reduced dosage of Riba, until my HMG reaches 10.8 to 11, because at first when it dropped to 10, that is when he reduced Riba dose. I am just frustrated that my HMG is increasing so slowly. Thank you for your Riba dosage chart. I think I can get way with 800 MLG , since I am 125 lb. All I need is one more tablet a day. Maybe I can convince my doctor to increase my dosage to 800MLG, once my HMG reaches 10, when I go for my CBC this Friday. 
How is your lab results today? I hope it's good.

Idyllic · Answer

You are probably OK on that amount but I would have been uneasy with  such a lengthy Riba dose reduction prior to the 12 week mark.

You have been on Procrit for four weeks *and* a Riba dose reduction and your Hgb has only increased from 8.5 to 9.8? I hope someone else chimes in but it seems like your results should be a little more...robust (?)
_______________________

I think you should  mention it to your doctor. Part of the reason we go on Procrit is to enable us to take the full dose of Ribavarin. Your Hgb would have eventually rebounded to some extent with the Riba dose reduction so your doctor likely had a strategy to get you back on your full dose. Otherwise why bother. Maybe your doctor wants your Hgb to get to 10.0 before you increase your Riba. 

My doctor wanted my Hgb to reach 10.8 - 11 before I went back to my full dose of Riba. According to some doctors that would be too high but I feel OK (I will be amazed if my Hgb ends up being in that range when I get my lab results on Monday).

To me the idea is to find the frequency you might need Procrit that will enable you to take 1000. You may not end up needing a shot of Procrit as often as once a week but you can see what works as you progress. Either way you will be having periodic CBC's while on the Procrit.

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FYI
I weight 120 and I take 1000 a day but according to the weight based chart for Riba I could get by on 800:

Riba Dose 1000 day:
66 to 75 kg: Ribavirin 400 mg orally in the morning and 600 mg in the evening plus peginterferon alfa-2b 96 mcg subcutaneously once a week 

66kg = 145.505lb
75kg = 165 lbs
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800 is supposed to be the dose based on my weight (120 pounds = 54.545454 kg).

51 to 60 kg: Ribavirin 400 mg orally twice a day plus peginterferon alfa-2b 80 mcg subcutaneously once a week

♫

Pepela · Answer

Hey Patches. Congratulations with achieving 48 weeks and UND. What a relief that must feel.  I hope you to achieve SVR, I am sure you will. Enjoy freedom from drugs and end of summer!

hondapatches · Answer

They have had me on 600 mg for the past 5 months. I still test hcv neg. Today is my last shot. 48 today yeah...Hang in there it will get worse an then better. I have had two blood transfusions an been on procrit. An have had every side u could possibly imagine, so if u need help just let me know.
Patches