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Iron and Eprex/Procrit Doses

Hello all,


Anyone on procrit/eprex also given IRON supplements? I understand that iron loading is a no-no in Hep C, but the drug monograph is pretty insistent that iron should be given while on the med...

And how high have people gone with eprex/procrit? I'm on 40,000IU/wk, my doc is proposing putting it up to 60,000IU/wk. Anyone have any experience with the higher dose?
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Avatar universal
For the sake of discussion, the black box warnings all talk about the impact of procrit et al on those undergoing cancer treatment.  While we often talk about Hep C treatment being like chemotherapy because of the interferon, this study talks about the impact of using procrit with ribavirin.

http://www.natap.org/2001/ddw/ddw_4.htm

Yes, it's older and before the black box warning came out.  However, ribavirin is a different kind of drug with different impact.  This article mentions, for example, that depression was less in the epo arm and that adherence to treatment was increased because of the addition of epo.

Is it possible that it's "different strokes" to a degree when we're talking the ribavirin/procrit combination?

Interested in thoughts.

Trish
Helpful - 0
Avatar universal
I think this excerpt form the article tells us why our HbA1c tends to be low.

"Hb A1c is the product of the reversible reaction of hemoglobin A with glucose. A higher glucose concentration results in more Hb A1c. Because the reaction is slow, the Hb A1c proportion represents glucose level in blood averaged over the half-life of red blood cells, is typically 50-55 days."

Since our red blood cells don't live nearly 100 to 110 days our results appear way too low. I would guess that when I was treating my RBCs lived 45 - 60 days or about half of the expected life span of normal RBCs.

Mike
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87972 tn?1322661239
Complete my final shot 7/11/08, and final riba 7/18/08.
Helpful - 0
87972 tn?1322661239
Thanks for the Wiki link; it provides a little more insight as to why my HgA1c diabetes test continues to run extremely low. I know Mikesimon experienced the same thing on treatment; it hasn’t correlated well with finger-stick diabetes testing at all.
I’ve been wondering how the results of your recent lap biopsy turned out. Let me know here, or by private message if you like.

I complete my last shot on Friday, 7/18/08. We'll stir the tea leaves and see how they settle soon. As Jerry Garcia said "What a long, strange trip it's been" :o).

You must be feeling the smoke from the Big Sur fires, I imagine. Take care--

Bill
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Avatar universal
fg - as Bill wrote, Fe concentration during tx is a bit of a tightrope act. On one hand excess Fe is a no-no for the HCV-infected because excess concentration has been associated with enhanced viral replication and more rapid fibrosis progression, see eg

http://www.natap.org/2005/HCV/020705_01.htm

On the other, without a certain level of circulating Fe we're toast as it's an essential cofactor for hemoglobin's oxygen-binding function.  Wikipedia has a very nice article on HGb -

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

note the Fe ions coordinated by the heme group. Ribavirin accumulates in Hgb-containing red blood cells and kills them off (hemolytic anemia) which can be remedied by  epo ; however Hgb without the trace amount of necessary iron can't do its job.

Bill: hope you're surviving the heat; must be getting *very, very* close now. Thanks for that FDA warning link - seems a bit scary.
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Avatar universal
after 6 wks my hgb was at 9.5.  I think I started talking giberish and didnt make sense even to myself.  I took 1 shot procrit 2 wks ago and am now feeling pretty normal again.  My doc said he doesnt like giving shots weekly. 1 shot procrit and monitor I guess till my count goes down again.  Which I really dont want to go thru that again.  I was told not to take iron suppl either.  Eat red meat only twice weekly as to not overload on iron.  
This tx is such a balancing act . good luck
d
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Avatar universal
I've just been prescribed both Eprex and iron, for essentially what Bill said...my blood is iron deficient and the eprex will be less effective as a result.  I started the iron on Sunday and I start the Eprex this week.  I'll be at 40,000 IU / week also.  

From what I understand, iron loading is a no-no if you're high iron, which alot of us are and what I started out at.  Now I seem to be running low on alot of things.  So I'm on B12, folic acid and now iron and eprex.   I'm on that until my levels get up OUT of dosage reduction range.

I don't quite grab it completely myself, the iron thing, and still looking into it  Just wanted to let you know you aren't the only one.

Trish
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87972 tn?1322661239
http://sickle.bwh.harvard.edu/iron_epo.html
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87972 tn?1322661239
Love your nom de plume!

I understand that iron is essential for transport of oxygen; if a patient is iron-deficient, epo will be essentially worthless. I assume your doctor has performed iron studies? It’s one thing to have high iron storage problems in hepatic tissue, but another if the blood is deficient.

I’m not personally familiar with epo; I’ve never required it myself. I’ve heard anecdotal reports from other members here that have taken up to 80,000 units/week; but that was prior to the U.S. FDA black box warning issued in ’07:

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

I’d definitely stay with your doctor’s advice on this one; and good luck—

Bill
Helpful - 0
179856 tn?1333547362
I took 80,000 epo for 48 weeks then dropped down to 40,000 for the next 24 weeks at Dr. Jacobson's order.

I don't know of anyone on here who would consider taking iron at all since we've all been explicitly warned not to because iron is crucial for viral replication.  Much better odds just taking the epo/procrit and working towards that SVR goal. With the absurd amount of riba I was taking I needed the two shots a week - which we dropped to about once every five days as that kept me at 10.5 and with the 2x a week I just went too high.

So sometimes you do need to tailor it up a little bit to find a comfort zone you can live at without overdoing it.  As per the black box warning that isn't a good thing to do but I don't remember the exact numbers off hand of how high they don't want you to get too fast.

I'm not sure why you'd want to risk taking iron - I'd really think that one through if I was you. The procrit should do the job on it's own.

Helpful - 0
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