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3203287 tn?1346460234

Medication reduction already

I just started treatment and had to go into lab yesterday to get blood redrawn due to a bilirubin spike after one week.  Common according to my doc but he wanted to make sure.  Sure enough the RBC is starting to go low.  He had to reduce my dosage due to low RBC (3.45), hgb 10.3, hct 30.3, RDW 14.5%.  Bilirubin went retest came down to 1.9.  It's getting better since it went up to 4 after one week of tx.  I'm on triple tx and started with 1200 mg daily riba, but doc cancelled my evening dose yesterday so only took 600 mg yesterday.  Today he has me on 300 mg (1/2 pill) until I get my 200 mg pills in the mail which he'll have me take 2 per day.  I'm only on day 16.  My viral load was:
12/5/2011 344933
7/13/2012 371829
7/30/2012 259914  (start of tx)
9/5/2012   284 (one week on tx)
He's hoping I was undetected end of week 2 which was Wed.  I won't get the results for one week so we don't know for sure.  I guess the reduction in riba is okay if I was undetected.  If not, not sure what that means, but the doc said he couldn't take the chance of my blood getting too low.
Platelets are good so far at 229.
I just thought I'd give my results as I just started and am already disappointed on having to reduced meds, but understand the blood issue can get out of control quickly and he didn't want that.  This is my second time on tx but first time was in 2005 and only the interferon/riba.  I had to do procrit a lot last tx so I have had low RBC & WBC before.  So far my WBC is okay.  I was a responder but relapsed.  Hoping for the best.
thanks to all for your support and advice.
27 Responses
766573 tn?1365170066
I know Triple is a real game changer to how treatment was on just the Peg & Riba but wow did your Hgb drop. Since it dropped this soon in treatment you might want to talk to your doctor the next time you see him and work out some kind of treatment strategy for managing your side effects. Or rather, ask him what his long-term plan would be to manage your Hgb throughout the duration of treatment.

That way you won't be freaked if you you are possibly on a reduced Riba dose throughout treatment and you will find out his position about Procrit.

OrphanedHawk has asking how the doctor manages sides and rescue meds as one the questions you should ask prior to treatment. I did not do that this time around and as I think about it I feel fortunate my doctor strives to keep me on the full dose of Riba. Yes there are studies that indicate Riba dose reduction does not impact SVR but I would not want to be on a reduced dose for a prolonged period. Especially not until week 24.
I know that is fear talking as a Prior partial responder though :)

Here is to hoping and praying UND for you by week 4!
Avatar universal
Hi PJ....I typed a response and don't know where in the hell it went so here we go again.  

First of all, are you really confident in your physician in treating you?  I am just shocked by the drastic reduction in your Riba!  I mean 1200 to 600 to 300 (just for today)?  I am totally confused here because I don't understand his thought process whatsoever.  Why didn't he call the pharmacy and have your correct dosage overnighted to you?  Is he lazy and can't pick up the phone?

Also you said you HGB was 10.3.  Are you having difficulty breathing?  Is the low HGB too much for you?  The reason I am asking is because I thought protocol on Riba was to reduce if HGB is <10.  So I am guessing you feel like sh$& ?  You also said your RBC was 3.45 that is low but I wouldn't think much of a concern.  I just had mine checked about 3 hrs ago and it was 3.32.  

Since you relapsed last time I would be raising all kinds of hell about reducing the Riba.  This is JMHO....but if this was my second time around I would be in his office asking a million questions of WHY?  

I hope everything works out well for you!

Jules
Avatar universal
Seems kinda drastic to me as one wants to be UND at week 4. Alot depends on it, like doing 24 more weeks of treatment if not.

Reducing all the way from 1200 to 400 at week 2 with an HGB of 10.3, one sure hopes he's guessing right. But then again its not your doctor who is treating........... Wishing you the best
190885 tn?1333029491
i wish i was 10hgb at day 16.......week 4 is a big one to get through
Avatar universal
Treatment Outcome T12/PR
N = 363
n/N (%) Pbo/PR48
N = 361
n/N (%)
Overall SVR 79% (285/363)
46% (166/361)
eRVR 58% (212/363) 8% (29/361)
SVR in eRVR subjects 92% (195/212) 93% (27/29)
No eRVR 42% (151/363) 92% (332/361)
SVR in no eRVR subjects
60% (90/151) 42% (139/332)
Outcome for Subjects without SVR
On-treatment virologic failurea 7% (26/363) 29% (105/361)
Relapseb 4% (11/298) 24% (53/220)
Otherc 11% (41/363) 10% (37/361)
----------------------------------
As one can see response was... eRVR 58% (212/363) 8% (29/361).
So a doctor is " guessing, hoping" your und at week 2 yet only 58% was at week 4............

  
1815939 tn?1377995399
A Riba reduction of 1200 mg to 400 mg would scare me to death, especially at day 16. An incremental reduction from 1200 mg to 1000 mg and starting Procrit would be my option if it was me. I would even take a blood transfusion if necessary. My Hgb dropped to 10.2 and I never reduced anything.

I know this is early in your treatment (day 16) and it appears the doctor is nervous about the Hgb drop, but I still think it is a drastic reduction. He does not even know if you are UND yet. Even being UND does not mean the virus is gone. It simply means the test cannot count find it.

Is this doctor a Hepatologist or a GI or a Primary Care Physician. If it was me, I would discuss this with the doc and if he insists on only 400 mg a day, I would find a Hepatologist who tries not to reduce Riba anymore than absolutely necessary and who uses a combination of treatment (including Procrit and blood transfusions) so one can stay on an adequate dose of Riba. (Actually, that is what I did when my Hgb started to get near 10.  

It is true that they concluded that Riba reduction did not impact SVR, but they were not specific about how much it can be reduced, at what point in treatment it can be reduced, and how long  it can stay reduced.
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