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Missed a RIBA dose - suggestions?
Been on RIBA and PEG and PIs for 4 weeks. Last night missed my 600mg RIBA dose. No reason why. Just spaced out I guess. Anyone else done that? I know the reccommendation is NOT to take the dose if you've missed it by 6 hours. What about taking 800mg this morning? Any comments? This *****! Thanks!
"That's 80% minimum compliance over the life of treatment. Adherence is particularly critical in the first 12 weeks and I would be careful about suggesting to someone in the first 12 weeks that it's okay if they miss 20% of their dosages. And while minimum 80% adherence is the lower limit, striving for 100% adherence over the life of treatment is the goal wherever possible. "
I absolutely agree, which is why I said, "I don't recommend skipping doses so one is at 80% compliance, but the MDs do decrease dosage if they need to and those people still can get to SVR. " I certainly was not suggesting that it is okay to miss 20% of their doses. However, if one has missed a dose by accident, and it is already the following day, I definitely would not take any extra doses without consulting with my MD.
I worked in critical care for 25 years. I saw the end result of people taking too many medications or too high doses of medications. Personally, I would never do a make up dose without consulting with my MD. In addition, if I read (on this forum) that someone was going to take additional doses and I said nothing about it even though I knew it could be dangerous, I feel like I would be partially responsible (by saying nothing) if something detrimental happened to that person.
I absolutely agree, which is why I said, "I don't recommend skipping doses so one is at 80% compliance, but the MDs do decrease dosage if they need to and those people still can get to SVR. " I certainly was not suggesting that it is okay to miss 20% of their doses. However, if one has missed a dose by accident, and it is already the following day, I definitely would not take any extra doses without consulting with my MD.
I worked in critical care for 25 years. I saw the end result of people taking too many medications or too high doses of medications. Personally, I would never do a make up dose without consulting with my MD. In addition, if I read (on this forum) that someone was going to take additional doses and I said nothing about it even though I knew it could be dangerous, I feel like I would be partially responsible (by saying nothing) if something detrimental happened to that person.
"However, from the literature I have read and from my doctor, if you get 80% of the recommended Riba dose throughout treatment, you are okay. I don't recommend skipping doses so one is at 80% compliance, but the MDs do decrease dosage if they need to and those people still can get to SVR. "
That's 80% minimum compliance over the life of treatment. Adherence is particularly critical in the first 12 weeks and I would be careful about suggesting to someone in the first 12 weeks that it's okay if they miss 20% of their dosages. And while minimum 80% adherence is the lower limit, striving for 100% adherence over the life of treatment is the goal wherever possible.
Aside from that, always best to consult with your doctor rather than rely on opinion only.
Good luck with this, Adamben.
Trish
That's 80% minimum compliance over the life of treatment. Adherence is particularly critical in the first 12 weeks and I would be careful about suggesting to someone in the first 12 weeks that it's okay if they miss 20% of their dosages. And while minimum 80% adherence is the lower limit, striving for 100% adherence over the life of treatment is the goal wherever possible.
Aside from that, always best to consult with your doctor rather than rely on opinion only.
Good luck with this, Adamben.
Trish
I would have taken the whole amount today considering your hgb level. Many people on this forum have taken that amount regularly after a relapse or unsuccessful tx.
I don't know if anything will help at this point because of the breakthrough. As I am sure you realize you may have to stop tx and wait some time before trying again. If it was me and I had the drugs id take more interferon and more riba for a week or two to see if it would get me anywhere.
I am sorry about this adam, I truly am. At least you have little damage to your liver and can afford to wait for another time to treat again. Since you responded so well initially to these drugs I think your chance of success once the resistance virus has reverted back to the standard wild type virus will be good. That may take 2-3 years or another type of drug may work on the resistant virus at some point.
Good luck,
Dave
I don't know if anything will help at this point because of the breakthrough. As I am sure you realize you may have to stop tx and wait some time before trying again. If it was me and I had the drugs id take more interferon and more riba for a week or two to see if it would get me anywhere.
I am sorry about this adam, I truly am. At least you have little damage to your liver and can afford to wait for another time to treat again. Since you responded so well initially to these drugs I think your chance of success once the resistance virus has reverted back to the standard wild type virus will be good. That may take 2-3 years or another type of drug may work on the resistant virus at some point.
Good luck,
Dave
It is great your doctor got back to you fairly quickly and was able to advise you.
I agree, this entire thing is stressful. However, if the treatment works, it will be worth it. I wish you the best of luck.
I agree, this entire thing is stressful. However, if the treatment works, it will be worth it. I wish you the best of luck.
Pooh, Thanks for the suggestions. As you can see I took one additional pill this morning and leaving it at that. As for how to add 200mg, each pill is 200mg, so there's no need to break any apart.
Well, Dr jsut called back and said not to double up. So the upshot here is that about 30 mins ago, I took 1 of the missed pills from last night. Not going to double up on the other 2. Oh damn, this whole thing is stressful!
I do not claim to be an expert and I know I am new to this forum and Hep C. However, from the literature I have read and from my doctor, if you get 80% of the recommended Riba dose throughout treatment, you are okay. I don't recommend skipping doses so one is at 80% compliance, but the MDs do decrease dosage if they need to and those people still can get to SVR.
From my professional opinion (as a medical professional for 44 years), I agree with halbev. I definitely would NOT start trying to make up the missed dose by adding 1/3 the does for the next three doses of pills, at least not without talking to your doctor first. Many medications are toxic at higher doses and can cause major physiological problems. I am not sure how toxic Riba is, but I would not be playing Russian Roulette with my body. Anyway, you are not supposed to break the pills, so how can you add 200mg at a time to your other doses.
If you can, insist on talking with your doctor or whomever is on call for him/her.
This is just my opinion and how I would proceed in the same circumstance.
From my professional opinion (as a medical professional for 44 years), I agree with halbev. I definitely would NOT start trying to make up the missed dose by adding 1/3 the does for the next three doses of pills, at least not without talking to your doctor first. Many medications are toxic at higher doses and can cause major physiological problems. I am not sure how toxic Riba is, but I would not be playing Russian Roulette with my body. Anyway, you are not supposed to break the pills, so how can you add 200mg at a time to your other doses.
If you can, insist on talking with your doctor or whomever is on call for him/her.
This is just my opinion and how I would proceed in the same circumstance.
You're taking pills you were supposed to take and didn't. I don't think that contravenes your trial or skews the data. You're taking them a little late. If it were me, I'd take the one extra this morning and continue to wait on your doctor to return your call and decide as you go...but for me, I'd take them. Do what sits right for you. Good luck.
Trish
Trish
Yes. Started all oral trial. UND in first week. Week 8 breakthrough at 3000. Added PEG, removed Tegobuvir (PI). Week 9 at start of PEG was 400. Week 10 was 600. Not sure if that's statistically significant change from previous week. Now in week 12 total, week 4 on PEG. I hope this all makes sense. Not sure what to do with these 3 extra pills but need to make a decision quickly.
You are in a trial? You say your viral load is 600 and hostalavistababy says you've had a breakthrough. Were you UND at one point in the trial and now you're DET?
It appears you are in an all oral trial and experienced breakthrough and they put in the peg along with the other meds. IMO, I would incorporate yesterdays missed riba dosage throughout the day today. You need every advantage you can get.
Thanks. I'm 1a. VL is 600. Not 600k, but 600. HGB is fine at 11.9. I've got a page into the on-call dr but of course I can't seem to get any attention.
Ribavirin stays in the body for six months but not in the same amounts or efficacy as when you take it daily. If that were the case, we could take a dosage once and not again for six months.
I'm with flcyclist....really should talk to your doc about this but on a personal level only...if it were me...I'd do similar or the same to what flcyclist has recommended to get your concentration back to what it should be. You would have taken 600mg last night that aren't in your body but by the end of today, you'd have that and today's dosage and back on track tomorrow. That is not a medical opinion, it's my own and what I'd do.
The *exception* to that....is what are your HGB levels at last test and when is your next test? I would hate to see you end up with an actual dosage reduction because your HGB levels did a temporary little tank because you played catch-up. It could be a remote possibility but it needs to be considered in your scenario.
I would talk with your doc to get his medical opinion, particularly if you respect him/her and trust him. Then you can decide.
Good luck with your treatment.
Trish
I'm with flcyclist....really should talk to your doc about this but on a personal level only...if it were me...I'd do similar or the same to what flcyclist has recommended to get your concentration back to what it should be. You would have taken 600mg last night that aren't in your body but by the end of today, you'd have that and today's dosage and back on track tomorrow. That is not a medical opinion, it's my own and what I'd do.
The *exception* to that....is what are your HGB levels at last test and when is your next test? I would hate to see you end up with an actual dosage reduction because your HGB levels did a temporary little tank because you played catch-up. It could be a remote possibility but it needs to be considered in your scenario.
I would talk with your doc to get his medical opinion, particularly if you respect him/her and trust him. Then you can decide.
Good luck with your treatment.
Trish
I would say you would be OK ribavirin stays in body 6 months, so 1 dose is not big problem,
I have done it several times in my 2 Int/rib treatments, 96 weeks total before with no effect.
What I DO NOT suggest is to double up to catch up DO NOT do this!!!
Because it stays in body for 6 months, and leaves slow you can push you level to high
I have done it several times in my 2 Int/rib treatments, 96 weeks total before with no effect.
What I DO NOT suggest is to double up to catch up DO NOT do this!!!
Because it stays in body for 6 months, and leaves slow you can push you level to high
Understand that the following is my unprofessional opinion and this is something you should discuss with your doctor if possible before making a decision. Having said that, I'd be asking the same advice and looking for input.
If you were 12 weeks or beyond and were und at 4 weeks, I'd say skip it and don't worry. However, you're only at 4 weeks and you didn't mention your current VL. Although the half-life of Riba is long, this essentially is a dose reduction rather early in treatment. I'd be leaning toward incorporating the (3) 200mg tabs into the day, one morning, afternoon, then evening to get you back to full compliance. Again, just sharing my opinion, so talk to your doc if possible. I hope others chime in. Others may feel very differently about this and may have more experience or studies to support their suggestions. Good luck.
If you were 12 weeks or beyond and were und at 4 weeks, I'd say skip it and don't worry. However, you're only at 4 weeks and you didn't mention your current VL. Although the half-life of Riba is long, this essentially is a dose reduction rather early in treatment. I'd be leaning toward incorporating the (3) 200mg tabs into the day, one morning, afternoon, then evening to get you back to full compliance. Again, just sharing my opinion, so talk to your doc if possible. I hope others chime in. Others may feel very differently about this and may have more experience or studies to support their suggestions. Good luck.
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