Rifaximin. Genotype change?

[ChrisDDD]

My doctor prescribed Rifaximin to help with mild hepatic encephalopathy, but there's a catch.  The prescription is $2,000!  I said no.  I'm on Lactulose and it doesn't always work so well, and sometimes it causes embarrassing moments.  I'll leave it at that.

My doctor's note of my visit 5/6/2014 says "genotype change to 1a with new assay".  I've done some research, but am not finding what exactly this means.  I do know it makes me the harder of the two genotype 1's to cure, and here I thought 1b was the most difficult.  It isn't.  It's 1a.  So if I had 1b, I'd be easier to cure, but I get screwed on that one, too, because it turns out 1a is the most difficult to cure.  Now I need to find out what "new assay" means.

Chris

[nan535]

     I don't know if this is just because of my husband's unique circumstances (post transplant with cirrhosis) but I had to take him off the Xifaxin while he is on Sovaldi + Ribavirin treatment (now week 14). He was actually having more serious HE, mixing the two.  
     A Sovaldi company liaison now denies interaction but when I initially called the helpline the nurse told me they should not be taken together.  When the HE continued after I gave him the Xifaxin,  I decided to take  him off it  during the HCV treatment and just increase the lactulose to 30 mg. 3x a day. Some days I give him an extra dose if I think he needs it.  He is doing much better now.

As Hector said, too much lactulose can cause diarrhea so see what works for you.  Of all the things my husband has gone through, I think the HE episodes are the worst so its really important to try to keep it under control.

I am not advising you to not use the Xifaxin, just to look out for any interaction issues if you do.  As I said my husband's situation is a unique one.

Good luck!
Nan

[HectorSF]

Depending on your insurance you may qualify  for Salix's Patient Assistance Program.
http://cdn.salix.com/xifaxan550/assets/pdf/xifaxan-patient-assistance-program-application.pdf

Lactulose does work when taken properly. You have to learn how to titrate it properly. It takes time. Too little infective. Too much...diarrhea which is not only an "inconvenient truth" of Lactulose but dehydration can trigger an HE episode. Ironic isn't it. Lactulose not only can manage HE but if improperly dosed it can case HE.

The key to the effective use of Lactulose is titrate so you have 2-4 loose stools per day. Loose stools, not diarrhea or the runs. That only makes things worse. Yes cirrhosis is a messy business but unmanaged it can get really nasty. Coma, vomiting blood, paracentesis, and many things way worse.

"assay" is alaboratory blood test.

Genotype 1a or 1b makes very little difference.
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Analysis of Cohort 2 in COSMOS: multicenter, open-label, randomized phase IIa study

•12-24 weeks of treatment with simeprevir + sofosbuvir, with or without ribavirin, highly effective in treatment-naive patients and previous null responders with genotype 1 HCV infection and METAVIR F3-F4 fibrosis •SVR12 93% to 100% regardless of treatment duration or addition of ribavirin

•High SVR12 rates across subgroups, including HCV subtype, Q80K polymorphism, METAVIR score, IL28B genotype, or previous treatment history

•Simeprevir + sofosbuvir, with or without ribavirin, safe and well tolerated
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Genotype 3 is the hardest genotype to cure with current treatments not genotype 1. Cirrhosis is always the largest factor effecting SVR rates. Not subtypes, ILB28, diabetes, etc.

Good luck.
Hector