Aa
The importance of taking Ribavirin with fatty foods !
I thought this was important enough to post since some members here may be giving out the wrong information. Also people may confuse taking only Incivek with fatty food and not the Ribavirin. It is just as important to take the Riba with fatty food. Since people take their riba and Incivek at the same time the fatty food will help both meds to be better absorbed.
Let me state this again. Ribavirin is better absorbed with a high fat meal. Like I said there are studies and proven data to back it up. Google " taking ribavirin with fat". Here is one example from PubMed, a well respected website:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804105/
The component of the final population pharmacokinetic model that describes the absorption phase is complex. Although a standard meal did not affect ribavirin bioavailability (F1), administration of ribavirin with a high-fat meal increased bioavailability by 46% relative to the fasting state. A high-fat meal prolonged the duration of the zero-order input part of the absorption model, with D1 increasing from 0.498 h (fasting and standard meal) to 0.740 h. The type of meal also influenced the first-order input part of the absorption model (Table 1).
Let me state this again. Ribavirin is better absorbed with a high fat meal. Like I said there are studies and proven data to back it up. Google " taking ribavirin with fat". Here is one example from PubMed, a well respected website:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804105/
The component of the final population pharmacokinetic model that describes the absorption phase is complex. Although a standard meal did not affect ribavirin bioavailability (F1), administration of ribavirin with a high-fat meal increased bioavailability by 46% relative to the fasting state. A high-fat meal prolonged the duration of the zero-order input part of the absorption model, with D1 increasing from 0.498 h (fasting and standard meal) to 0.740 h. The type of meal also influenced the first-order input part of the absorption model (Table 1).
This topic keeps coming up and I had saved this to my hard drive so here it is again..
frijole
July 2011
Hi Susan ..I was doing some looking back at some threads recently myself on this issue and...something COWriter posted seemed to make as much sense on this topic as anything I had read. Don"t know if you saw it or not...and if not hope it is helpful
Will..
....
Should you take the Ribavirin with a high fat meal to increase the concentration????
Every time I hear people tell a newbie to take the Riba with a HIGH FAT MEAL or to eat all the ice cream they want, I cringe. So I decided to look into it. Please feel free to jump in. All comments welcome even if you don't agree with me.
First of all, let's see what the drug company means by "a high-fat meal"....( 53.8 gramsof FAT, 31.6 gramsof Protein, and 57.4 grams of Carbohydrate. A total of 841 calories per meal).
53.8 grams FAT = 482 calories. If you have 2 high fat meals a day to take your Riba, that would give you a total of 1682 calories.....and 964 calories would be from fat. That means that over 50% of the total calories would come from fat. Considering that only 30% of a person's total calories each day should come from fat, that would be a very unhealthy diet.
Diabetics are usually allowed a total of 1800 calories a day. So that means that after eating the two high fat meals, they'll have 118 calories left to cover one more meal and two snacks....which may cause their blood sugar to be out of control.
What are you guys going to eat to make your meal "high fat"? Did you say TWO tablespoons of peanut butter? Hmmm.....that's only 16 grams of fat.....so you'll have to eat at least 6 tablespoons. Or a Big Mac, fries and 2 tablespoons of peanut butter.....Twice a day!
What they're suggesting is ridiculous and unhealthy. Having some fat with your meal is fine, but do you really need 54 grams????
To help you decide, I did a little research on the effects of food on Riba bioavailability.....
(The quotes come from published data on Riba pharmacokinetics. Sources listed below)
"Bioavailability" means the portion of the dose that reaches the systemic circulation. When a medication is administered intravenously, its bioavailability is 100%. However, when a medication is administered orally, its bioavailability decreases because not all of it is absorbed. So 70% bioavailability means that, from the dose you took, 70% of it reached systemic circulation.
"Two studies have been carried out to assess the effect of food (ie, a high-fat breakfast) on the bioavailability of a SINGLE oral dose of ribavirin. An initial study by ICN Pharmaceuticals, Inc. showed MINOR EFFECTS on bioavailability, but a 33% increase in Tmax (Time to Maximum Concentration)"
In other words, a high-fat breakfast (54 grams of fat) slowed the absorption of Ribavirin by 33%. It took 33% longer to reach the maximum concentration and had only a minor effect on bioavailability. So according to that study, eating a high fat meal had no benefit.
"A subsequent study by Schering-Plough demonstrated more substantial increases in bioavailability: food increased the AUC (Area Under the Curve) and Cmax (Maximum Concentration) by 70% compared to the FASTING population, and Tmax (Mean Time to Maximum Concentration) which is usually 1.5 hours was more than doubled."
So that means that compared to people who were fasting, eating a high fat meal (54 grams of fat), increased the maximum concentration of Riba by 70% but it took twice as long to do it. Ribavirin is rapidly absorbed following oral administration. The time to reach the Maximum Concentration of Riba after taking a single oral dose is usually 1.5 hours. After a high fat meal, it took over 3 hours to reach the maximum concentration.....but bioavailability is more important than absorption time.
"Although both studies consistently showed that food slowed the absorption of ribavirin, the extent to which food affected ribavirin bioavailability differed widely between the studies."
That's right, one study showed that a high fat meal had no effect on bioavailability and the other one showed that it did.....if you ate 54 grams of fat.....as compared to people who ate nothing. That means that we don't know whether bioavailability would be 69% or 71% or whatever if people eat a regular, non high-fat meal because they didn't look at that. They compared people who ate a high fat meal to people who ate nothing.
"It is also UNKNOWN whether any food effect might be altered by the type of meal consumed (eg, high versus low fat), IF A FOOD EFFECT WOULD STILL BE EVIDENT UPON MULTIPLE DOSING OF RIBAVIRIN, and, finally, what clinical implications the food effect might have. It should be noted that in the pivotal Schering-Plough clinical efficacy studies, ribavirin was administered without regard to food. Because of the uncertainty about the effects of food, it may be prudent for patients to TAKE RIBAVIRIN WITH FOOD."
Notice how it DOES NOT say HIGH FAT food.....just food.
But 70% concentration sounds so impressive, doesn't it? But remember....that was after taking ONE SINGLE DOSE of Riba. Taking multiple doses is totally different. You cannot predict what the bioavailability will be after taking multiple doses from looking at what happened after taking ONE DOSE.
"The fact that the multiple-dose ribavirin half-life (298 hours) is considerably longer than the single-dose half-life (79 hours) MEANS THAT IT IS NOT POSSIBLE TO PREDICT MULTIPLE-DOSE RIBAVIRIN PHARMACOKINETIC PARAMETERS BASED ON SINGLE-DOSE PARAMETERS. This has implications for interpretation of food effect pharmacokinetic data."
In other words, the data from the two high fat meal studies pertains to those of you who are planning on taking ONLY ONE Ribavirin dose....
Fat is a good source of energy and we all need some fat in our diet. For somebody on treatment who has lost lots of weight and can't afford to loose any more, the recommendation is certainly to eat whatever they can tolerate and that includes fat. If it means survival, it's better to eat junk than to eat nothing at all. At that point, getting calories is the important thing, doesn't matter where they come from.
I have no problem with people having some fat with their Riba. But I can't agree with suggesting people starting treatment eat 54 grams of fat twice a day as suggested by the study (especially if they're already obese) to MAYBE increase Riba bioavailability. Not when multiple dosing may already be doing that. Not when up to two thirds of them may have insulin resistance and many of them have fatty liver.
A high fat diet promotes oxidative stress, fatty liver, high blood sugar, an increase in CYP2E1, cytokine-induced beta-cell death, hepatic insulin resistance and hyperinsulinemia. All the things that lower SVR.
When you become insensitive to insulin (Insulin Resistance), the pancreas increases its production of insulin....so you end up with too much insulin (hyperinsulinemia).....And large levels of insulin, MAKE INTERFERON INEFFECTIVE....and at that point, Riba bioavailability will no longer matter.
As always, the choice is yours.
frijole
July 2011
Hi Susan ..I was doing some looking back at some threads recently myself on this issue and...something COWriter posted seemed to make as much sense on this topic as anything I had read. Don"t know if you saw it or not...and if not hope it is helpful
Will..
....
Should you take the Ribavirin with a high fat meal to increase the concentration????
Every time I hear people tell a newbie to take the Riba with a HIGH FAT MEAL or to eat all the ice cream they want, I cringe. So I decided to look into it. Please feel free to jump in. All comments welcome even if you don't agree with me.
First of all, let's see what the drug company means by "a high-fat meal"....( 53.8 gramsof FAT, 31.6 gramsof Protein, and 57.4 grams of Carbohydrate. A total of 841 calories per meal).
53.8 grams FAT = 482 calories. If you have 2 high fat meals a day to take your Riba, that would give you a total of 1682 calories.....and 964 calories would be from fat. That means that over 50% of the total calories would come from fat. Considering that only 30% of a person's total calories each day should come from fat, that would be a very unhealthy diet.
Diabetics are usually allowed a total of 1800 calories a day. So that means that after eating the two high fat meals, they'll have 118 calories left to cover one more meal and two snacks....which may cause their blood sugar to be out of control.
What are you guys going to eat to make your meal "high fat"? Did you say TWO tablespoons of peanut butter? Hmmm.....that's only 16 grams of fat.....so you'll have to eat at least 6 tablespoons. Or a Big Mac, fries and 2 tablespoons of peanut butter.....Twice a day!
What they're suggesting is ridiculous and unhealthy. Having some fat with your meal is fine, but do you really need 54 grams????
To help you decide, I did a little research on the effects of food on Riba bioavailability.....
(The quotes come from published data on Riba pharmacokinetics. Sources listed below)
"Bioavailability" means the portion of the dose that reaches the systemic circulation. When a medication is administered intravenously, its bioavailability is 100%. However, when a medication is administered orally, its bioavailability decreases because not all of it is absorbed. So 70% bioavailability means that, from the dose you took, 70% of it reached systemic circulation.
"Two studies have been carried out to assess the effect of food (ie, a high-fat breakfast) on the bioavailability of a SINGLE oral dose of ribavirin. An initial study by ICN Pharmaceuticals, Inc. showed MINOR EFFECTS on bioavailability, but a 33% increase in Tmax (Time to Maximum Concentration)"
In other words, a high-fat breakfast (54 grams of fat) slowed the absorption of Ribavirin by 33%. It took 33% longer to reach the maximum concentration and had only a minor effect on bioavailability. So according to that study, eating a high fat meal had no benefit.
"A subsequent study by Schering-Plough demonstrated more substantial increases in bioavailability: food increased the AUC (Area Under the Curve) and Cmax (Maximum Concentration) by 70% compared to the FASTING population, and Tmax (Mean Time to Maximum Concentration) which is usually 1.5 hours was more than doubled."
So that means that compared to people who were fasting, eating a high fat meal (54 grams of fat), increased the maximum concentration of Riba by 70% but it took twice as long to do it. Ribavirin is rapidly absorbed following oral administration. The time to reach the Maximum Concentration of Riba after taking a single oral dose is usually 1.5 hours. After a high fat meal, it took over 3 hours to reach the maximum concentration.....but bioavailability is more important than absorption time.
"Although both studies consistently showed that food slowed the absorption of ribavirin, the extent to which food affected ribavirin bioavailability differed widely between the studies."
That's right, one study showed that a high fat meal had no effect on bioavailability and the other one showed that it did.....if you ate 54 grams of fat.....as compared to people who ate nothing. That means that we don't know whether bioavailability would be 69% or 71% or whatever if people eat a regular, non high-fat meal because they didn't look at that. They compared people who ate a high fat meal to people who ate nothing.
"It is also UNKNOWN whether any food effect might be altered by the type of meal consumed (eg, high versus low fat), IF A FOOD EFFECT WOULD STILL BE EVIDENT UPON MULTIPLE DOSING OF RIBAVIRIN, and, finally, what clinical implications the food effect might have. It should be noted that in the pivotal Schering-Plough clinical efficacy studies, ribavirin was administered without regard to food. Because of the uncertainty about the effects of food, it may be prudent for patients to TAKE RIBAVIRIN WITH FOOD."
Notice how it DOES NOT say HIGH FAT food.....just food.
But 70% concentration sounds so impressive, doesn't it? But remember....that was after taking ONE SINGLE DOSE of Riba. Taking multiple doses is totally different. You cannot predict what the bioavailability will be after taking multiple doses from looking at what happened after taking ONE DOSE.
"The fact that the multiple-dose ribavirin half-life (298 hours) is considerably longer than the single-dose half-life (79 hours) MEANS THAT IT IS NOT POSSIBLE TO PREDICT MULTIPLE-DOSE RIBAVIRIN PHARMACOKINETIC PARAMETERS BASED ON SINGLE-DOSE PARAMETERS. This has implications for interpretation of food effect pharmacokinetic data."
In other words, the data from the two high fat meal studies pertains to those of you who are planning on taking ONLY ONE Ribavirin dose....
Fat is a good source of energy and we all need some fat in our diet. For somebody on treatment who has lost lots of weight and can't afford to loose any more, the recommendation is certainly to eat whatever they can tolerate and that includes fat. If it means survival, it's better to eat junk than to eat nothing at all. At that point, getting calories is the important thing, doesn't matter where they come from.
I have no problem with people having some fat with their Riba. But I can't agree with suggesting people starting treatment eat 54 grams of fat twice a day as suggested by the study (especially if they're already obese) to MAYBE increase Riba bioavailability. Not when multiple dosing may already be doing that. Not when up to two thirds of them may have insulin resistance and many of them have fatty liver.
A high fat diet promotes oxidative stress, fatty liver, high blood sugar, an increase in CYP2E1, cytokine-induced beta-cell death, hepatic insulin resistance and hyperinsulinemia. All the things that lower SVR.
When you become insensitive to insulin (Insulin Resistance), the pancreas increases its production of insulin....so you end up with too much insulin (hyperinsulinemia).....And large levels of insulin, MAKE INTERFERON INEFFECTIVE....and at that point, Riba bioavailability will no longer matter.
As always, the choice is yours.
Thanks....I will probably take incevik at 6am , 2pm, and 10 pm and double up the first two doses with the riba - I think it will make it easier to take them together and perhaps as you say, not affect sleeping as much. And hopefully we can all say it is worth it ;)
It is ok to take the riba with the Incivek. When I treated I took the riba and telap together 2 x's a day then telaprevir 3rd dose by itself. I hated getting up every morning at 6am to take 1st dose of Rib & Tel each day. My dose times were 6am, 2pm (both meds) & 10pm (Telap only). In the end it was all worth it :)
In a way there already is, called "the most viewed health pages". Never went over to big though, got bogged down with to much junk.
I agree totally, flcyclist! Great idea.
@ ginger...I take my Incivek and Riba together. I also have no problems sleeping at all. My last dose of Riba is at 2:30 pm.
I was told it was okay to take them together and for the reasons that copyman stated, it makes perfect sense.
@ ginger...I take my Incivek and Riba together. I also have no problems sleeping at all. My last dose of Riba is at 2:30 pm.
I was told it was okay to take them together and for the reasons that copyman stated, it makes perfect sense.
I agree with Fly. There needs to be an area for general information and I would go futher, an area to post esp helpful links eg slide shows about drug mechanisms etc.
Have an Answer?
You are reading content posted in the Hepatitis C Community
Learn about this treatable virus.
Getting tested for this viral infection.
3 key steps to getting on treatment.
4 steps to getting on therapy.
What you need to know about Hep C drugs.
How the drugs might affect you.
These tips may up your chances of a cure.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
