alcohol and interferon

[joel6483]

So, why can't you drink if youre going through treatment? Does it make you sick? Or is it because youre doing damage to your liver

Yesterday I didn't drink enough water. I had a few beers, though its frown upon, and I woke up today with a fever a feeling really sick. I slept until 3 or 4 in the afternoon. Everything was sore and achey...

Feedback please

[CockSparrow]

>Alcohol use causes a speeding of liver damage.  
Alcohol avoidance is demanded pre, and during TX by doctors
Failure to comply can be a reason that doctors end treatment.
Failure to comply can negate the effectiveness of TX or threaten ones chances at SVR.
A history of alcohol abuse can prevent one from attaining a TP
......all of them true or substantially true, I think.

And all I am saying is where is the evidence to support this?
There isn’t much at low level alcohol consumption.
How does any of this apply to someone who is F0/F1 it doesn’t.

>A history of alcohol abuse can prevent one from attaining a TP
This line is what got to me. How does it apply to the poster?

>Alcohol avoidance is demanded pre, and during TX by doctors
Demanded by who and for what reason?
Where is the evidence that this makes any difference.
And what did it have to do with the posters question?

>Alcohol use causes a speeding of liver damage.  
Does it, at what levels? For all of us at all time points in the disease.
Or is it for some of us at certain time points in the disease and at certain levels of alcohol consumption.

>2 drinks per day for men, 1 per day women is considered heavy drinking.
No its not. Its considered moderate.
The studies on Alcohol and HepC consider 4 drinks heavy and some go down to three with the odd one saying two. None of which is one is it.
Note: A standard drink or 10g of alcohol is not 1 normal strength beer at 5% apx alcohol.
Its 1 drink at around 3% alcohol.

>Alcohol is not required for TX.
Who the hell said it was?

>1)  " I certainly advise my patients not to drink more than 7 standard drinks per week"
2)  " There is no evidence to suggest that total abstinence from alcohol is necessary when you have hepatitis C, unless you have cirrhosis."

>I would assume you are in substantial agreement with these statements since you posted them and even repeated them.

I agree there is little or no evidence yes. Why cause there isn’t any.

>I'd also suggest that by the time one has progressed to cirrhosis it's a bit late to start taking proactive steps to slow down damage progression.......such as limiting alcohol consumption

There you go jumping to conclusions again.
Cant you see that if you are F0/F1 it is not the same as if you are F3/F4
And I agree if you are F3 then some life style changes are probably in order and not just with alcohol. But once again show me where the evidence is that an occasional drink speeds up progression to F4.
This does not mean I advocate getting P1ssed or drinking any amount when you are F3.
It does mean I am not going to crucify someone who has an occasional drink.
I will tell anyone who drinks heavily at F3 to stop or at the very least cut back to below 4 a week.
But then I would suggest that anyone at any Fibrosis stage who drinks more than 7 a weeks is taking a risk.

All of which misses the point somewhat I didn’t realise I actually said we can all go off and have up to 7 drinks a week. I was trying to point out  that zero alcohol has little evidence to support it especially when you are in the lower fibrosis stages and that the poster didn’t need to take any notice of a few beers on tx meant he was going to be denied a transplant or he was going to die sooner rather than later. When all he asked was what the reasons for not drinking on tx were.
You didn’t answer that you gave him a lecture.

>The vast majority of data, and current data supports the no drinking edict.
No it doesn’t. Show me one study, just one. All the studies support no heavy drinking.
I will admit that it is probably easier to stop than to cut back. And it is definitely easier to get the message home that heavy drinking aint wise.

Everything you have said is 100% accurate if you have cirrhosis and no one is saying otherwise.
No real disagreement with you when F3 either. Below that what you are saying doesn’t make sense. I cant see how you can compare 1 drink with 10, or F1 with F4.

What would you say to this person about Alcohol during Tx.
http://www.hepcvsg“ dot “.org/hyperthermia.htm#nov
Remove the “ dot ”
Tx started April 4, 2003
January 3, 2004
We had a super day and ended it with dinner at the Cannery- we haven’t been there in years. It was wonderful. I even had a glass of wine.
January 5, 2004
Had a great birthday dinner with Mom and Joan. Lots of fun. Also had another glass of wine.

Now if any amount of drinking while on Tx is such a no no and always leads to non response and faster progression then how come this person svr-ed
Now Ok it was only 2 glasses on wine 9 months or so into Tx but hopefully this time you will get my point. Interesting Tx that link.

Just to be clear I am not saying we should drink on Tx but neither can you say that it is always harmfull. It depends on How much you drink, How often you drink and of course what your fibrosis stage is.

Anyway that it for me this is going round and round in circles.

All the Best
CS

[vincenos]

i just want to say  probably what every1 else has  said  i was an alcoholic for 14 years strait a case  a day (well still am an  alcoholic if you  understand but dont drink anymore )3.5  years  ago when going through rehab i was tested for hep c i was educated deeply about the importance of the absence of alcohol from here on out with hepc  no exceptions  ,wedding ,cough syrup , nothing  zippo not even a tiny glas of wine  1 im an alcoholic and 2 i have hep c with hepc YOU CANNOT DRINK ANY ALCOHOL IT WILL SPEED THE DAMAGEING EFFECTS OF THE HEP C VIRUS  if im wrong  some 1 please  clear  or add to this by the  way 1/20/05 sobriety date  i hope this helps its important dont mess around with it please

[GSDgirl]

I also know someone who was not informed by the VA hospital about ADs.  He went in not feeling well at week 4 almost shot 5.  The VA told him to go home and have chicken soup.  He went home and hung himself.  True story, I was scared to death about the sucicide possibility.

[MKAndrew]

This is my favorite thread that I've ever been a part of.  Debbie, Wellbutrin is a 3A4 substrate of P450, so it activates the enzyme.  I have already stopped taking this drug, but I am looking forward to a time when I might be able to take a protease/polymerase inhibitor.  The coming strategy for the inhibitors with interferon/riba seems to be boosting the bioavailability of either the Schering or Vertex drug, by using ritonavir, an HIV anti-viral that strongly inhibits 3A.  If I am taking other 3A4 drugs, I won't be able to take advantage of this strategy.

To the person who asked, "Why should I start taking an antidepressant before starting treatment?"  Because it takes 3-6 weeks for a typical SSRI AD to start working, and some people become depressed on IFN right away.  So let's say you get six weeks in, which is the average point at which people experience major sides from Pegasys.  You're six weeks into treatment, possibly with suicidal ideation, and you need an antidepressant, and the doctor knows it's going to take 3-6 weeks to start working.  

Check out the package insert that comes with your interferon.  The first warning listed is all about severe depression and suicidality.  While it is true that some people are able to function normally on treatment, there is no way to predict what your sides will be, or how severe.  

Also, I've never read anything about any so-called "addiction" to, or abuse of SSRI antidepressants.  If anyone can show me hard data on addiction to an SSRI, I'll post it on my site.  I've known many, many people who have done tx on an AD, achieved SVR, then successfully stopped taking the AD.  

  

[marsfreek]

I know someone who was on tx and started drinking on a friday afternoon, the reaction started around midnight and he was at the er at 2:00 am and was pronounced dead at
7:30 AM

[Willy50]

CS quote;  "Then we could have told him whether he was taking a risk with svr or further liver damage, or not, depending on the answers. Instead he was hammered with things like Alcohol consumption=cirrhosis or death and this simply isn’t true."
------------------------------------------------------------------------------
my friend;

Only 4 people responded to Joel prior to you.  Your reply in which you used the term "alcohol nazis" was reply post #5.  You said "ignore" the advice that was given.  Who is doing the "hammering"?      ; )

The information given Joel was sound.  In the interest of accuracy, not one person said that alcohol consumption = cirrhosis.  The word doesn't even appear in any of the posts.   If it were a question of only MY post or only my tone it would have been good to have distinguished that point.

The main points made by the first 4 replying members were generally;

Alcohol use causes a speeding of liver damage.  
Alcohol avoidance is demanded pre, and during TX by doctors
Failure to comply can be a reason that doctors end treatment.
Failure to comply can negate the effectiveness of TX or threaten ones chances at SVR.
A history of alcohol abuse can prevent one from attaining a TP
......all of them true or substantially true, I think.

I'm not sure which of these concepts you believe should be ignored.

You seem to be of two minds in this thread.  You argue that the advice given by the first 4 replying members should be ignored, and then you provide something very much akin to the same advice throughout this thread. On the other hand the information you posted from the 2 AUS sources are far from mild consumption for heppers (IMHO);
1)  " I certainly advise my patients not to drink more than 7 standard drinks per week"
2)  " There is no evidence to suggest that total abstinence from alcohol is necessary when you have hepatitis C, unless you have cirrhosis."

I would assume you are in substantial agreement with these statements since you posted them and even repeated them.  These guidelines are only half of what the CDC calls "heavy drinking" for men.---2 drinks per day for men, 1 per day women is considered heavy drinking.   Yes, that's for people WITHOUT liver disease.
http://www.cdc.gov/alcohol/faqs.htm
I'd also suggest that by the time one has progressed to cirrhosis it's a bit late to start taking proactive steps to slow down damage progression.......such as limiting alcohol consumption.

The vast majority of data, and current data supports the no drinking edict.  And yes, if a person were to follow that principle one may have a little wriggle room.  The experts recommend zero alcohol intake.  I feel more comfortable recommending that than trying to provide an amount that people can drink.  There is greater safety in recommending abstinence than recommending the edge on which one might surf.

Alcohol is not required for TX.  Some pain medications, sleep aids, or antidepressants may be; it's a long treatment after all.  Alcohol is the most widely abused drug of choice, not only in sheer quantity (number of drinks per year, decade, or in ones life ) but in frequency (# of drinks per day, per week), and use by our demographic.  It may at the same time be among the worst substances to take which impact on disease progression or negatively impacting the efficacy of TX.

Yes, I agree it is an interesting and informative thread.  It's good to have a little back and forth about the subject.  It will be debated in future threads as well no doubt.  I'm heading out of town in a day or 2 and so won't likely be posting much at all for a spell.  Take care all, and CS, thanks for the lively debate.  I'm fine with "agreeing to disagree".

best,
Willy