Aa
changed mind....again!
I have decided to not go with Inc. and do Vic instead (4 week lead in). I start tx on the 22nd so this is a last min. decision. The anxiety I was having was unbearable. I could not rap my brain around the 60 grams of fat. I don't eat cheese or bread so that didn't help so after a week of anxiety I talked with doctor and we decided to do the other triple therapy. Now I feel better and not spending so much time with list of fat and searching the stores for what I could possibly eat. I know i have to eat with the Reba dose but she said a snack will do. Does not have to be high fat. Its not that I was afraid of putting on weight, it was more of not being able to do it! What surprises me the small amount of people on this sight who are doing Inc instead of Vic. Either way, I just want to get this started!
Well guys/gals, I've treated too many times to count and I only heard about this Riba/fat thing on about the past 3 TX's, the rest of them, it was just 'take it with food'. It doesn't matter to me one way or another because I didn't clear on any of the 10(or 11 TX's-if you include the 1 maintenance TX I did), with or w/o a fatty/Riba meal. This last TX was only SOC since I got the placebo and at this time, I have practically no response to SOC and that was with a fatty/Riba administration. So, you can take what you want from that. I feel that if you're going to clear-if it's meant to be-you'll clear..., if not, then, oh well, it wasn't the right TX for you at this time. I just wish I got get the right TX/time w/fatty foods, or w/o fatty food. It's the Hep C drugs that are what's important. I don't really think it has that much to do with what you're eating, whether you're a vegan, or a meat eater, or a purine eater, or a non-purine eater... That's my opinion and it's mine and you don't have to agree with it, that's okay...
Susan400
Susan400
It is far more important for trough ribavirin plasma concentrations to be reached. And it takes about 12 WEEKS for that to happen
errata - read the labeling wrong ---- it does not take 12 weeks for maxium serum concentration. -- That was the length of the study, duh --- anyway it is 3-4 weeks to reach max
Now, goof -- what's this about a family website........
can-do -- you old icecream pusher you......
magnum - oh yes, I remember well your foray into infergen. We almost lost you! THis has just got to be the one. I too wish your lead-in VL were better but it is what it is. I am pulling for you ----- what is your screenplay about?????
willing -- I really need a translator when I read this stuff -- max t, AUR blah blah blah - it is a very different world trying to "cipher" it all out.
frijole
He's very well aware of my past 4 failed treatments, but we're treading in undiscovered territory with Victrelis. Interestingly, he said if that doesn't work, we then switch over to Incivek. There are no more choices after that. Wait until the newer drugs come out? That’s a good question. My liver functions have always been normal, so who can predict the future?
Keep in mind that the pharmacist at Merck told me that partial responders have had miraculous results with Victrelis. I certainly hope so. These horse capsules at 12 a day should kill anything smaller than a cat. It’s been very hot here in Las Vegas, which doesn’t help the sides when it comes to sudden nausea attacks. Thankfully they only last a few torturous moments. It’s been so hot here that the chickens have been laying hard boiled eggs... Stay tuned...
Magnum
Keep in mind that the pharmacist at Merck told me that partial responders have had miraculous results with Victrelis. I certainly hope so. These horse capsules at 12 a day should kill anything smaller than a cat. It’s been very hot here in Las Vegas, which doesn’t help the sides when it comes to sudden nausea attacks. Thankfully they only last a few torturous moments. It’s been so hot here that the chickens have been laying hard boiled eggs... Stay tuned...
Magnum
It would have more encouraging if you'd seen a better response to P/R than a .56 log drop in the 4 week lead in. Did your doctor discuss any of the info below? Regardless of the stats, hoping triple is the winning ticket for you.
Subjects Who Failed Previous Therapy with Peginterferon Alfa and Ribavirin
In subjects who were previous relapsers and partial responders evaluated in RESPOND-2, interferon responsiveness (defined as greater than or equal to 1-log10 decline in viral load at TW4) was predictive of SVR. VICTRELIS-treated subjects who demonstrated interferon responsiveness at TW4 achieved SVR rates of 74% (81/110) in VICTRELIS-RGT arm and 79% (90/114) in VICTRELIS-PR48 arm, compared to 27% (18/67) in subjects treated with PegIntron/REBETOL. VICTRELIS-treated subjects who demonstrated poor interferon responsiveness (defined as less than 1-log10 decline in viral load at TW4) achieved SVR rates of 33% (15/46) in VICTRELIS-RGT arm and 34% (15/44) in VICTRELIS-PR48 arm,compared to 0% (0/12) in subjects treated with PegIntron/REBETOL.
Subjects Who Failed Previous Therapy with Peginterferon Alfa and Ribavirin
In subjects who were previous relapsers and partial responders evaluated in RESPOND-2, interferon responsiveness (defined as greater than or equal to 1-log10 decline in viral load at TW4) was predictive of SVR. VICTRELIS-treated subjects who demonstrated interferon responsiveness at TW4 achieved SVR rates of 74% (81/110) in VICTRELIS-RGT arm and 79% (90/114) in VICTRELIS-PR48 arm, compared to 27% (18/67) in subjects treated with PegIntron/REBETOL. VICTRELIS-treated subjects who demonstrated poor interferon responsiveness (defined as less than 1-log10 decline in viral load at TW4) achieved SVR rates of 33% (15/46) in VICTRELIS-RGT arm and 34% (15/44) in VICTRELIS-PR48 arm,compared to 0% (0/12) in subjects treated with PegIntron/REBETOL.
Viral count after one month lead-in 2,325,024 to 652.332. This means I'm a partial responder. Doc is happy with this. I will add that the ALT (62) and AST (58) readings have been the lowest in 17 years since diagnosed.
If you recall the near death scenario with the Infergen overdosing, the AST was 377 and ALT 368. Bilirubin 2.2. (scary considering the high point being 0.3)... Any higher and I would not be writing this....
AFP marker went down from 24 to 17. It’s been as high as 34. Bilirubin slightly elevated (to be expected). Plateletes at 66 (acceptable), and a good mental and physical attitude helps a lot. Naturally, some med marijuana is a catalyst for at least keeping the sleep cycle regular as well as hunger (hope I don't get attacked again), and so on it goes. I will see in 3 weeks the count, now that Victrelis has been added. Aside from acid reflux, I see virtually no added side effects after adding Victrelis...
Magnum
If you recall the near death scenario with the Infergen overdosing, the AST was 377 and ALT 368. Bilirubin 2.2. (scary considering the high point being 0.3)... Any higher and I would not be writing this....
AFP marker went down from 24 to 17. It’s been as high as 34. Bilirubin slightly elevated (to be expected). Plateletes at 66 (acceptable), and a good mental and physical attitude helps a lot. Naturally, some med marijuana is a catalyst for at least keeping the sleep cycle regular as well as hunger (hope I don't get attacked again), and so on it goes. I will see in 3 weeks the count, now that Victrelis has been added. Aside from acid reflux, I see virtually no added side effects after adding Victrelis...
Magnum
"Okay, I admit to being a little anal"
Nothing wrong with that girl, if for some reason your not happy with having a little one may i suggest eating alot of fat????.....:)
Nothing wrong with that girl, if for some reason your not happy with having a little one may i suggest eating alot of fat????.....:)
>I still do 12 laps in the pool daily,
wow! On a good day I sometimes manage 12 'laps' up and down my drive way....
wow! On a good day I sometimes manage 12 'laps' up and down my drive way....
frijole:nice post - made me go back and dig up the "patient information" section for my ribasphere rx : "Take this medicine with food". As with the copegus directions above, no mention of fat.
the main point, nicely summarized by lynda, is not that taking fat won't improve rbv absorption (it will) or that adequate rbv is not a key factor in svr (it is) but that adjusting rbv levels with avocadoes and peanut butter is not the best way to do the job. Given that we are saturated with rbv within a few weeks of tx, AUC rather than Cmax or absorption time from single dose measurement is the relevant stat. (and what's the AUC difference relative to an ordinary meal?).
Strange thing is that though there is unanimous agreement about the importance of rbv, what constitutes an "optimal" rbv dose is still very murky. Serum concentration is hard to measure in the US (though possibly available through trial NCT01097395 at UC Denver) and is still missing reliable comparison points. This leaves weight (at least 13-14 mg/kg) and Hgb decline (at least 3 units of Hgb drop - from rbv, not PI).
Not a very optimal definition of optimal...
the main point, nicely summarized by lynda, is not that taking fat won't improve rbv absorption (it will) or that adequate rbv is not a key factor in svr (it is) but that adjusting rbv levels with avocadoes and peanut butter is not the best way to do the job. Given that we are saturated with rbv within a few weeks of tx, AUC rather than Cmax or absorption time from single dose measurement is the relevant stat. (and what's the AUC difference relative to an ordinary meal?).
Strange thing is that though there is unanimous agreement about the importance of rbv, what constitutes an "optimal" rbv dose is still very murky. Serum concentration is hard to measure in the US (though possibly available through trial NCT01097395 at UC Denver) and is still missing reliable comparison points. This leaves weight (at least 13-14 mg/kg) and Hgb decline (at least 3 units of Hgb drop - from rbv, not PI).
Not a very optimal definition of optimal...
As the doctor pointed out on my blood work results visit Tuesday, it's not necessary for 20 grams of fat, and warned me about weight gain. I've been on treatment almost 6 weeks and put on 6 pounds. So let's see, I'm pretty good with math, 48 weeks = 48 lbs.....
No, I can't agree with the 20 grams. I will take my chances with 10 grams, and let's not forget that this fat protocol was mandated to be taken with Ribavirin without Victrelis or Incivek Now that those have been added to patients, is this fat thing necessary? A question that will raise debates, perplex even scientists and especially some patients.
So far in this treatment plan (one month traditional lead-in and 9 days Victrelis), I notice the constant medicinal taste in my mouth. I will add that the doctor has me on Prevacid as I developed acid reflux after adding Victrelis. It’s well under control now..
Surprisingly enough, I still do 12 laps in the pool daily, no lip sores (first week, yes), not ready to strangle anyone, hair not falling out, not losing weight (quite the contrary), good humor. What's right with this picture?
Here's something: The nurse who works for the company that sends my meds is very well aware of patients’ reactions regarding agonies, as well as successes. She pointed out that attitude is everything, and she’s right. In fact after I told her how good I feel under this bombardment, she said “I told you so”.
I for one, never think I’m on treatment. I keep very occupied writing my new screenplay, doing things around the house, working on new songs, etc... and the only time I think about treatment is when the alarm goes off to take the meds. Otherwise, it’s up to you. 48 weeks = 48 lbs....?
Magnum
No, I can't agree with the 20 grams. I will take my chances with 10 grams, and let's not forget that this fat protocol was mandated to be taken with Ribavirin without Victrelis or Incivek Now that those have been added to patients, is this fat thing necessary? A question that will raise debates, perplex even scientists and especially some patients.
So far in this treatment plan (one month traditional lead-in and 9 days Victrelis), I notice the constant medicinal taste in my mouth. I will add that the doctor has me on Prevacid as I developed acid reflux after adding Victrelis. It’s well under control now..
Surprisingly enough, I still do 12 laps in the pool daily, no lip sores (first week, yes), not ready to strangle anyone, hair not falling out, not losing weight (quite the contrary), good humor. What's right with this picture?
Here's something: The nurse who works for the company that sends my meds is very well aware of patients’ reactions regarding agonies, as well as successes. She pointed out that attitude is everything, and she’s right. In fact after I told her how good I feel under this bombardment, she said “I told you so”.
I for one, never think I’m on treatment. I keep very occupied writing my new screenplay, doing things around the house, working on new songs, etc... and the only time I think about treatment is when the alarm goes off to take the meds. Otherwise, it’s up to you. 48 weeks = 48 lbs....?
Magnum
I am really glad you are doing so well. What was your start date and what was your VL at the end of the lead in and after 4 weeks of VIC (if you are there yet)
Okay, I admit to being a little anal but I have started a spreadsheet of people starting therapy since May. I have missed a lot but it looks like INC - 30, VIC - 8.
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lol..it is good sometimes good to keep score :)
To new folks..frjole"s advice will be invaluable to you going forward ..with her knowledge of HCV and tx.
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lol..it is good sometimes good to keep score :)
To new folks..frjole"s advice will be invaluable to you going forward ..with her knowledge of HCV and tx.
"I was told that the incivek was mostly for non responders. :( That's me..lol "
I think this is totally false. I think you could succeed with either one
I think this is totally false. I think you could succeed with either one
Lynda
"Ribavirin dose optimization is not ultimately achieved through a high fat diet. It may be helpful but primarily it has to do with how well the body metabolizes the ribavirin and how well plasma ribavirin concentrations are maintained. Dosage can play a significant role in this. "
Exactly - you are able to put this in concise words oh so well! We know if that riba is working, when we get anemic. In reverse, there have been members -- bill1954 and fishdoc -- who have been riba resistent (whose hgb never dropped significantly). The way they solved the problem was NOT eating more fat, but upping the riba dose
frjiole
"Ribavirin dose optimization is not ultimately achieved through a high fat diet. It may be helpful but primarily it has to do with how well the body metabolizes the ribavirin and how well plasma ribavirin concentrations are maintained. Dosage can play a significant role in this. "
Exactly - you are able to put this in concise words oh so well! We know if that riba is working, when we get anemic. In reverse, there have been members -- bill1954 and fishdoc -- who have been riba resistent (whose hgb never dropped significantly). The way they solved the problem was NOT eating more fat, but upping the riba dose
frjiole
'What surprises me the small amount of people on this sight who are doing Inc instead of Vic'
Okay, I admit to being a little anal but I have started a spreadsheet of people starting therapy since May. I have missed a lot but it looks like INC - 30, VIC - 8.
My Ribashere labeling says this under Clincal Pharmcology - Pharmacokinetics:
"Effect of Food on Absorption of Ribavirn - Bioavailability of a single oral dose of ribavirin was increased by co-administration with a high-fat meal. The absorption was slowed (T max was doubled) and the AUC 0-192h and C max increased by 42% and 66% respectively, when the ribavirin was taken with a high-fat meal rather than fasting."
So the absorption is better with a high-fat meal but the absorption is slowed down (over fasting). It is far more important for trough ribavirin plasma concentrations to be reached. And it takes about 12 WEEKS for that to happen. In the long run take food or not -- I think taking all of your doses and taking them close to 12 hours apart is more important.
One of the biggest differences between ribavirin and incevik is the half-life. The half-life of a single dose of ribavirn is 120-170 hours. The half life of Incevik 9-11 hours according to the FDA advisory committee briefing document (page 4) The only way to keep INC in the system is to take it every 8 hours or so. The fat helps with that maximum short-term bioavailability. With the ribavirin, overall, we just need to keep it going in our system and let it build up -- with or without fat.
I have never seen anything about the amount of fat and nothing on 20 grams for riba.
frijole
Okay, I admit to being a little anal but I have started a spreadsheet of people starting therapy since May. I have missed a lot but it looks like INC - 30, VIC - 8.
My Ribashere labeling says this under Clincal Pharmcology - Pharmacokinetics:
"Effect of Food on Absorption of Ribavirn - Bioavailability of a single oral dose of ribavirin was increased by co-administration with a high-fat meal. The absorption was slowed (T max was doubled) and the AUC 0-192h and C max increased by 42% and 66% respectively, when the ribavirin was taken with a high-fat meal rather than fasting."
So the absorption is better with a high-fat meal but the absorption is slowed down (over fasting). It is far more important for trough ribavirin plasma concentrations to be reached. And it takes about 12 WEEKS for that to happen. In the long run take food or not -- I think taking all of your doses and taking them close to 12 hours apart is more important.
One of the biggest differences between ribavirin and incevik is the half-life. The half-life of a single dose of ribavirn is 120-170 hours. The half life of Incevik 9-11 hours according to the FDA advisory committee briefing document (page 4) The only way to keep INC in the system is to take it every 8 hours or so. The fat helps with that maximum short-term bioavailability. With the ribavirin, overall, we just need to keep it going in our system and let it build up -- with or without fat.
I have never seen anything about the amount of fat and nothing on 20 grams for riba.
frijole
i'm having some brain fog/wallowing issues right now and the mention of having to indulge in fattening food sounded comforting so I went with that.... with the brain fog I thought I was arguing my point well but with bs... so i will openly admit now that i don't what the hell i'm talking about right now... LOL... i think i'll quietly step away from this discussion now...
I try to have some additional fat with each meal taken with Riba. I don't obsess about how much or if I forget, but figure it won't hurt.
Perfect :)
Perfect :)
Hey brianmo, I bet you didn't expect your post to turn into a Riba and fat vs no fat debate. lol
Based on the studies I've read I try to have some additional fat with each meal taken with Riba. I don't obsess about how much or if I forget, but figure it won't hurt.
Based on the studies I've read I try to have some additional fat with each meal taken with Riba. I don't obsess about how much or if I forget, but figure it won't hurt.
Oh look..the centuries old (well since 2001 anyway) argument about fat with Riba again.
"Bioavailability" means the portion of a dose that reaches circulation. Higher fat food will slow absorption of most drugs(including Riba) ..but will not have much effect on "bioavailability"
In the Schering Plough study Riba was given with no regard to food, and concluded because uf uncertainty about effects of food they said it may be prudent to take Riba "with food" it said nothing about "high fat food"
For those of you on Inci..it is mostly moot anyway as I would imagine you are taking the Riba at or about the same time as Inci and the fat is adequate ....for those on Vic because "some fat" may increase "bioavailability a little fat with the Riba can"t hurt ...however nothing to stress over....according to the company that makes it and most knowledgeable Hepa"s
Will
"Bioavailability" means the portion of a dose that reaches circulation. Higher fat food will slow absorption of most drugs(including Riba) ..but will not have much effect on "bioavailability"
In the Schering Plough study Riba was given with no regard to food, and concluded because uf uncertainty about effects of food they said it may be prudent to take Riba "with food" it said nothing about "high fat food"
For those of you on Inci..it is mostly moot anyway as I would imagine you are taking the Riba at or about the same time as Inci and the fat is adequate ....for those on Vic because "some fat" may increase "bioavailability a little fat with the Riba can"t hurt ...however nothing to stress over....according to the company that makes it and most knowledgeable Hepa"s
Will
Ribavirin has been around for a few more years and has been through all of the studies if not more than incivek, yet the label still doesn't call for fat intake before dose but the incivek does and how do you know that you are not absorbing to much riba which must be bad for you or they would say take 2000 mg's a day just to make sure you get enough. Riba is a major cause in hgb decline so maybe to much is not a good thing, but I guess maybe it is better to be safe than sorry right.
because it is better to be safe than sorry...
I haven't seen any research proving that it's bad to take riba with high fat, but there's research that it may be beneficial. It seems that this is still being studied... So why not just take the riba with high fat which won't do any harm..
as far as second guessing my doctor, the incivek protocol was studied... and in my opinion I'd rather be safe then sorry...
I haven't seen any research proving that it's bad to take riba with high fat, but there's research that it may be beneficial. It seems that this is still being studied... So why not just take the riba with high fat which won't do any harm..
as far as second guessing my doctor, the incivek protocol was studied... and in my opinion I'd rather be safe then sorry...
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