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!
I think Vic. is prescribed more. That may have something to do with less sever side effects or the price tag. Vic. is about 1/4 the price of Incivek. The clinical trials indicated that Inc is more effective in non responders/relapses but the difference in naives was small.
As the following article mentions, neither drug has been proven superior. It comes down to patient preference and risk factors. I haven't read anything about either having an advantage for non-responders, but that might be the case. If so, it would be good to list a reference for a published trial.
If I had to do things all over and needed to choose a PI, I'd be leaning toward Vic since I'm a rashy guy and my Hgb hasn't been an issue.
The following article was posted last month by Diane12855 and is a good read.
http://www.idse.net//ViewArticle.aspx?ses=ogst&d=Hepatitis&d_id=213&i=ISSUE%3a+August+2011&i_id=753&a_id=18862
Best of luck as you begin. Try not to overthink this stuff. I know I don't. hahaha.
If I had to do things all over and needed to choose a PI, I'd be leaning toward Vic since I'm a rashy guy and my Hgb hasn't been an issue.
The following article was posted last month by Diane12855 and is a good read.
http://www.idse.net//ViewArticle.aspx?ses=ogst&d=Hepatitis&d_id=213&i=ISSUE%3a+August+2011&i_id=753&a_id=18862
Best of luck as you begin. Try not to overthink this stuff. I know I don't. hahaha.
Hate to tell you this but for Riba to be effective it should be taken with just as much fat if not more then incivek. This has been proven with data to back it up. My thought was is if I had to take fat with riba anyway I might as well take the incivek at the same time with the same fatty food.
Also one of the main reasons people are doing incivek more is the possibility of only having to treat for 24 weeks. That by itself is a huge factor. The less time these drugs are in your body the better. And of course you will take a lot less fat in 24 weeks vs 48 weeks :)
Also one of the main reasons people are doing incivek more is the possibility of only having to treat for 24 weeks. That by itself is a huge factor. The less time these drugs are in your body the better. And of course you will take a lot less fat in 24 weeks vs 48 weeks :)
Really? From the posts I have read since June, there seem to be many more people on INVICEK than on VICTRELIS. But then, I am only checking this community, so maybe there are more in the Social Community or somewhere else. The draw of INV is shorter treatment time (typically), while the draw for VIC is less intense sides. My doc initially had me scheduled for INV but after talking to her colleagues, she discovered that many were having trouble with the sides, particularly -- anal pain and/or bleeding and firey bowels, to the point where they had to stop treatment. So I am currently on the Pegasys (Interferon) and Ribavirin, then at the beginning of the 5th week, I will add VIC. Either way, there is a ton of helpful information on what to do about sides for both drugs, and everybody responds differently to tx.
As for the RIBA......To make the morning dose more comfortable.....my training session suggested a "robust" breakfast, to avoid tummy issues since you have been fasting while sleeping (and therefore; your stomach acid is higher and wants to suck up the first thing you give it; and since the RIBA is hard on GI issues.....you want to start off with a bit more food in the mornings). I found that I was overeating, trying to do this but I have decided/learned that a regular breakfast is good. So more than a snack. Hope this helps. Best to you in tx!
As for the RIBA......To make the morning dose more comfortable.....my training session suggested a "robust" breakfast, to avoid tummy issues since you have been fasting while sleeping (and therefore; your stomach acid is higher and wants to suck up the first thing you give it; and since the RIBA is hard on GI issues.....you want to start off with a bit more food in the mornings). I found that I was overeating, trying to do this but I have decided/learned that a regular breakfast is good. So more than a snack. Hope this helps. Best to you in tx!
>for Riba to be effective it should be taken with just as much fat if not more then incivek.
not true.The food requirements in the medication guide for copegus (one of the brand names under which rbv is sold) makes no mention of fat:
"Take COPEGUS with food."
http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=12149#Guide
whereas the language in the inci package insert is explicit about the requirement for 20g of fat/dose.
"Effects of Food on Oral Absorption
The systemic exposure (AUC) to telaprevir was increased by 237% when telaprevir was administered with a standard fat meal (containing 533 kcal and 21 g fat) compared to when telaprevir was administered under fasting conditions. In addition, the type of meal significantly affects exposure to telaprevir. Relative to fasting, when telaprevir was administered with a low-fat meal (249 kcal, 3.6 g fat) and a high-fat meal (928 kcal, 56 g fat), the systemic exposure (AUC) to telaprevir was increased by approximately 117% and 330%, respectively. Doses of INCIVEK were administered within 30 minutes of completing a meal or snack containing approximately 20 grams of fat in the Phase 3 trials. Therefore, INCIVEK should always be taken with food (not low fat)."
http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/201917lbl.pdf
Many pts do opt to take rbv with additional fat, to improve absorption, but this it is not a requirement (and the need/advisability is controversial).
>one of the main reasons people are doing incivek more is the possibility of only having to treat for 24 weeks
for naives who clear after 4w of PI both inci and vic specify 24 w of tx. Vic add a 4w lead in, making the total 28 w. The risk of not doing a leadin is potentially pointless exposure to the PI.
What is true however, is that the amount of PI exposure time with inci is never more than 12w and thus always shorter than vic.
not true.The food requirements in the medication guide for copegus (one of the brand names under which rbv is sold) makes no mention of fat:
"Take COPEGUS with food."
http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=12149#Guide
whereas the language in the inci package insert is explicit about the requirement for 20g of fat/dose.
"Effects of Food on Oral Absorption
The systemic exposure (AUC) to telaprevir was increased by 237% when telaprevir was administered with a standard fat meal (containing 533 kcal and 21 g fat) compared to when telaprevir was administered under fasting conditions. In addition, the type of meal significantly affects exposure to telaprevir. Relative to fasting, when telaprevir was administered with a low-fat meal (249 kcal, 3.6 g fat) and a high-fat meal (928 kcal, 56 g fat), the systemic exposure (AUC) to telaprevir was increased by approximately 117% and 330%, respectively. Doses of INCIVEK were administered within 30 minutes of completing a meal or snack containing approximately 20 grams of fat in the Phase 3 trials. Therefore, INCIVEK should always be taken with food (not low fat)."
http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/201917lbl.pdf
Many pts do opt to take rbv with additional fat, to improve absorption, but this it is not a requirement (and the need/advisability is controversial).
>one of the main reasons people are doing incivek more is the possibility of only having to treat for 24 weeks
for naives who clear after 4w of PI both inci and vic specify 24 w of tx. Vic add a 4w lead in, making the total 28 w. The risk of not doing a leadin is potentially pointless exposure to the PI.
What is true however, is that the amount of PI exposure time with inci is never more than 12w and thus always shorter than vic.
I'm on Victrelis and feel 90% normal. No Anemia, no anger, just a medicine taste in my mouth. Tic Tac. Partial responder. As for the fat with Riba, doc said 10 grams is enough. Get it from organic peanut butter. 48 weeks in the course of a lifetime is nothing. At least no horrendous rash from Incivek. Spoke to lab tech at Merck who said if partials don’t clear after 12 weeks, they could clear after 6 months, so don’t give up too easily...
Magnum
Magnum
Spoke to lab tech at Merck who said if partials don’t clear after 12 weeks, they could clear after 6 months, so don’t give up too easily...
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That may be ...keeping in mind the labeling says if>100 at 12 weeks or still DET at 6 months to discontinue per futility protocol .
Possibly this tech may not agree with the company's labeling?
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That may be ...keeping in mind the labeling says if>100 at 12 weeks or still DET at 6 months to discontinue per futility protocol .
Possibly this tech may not agree with the company's labeling?
Wow, I thought everyone knew this to be very true. Guess not. Just so any newbies get the RIGHT information here it is again.
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).
Ok now I'm confused, I am in a study of concentration controlled ribavirin dosing.
http://clinicaltrials.gov/ct2/show/NCT01097395?term=hepatitis+c+AND+colorado&rank=1
When I went in for my first day, for them to run the AUC 0-12 (11 blood draws) I was made to show up in a fasking state and was not allowed anything to eat until 5 hrs after my first dose of ribavirin, not once has the hep c research team at UC Denver told me I needed to take riba with fat, they have stongly suggested that I take the tela with 20 grams of fat but only needed to take riba with food to avoid nausea. So my thought is this, who do I believe people on the internet, who I know have done tons of research on the matter or the hep c research team at UC Denver who knows exactly how my body is absorbing the riba based on AUC 0-12 after my first dose.
http://clinicaltrials.gov/ct2/show/NCT01097395?term=hepatitis+c+AND+colorado&rank=1
When I went in for my first day, for them to run the AUC 0-12 (11 blood draws) I was made to show up in a fasking state and was not allowed anything to eat until 5 hrs after my first dose of ribavirin, not once has the hep c research team at UC Denver told me I needed to take riba with fat, they have stongly suggested that I take the tela with 20 grams of fat but only needed to take riba with food to avoid nausea. So my thought is this, who do I believe people on the internet, who I know have done tons of research on the matter or the hep c research team at UC Denver who knows exactly how my body is absorbing the riba based on AUC 0-12 after my first dose.
"not once has the hep c research team at UC Denver told me I needed to take riba with fat"
no such recommendation was made because no package insert for the drug requires it. As noted above many pts opt to take rbv with fat to increase absorption but this is a 'home brew' remedy aimed at increasing rnv concentration. Other, equivalent home brew remedies are a low purine diet (purines and rbv compete for the same molecules for transport from the gut to the blood stream) and simply taking a higher rbv dose.
Unlike the fat requirement for inci, none of these home-brew remedies are required/recommended . Searching the mh archives will show much discussion/controversy on the topic.
A key factor is the dramatic difference in the additional absorption effect induced by a high fat meal, For rbv bioavailability increases "46% relative to the fasting state" whereas for inci it increases 330% relative to fasting (from the quotes above).
The claim that rbv, to be effective, requires as much if not more fat than inci is nonsense,
no such recommendation was made because no package insert for the drug requires it. As noted above many pts opt to take rbv with fat to increase absorption but this is a 'home brew' remedy aimed at increasing rnv concentration. Other, equivalent home brew remedies are a low purine diet (purines and rbv compete for the same molecules for transport from the gut to the blood stream) and simply taking a higher rbv dose.
Unlike the fat requirement for inci, none of these home-brew remedies are required/recommended . Searching the mh archives will show much discussion/controversy on the topic.
A key factor is the dramatic difference in the additional absorption effect induced by a high fat meal, For rbv bioavailability increases "46% relative to the fasting state" whereas for inci it increases 330% relative to fasting (from the quotes above).
The claim that rbv, to be effective, requires as much if not more fat than inci is nonsense,
"The claim that rbv, to be effective, requires as much if not more fat than inci is nonsense,"
Totally agree.
Totally agree.
""The claim that rbv, to be effective, requires as much if not more fat than inci is nonsense"
100% agree
100% agree
LOL. home brew? read the studies make your own decision. Perhaps this is why some people clear the virus and some don't. Not a chance I want to take.
Agreed! If there's a way to make any of this more effective regardless of prescription labeling... sign me up!!! I'd rather be fat and hep free than skinny with hep C!!!
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.
" If there's a way to make any of this more effective regardless of prescription labeling... sign me up!!! "
Really then why are you second guessing your doctor on thier version incivek protocol
Really then why are you second guessing your doctor on thier version incivek protocol
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...
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.
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
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