low hemoglobin with ribavirin

Question

Triple combination therapy
week 5

My hemoglobin is going down. Last week blood test hemoglobin is at 8.7. My doctor just reduced Ribavirin from 1000mg daily to 800mg daily for the reason that my hemoglobin is going down. Blood work again in two weeks and he will see me after the blood test results. He told me he might stop the treatment is the hemoglobin continues to low. He will make that decision in the next visit after seen the results of the blood test he ordered. Does anyone has problems with low hemoglobin with this treatment, interferon & ribavirin. Does anyone have to stop the treatment because of this reason.

Moca3

can-do-man · Accepted Answer

Low HGB on triple treatment is common and dose reduction of Riba has been the proper course. I would plead with my doctor on starting Procrit before stopping treatment. You might even need to reduce down to 600mg of Riba a day. If I remember right your doing Incivek? Which also lowers one HGB and that is halfway over. Hang in there.

Paul_Anthony · Answer

That's exactly what was done for me, only my Dr.Clincea encouraged me to go full speed ahead. Procrit once a week after about 2- injections will bring you back from your exhaustion. The newest treatment on the market right now is the Simeprevir with Somosprevir. 90 day treament, with no Ribo or Intrferon.
Nan read the last blood test which she declared the virus is almost undetectable, after only 3 weeks!  I do have a 1A strand that has totally been destroying my treatments. Please do not let this MD set you back. We are to try all that is available to us. God Bless you! 
Paul_Anthony.

Paul_Anthony · Answer

Procrit gave me a boost of energy. This was during 1 of my first treatments where it involved Ribovirin and Pegyinterfueron. 1 more injection. Are you doing the Simeprevir and the other Somospevir? I may have changed the spelling a little:)

can-do-man · Answer

When your HGB drops below 10 for medical reasons, or in people on HCV tx in response to ribavirin in their blood it called Hemolitic anemia " This is not the anemia often called iron poor blood where you can eat food with more iron or take iron supplements to raise your HGB.

"(Hemolytic anemia is a condition in which there are not enough red blood cells in the blood, due to the premature destruction of red blood cells. There are a number of specific types of hemolytic anemia, which are described individually.)" 
--------------------------------------------
 As a matter of fact taking iron on treatment might not be wise and should be run by your Hepatologist as most suggest not even taking a Multivitamin with Iron. A lot of this depends on your live.r condition

Moca3 · Answer

If you are vegetarian you can a healthy diet of grains, brown rice and pasta and breads rich in iron, beans especially lentils, cereals and oats. vegetables such broccoli, sparagus and spinach. Fruits rich in citrus, pineapple, melons, strawberries, oranges and prunes. But not matter what you eat these medicines are strong and will low you red blood cell count. The first 4 weeks of treatment is very important to maintain a recommended dose of treatment. After four weeks the doctor can reduce the dose but not by much. You don't  want to jeopardize  the success of the treatment. Your doctor will continuely monitor you by having blood test.

Good Luck

nan535 · Answer

"I feel like I am going to die".

Listen to your body and have a conversation with your doctor asap. I never heard of anyone with such a large dosage.

Doctors are not infallible. They do make mistakes.  Trust yourself to know when something is wrong.

Nan

hepc4Sandi · Answer

Boy that Ribasphere seems really high. 

Here is a link for dosage:
http://www.drugs.com/dosage/ribasphere.html

Seems like the most you should be at is 1400 mg for the Ribasphere, and usually the doctor will reduce dosage once your HGB drops below 10. You need to have a conversation with your doctor. There really is nothing you can eat, as iron is not the issue, the issue is the Ribasphere is blasting your red blood cells. You can eat greens (chard), molasses, raisins. Most doctors will reduce your dosage for at least a short amount of time. I know that Ribasphere is based on weight, but usually with a max dose. The other dosages are normal.

Datakeyz · Answer

I am taking 2600 mg Ribasphere, 400 mg Sovaldi, and 180 Peg per week. Is anyone else on such a high dosage? I feel like I am going to die. My HGB went from 16 to 9 in 3 weeks. I am a vegetarian. What can I eat? Any suggestion would be greatly appreciated.

nsgirlie · Answer

I know how you feel. My HGB dropped from 14.5 to as low as 6.3. Five transfusion over 24 weeks. I was taking interferon and riba. Procrit not an option that is offered in Canada. It began at 4 weeks. Was taking 1200 riba a day and doc reduced to 600 a day. Didn't help with the low HGB but it didn't affect my UND results. 2 months EOT and I am still undetected. The whole 6 months of treatment was awful because of the low HGB, I had a hard time breathing and walking just wore me out. Had to sit and catch my breath. Not working was not an option. So I headed to bed as soon as I got home and on weekends I never left my bed. Made it through but it wasn't easy. Good news is that 4 weeks EOT my HGB levels rose to 10 and 8 weeks later they are at 13. Hair has stopped falling out ( lost 75% ). I was transfused when I got to 8 and felt a bit better for a few days. Perhaps that is an option your doc will consider so you don't have to stop treatment. Looking back it was so worth it all now that I am getting close to SVR. I wish you all the best in your treatment and fingers crossed that you can make it through.

mckansas · Answer

***9th week treatment***  6 ribavirin per day.

hepc4Sandi · Answer

Ribavirin dosage normally is weight based, with a normal maximum of 12,000 (6 pills) a day. I weigh 144 lbs, so I started out at 1,000 mg a day, 3 in the morning and 2 at night. The doctor may do a lot of adjustments during the treatment also.

Here is some info:
http://www.drugs.com/dosage/ribavirin.html#Usual_Adult_Dose_for_Chronic_Hepatitis_C

Usual Adult Dose for Chronic Hepatitis C

CAPSULES, ORAL SOLUTION:
In combination with peginterferon alfa-2b:
Less than 66 kg: 400 mg orally twice a day
66 to 80 kg: 400 mg orally in the morning and 600 mg in the evening
81 to 105 kg: 600 mg orally twice a day
Greater than 105 kg: 600 mg orally in the morning and 800 mg in the evening

Duration of therapy:
-Interferon alpha-naive patients with genotype 1: 48 weeks
-Interferon alpha-naive patients with genotype 2 and 3: 24 weeks
-Retreatment with peginterferon alfa-2b/ribavirin of prior treatment failures: 48 weeks, regardless of HCV genotype

In combination with interferon alfa-2b:
75 kg or less: 400 mg orally in the morning and 600 mg in the evening
Greater than 75 kg: 600 mg orally twice a day

Duration of therapy:
-Interferon alpha-naive patients: 24 to 48 weeks
-Retreatment with interferon alfa-2b/ribavirin in patients who relapse after nonpegylated interferon monotherapy: 24 weeks

Comments:
-The manufacturer's product information for peginterferon alfa-2b or interferon alfa-2b should be consulted.
-Combination therapy with peginterferon alfa-2b is preferred; provides substantially better response rates than combination therapy with interferon alfa-2b.
-Patients with previous nonresponse, previous pegylated interferon treatment, significant bridging fibrosis or cirrhosis, and/or genotype 1 infection are less likely to benefit from retreatment after a failing course of therapy.

Approved indication: In combination with peginterferon alfa-2b or interferon alfa-2b, for treatment of chronic hepatitis C in patients with compensated liver disease

TABLETS:
In combination with peginterferon alfa-2a:
-Genotypes 1 and 4 in patients less than 75 kg: 1000 mg/day orally in 2 divided doses for 48 weeks
-Genotypes 1 and 4 in patients 75 kg or more: 1200 mg/day orally in 2 divided doses for 48 weeks
-Genotypes 2 and 3: 800 mg/day orally in 2 divided doses for 24 weeks
-Genotypes 5 and 6: Insufficient data to make a recommendation
-In patients coinfected with HIV: 800 mg/day orally in 2 divided doses for 48 weeks, regardless of HCV genotype

Comments:
-The manufacturer's product information for peginterferon alfa-2a should be consulted.

Approved indication: In combination with peginterferon alfa-2a, for treatment of patients with chronic hepatitis C who have compensated liver disease and have not been previously treated with interferon alfa

Moca3 · Answer

I thought Ribavirin is only 2 pills a day. You said taking at the beginning 3 but now 2 pills a day. I know how you feel. I am going through the same, low white/red blood cells. I don't know how long have you been I treatment.

Moca3

Moca3 · Answer

I will definitely will look for at the health food store. Thanks.

Moca3

mckansas · Answer

I'm in the 9 th well.  I'm anemic,  low hemoglobin and low absolute neutraphils, low red and white cells.  So,  they had me take a Neupogen injection twice, which kicked my ***.  High fever over weekend and sicker than a dog.  I lied and told then I took the 3rd Neupogen shot but didn't.  It makes me not breathe worse than just walking fatigue.  I'm awaiting results from blood test today. They may lower my ribavirin from 3 to 2 pills each time.

indy531 · Answer

Try  wheatgrass juice in a shot glass 1x a day. My hepMD said ok and my hemo was at 7.7 from 14 originally. It actually helped enough to forego ending tx or transfusion. Buy this at health food store; mine was in frozen cubes.

Moca3 · Answer

I wonder too, why not 600mg instead of 800mg a day. I will keep in mind to drink a lot of water.

Moca3

Moca3 · Answer

I feel exhausted and tire. I stop working after 4 weeks in treatment. Doctor ordered to stay away from work until treatment finish. Luckily I have short term and long term disability for the company that I work. The status of my liver is pretty damage but is compensated. I need to finish this treatment. My liver can't wait more longer. My doctor told me that the goal of the treatment is to get rid off the virus but also to slow or stop progression to cirrhosis.

Moca3

Moca3 · Answer

I know fish oil is good but I am afraid of supplements over the counter I have liver damage I have to be careful.

Moca3

Moca3 · Answer

OH, I also heard about pocrit. I heard people  during this treatment has taking that when hemoglobin is low I will definitly will give a good fight before my treatment is stop it. I will mention that to my doctor, I will try anything available to fight my low hemoglobin before my treatment is stop it.

Moca3

Moca3 · Answer

My treatment is sovaldi-interferon-ribavirin. I believe that hemoglobin have to do with low red/white blood cell counts which I have low. My brother is taking medicines for another reason nort because of Hep C. He told me that his medicines are lowering his red blood cell counts and what he is doing is eating foods rich in iron and that's helping him but he doesn't have liver problems so my case is different. But I started eating foods rich in iron. I hope that will help for my next blood test. 

Moca3

cooderbrown · Answer

start taking fishoil it will help stabilize  low blood levels I read this from a Japanese study..

nan535 · Answer

How do you feel?  This is a very tough treatment.  Is your liver in good shape? My husband tried that treatment but his liver was decompensated and unfortunately he had to stop treatment after 5 weeks.  

Besides procrit, another  possibility to bring up your hgb is a blood transfusion. My husband needed a few. 

Should you have to stop, take heart, there are other treatments in the pipeline that will be much easier on you. 

I wish you the best.
Nan

hepc4Sandi · Answer

My hemoglobin went from:
13.3 (start)
10.5
9.7 (at which point he reduced my riba from 1,000 mg to 600 mg, which is in the guidelines as proper to do)
9.6 (at which point he took me off riba for 2 days)
10.3 (after 2 days off, then he raised me to 200 mg for 3 days, then back to 600 mg)
11.1 (then he raised my riba to 800 mg at my request where I am now)

Was UND at 1 and 2 months. So hang in there, the body does seem to adjust to the ribavirin after 1 month. I wonder why he doesn't drop you to 600 mg too? Well hang in there, rest, drink LOTS of water. My hemoglobin seemed to respond right away to the dosage reductions, so hopefully yours will too.