naragenin and pegasys in transplant patient

[tp11j]

I am 6 years post liver transplant from genotype 3 Hep C.  My doctors want to start treatment to clear the virus.  I take Prograf for the liver transplant and I know Naragenin affects the Prograf levels.  My question is if during treatment I also took Naragenin and my prograf levels were closely watched and adjusted for the Naragenin effects, wouldn't I have a better chance of clearing the virus.

[copyman]

why even mess with Naragenin? there are better things that could be added to the combo drugs that could help you acheive SVR. i.e. aliana, supplements like PPC, etc,etc. best of luck

[IAmTheWalrus]

Ditto on all the above. Grapefruit is a no-no with prograf. I definitely would not try anything like that without the advice of a good hepatologist.

Brent

[CoWriter]

I agree with Mike and Sparrow.  The effect from grapefruit can last longer than 24 hours and some people are more sensitive to it than others.  Besides that, interferon is also metabolized by CYP450 and we don't know what inhibiting the enzyme with grapefruit juice would do to the levels of interferon.  I would love to find out but not by trying it on a post-transplant patient.  

When the risk by far outweighs the possible benefit, then the answer has to be, "Don't do it".

[mikesimon]

If narigenin is grapefruit then it is definitely not a good idea. I didn't know what narigenin was but, if I had, I would have more strongly advised against it. Don't eat grapefruit while taking Prograf is one of the first things I was told and told many times immediately after transplant.

"Do not consume grapefruit or grapefruit juice during treatment with Prograf unless your doctor has told you do(sic). Prograf can have a dangerous interaction with grapefruit or grapefruit juice."     http://www.drugs.com/prograf.html

Mike

[CockSparrow]

If the immunosuppressants you are taking are metabolised by CYP3A4 then taking Grapefruit (naragenin) will increase their levels as grapefruit inhibits this enzyme.

This could be counter productive as side effects could develop.

Taking any drug that is metabolized by 3A4 and grapefruit is not a good mix.

CS

[mikesimon]

What does your doctor think? I wouldn't dream of fooling around with my immunosuppressive regimen unless a doctor I really respected strongly advocated adding  narigenin into the mix. I cleared while on Prograf and I was genotype 1b. I haven't read anything definitive about the impact of tacrolimus on treatment outcome in the transplant population. There are articles which suggest that Cyclosporine may have benefits over Prograf insofar as recurrence of HCV post transplant is concerned but, I haven't seen anything related to HCV treatment response. I think I would play it safe and keep it simple and just do the treatment with Prograf. Good luck.
Mike