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riba pre dosing

what would be the down side to a two month riba pre dose ramp up to over dose levels for a naive patient? EPO allowed if needed.
riba monotherapy does bring UND (not svr) to 10% of patients.
would you start your "time to UND" at the first INF shot? or would that time frame be diluted (extended) to include ramp up time?
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Avatar universal
Last year someone reported being in a pre-dosing trial, but no follow-up. A few here -- FlGuy and Spacecoast come to mind --  also pre-dosed riba for a week or two prior to treatment.

Personally, the idea intrigues me, but have nothing scientific to back it up. That says, two months seems a bit excessive, but I suppose the upside might be that it gives your body time somewhat adjust to any resultant anemia. By using  something like Procrit (epo), I would think 3-4 weeks of pre-dosing would be enough to get high serum riba levels prior to the first peg shot, the epo helping to prevent any anemia.

It has to be said that this is uncharted waters and really should be done under a doctor's supervision so blood chemistries can be tracked and helper drugs administered if needed.

While I doubt if you would find a doctor to suggest such an approach, I'm sure there are good liver specialists out there who would be more than happy to experiment on you, given it's your idea. At least that's what I found when I wanted to high-dose ribavirn while double-dosing Peg. Being your idea sort of gets the doc off the hook if something goes wrong.

BTW, my take is the purpose of pre-dosing is not so much to get UND but to raise the serum riba levels  so that by the time of the first peg shot, they will be at a maxium. Are you planning on combining pre-dosing with high dose riba? Again, get a knowledgeable liver specialist who will work with you.

Let us know what you end up deciding.

-- Jim
Avatar universal
there has been some success with pre-dosing riba but i do not think that long. i believe some have pre-dosed a few weeks and even double dosed the peg for a few weeks.  it does make sense and i will do it when i tx.
Avatar universal
To directly answer your question, the "downside" is that there is little data collected on pre-dosing ribavirin in terms of SVR. Intuitively, one would think it would help, but again no hard data. Also, there's the chance of more drug toxcity/side effects which could come back and bite you. As to when you start counting for RVR, EVR, etc. I would start counting at the first peg shot. Again no data here but that's how I would do it.

-- Jim
Avatar universal
my doctor did say he would go off lable and allow this so maybe there is something to the idea.
148588 tn?1465782409
Riba moves into and out of your bloodstream in a matter of hours - not days, not weeks, not months. It's why you have to take the stuff twice a day. There's this idea that it has a hellaciously long half-life because of all the "wait six months to have kids" warnings. What you're waiting for is your body to repair the cellular damage - not for the drug to leave your system.
I'd be interested to see any proof that pre-dosing for more than a day is anymore effective than using an inhaler, popping a couple tabs, and doing your first shot six hours later.
There's an old Hazard Evaluation Sheet from 1990 regarding riba exposure to healthcare workers that gives an idea how readily aerosol exposure is absorbed.
www.dhs.ca.gov/ohb/HESIS/riba.htm#HOW%20RIBAVIRIN%20ENTERS%20THE%20BODY
148588 tn?1465782409
www.dhs.ca.gov/ohb/HESIS/riba.htm
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