Hemo Riba down

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Maitake - 09 Jun 2006 18:30 GMT

Ah...week 4/5 visit yesterday. Mostly uneventful cept took #1 with me.
(That's always a blast) Anyway at first visit I had dropped 7 lbs and Hemo
was down. At this visit weight was holding steady but Hemo was
(yawn...stretch) down more. By time #1 and I got back home we had message
from CM to reduce the morning Riba one cap. What's up with this?
den

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Cactus Jammies - 09 Jun 2006 19:57 GMT

hey Den,
It might have something to do with your weight loss, you could be taking
more than the original prescription parameters (weight based dosage)
allowed, now that you are losing weight so fast. Are you on the 6 caps per
day regimen? Anyhow that is my thought. My body seemed to adjust to the
dosage I was on, but I was overweight for the guide anyway (6 caps, orange
box) and when I lost the 30 lbs by week 48, I knew I was OD'ing on
something. I burned food like crazy, all carbs and etc. Stuff I would
normally never eat except when loaded (good old days). The doctors left me
alone. Ha ha don't ask, keep going, it will help I said to myself.

hope that helps open the curtains on this for you

cactus jammies------------------------------------------------

> Ah...week 4/5 visit yesterday. Mostly uneventful cept took #1 with me.
> (That's always a blast) Anyway at first visit I had dropped 7 lbs and Hemo
> was down. At this visit weight was holding steady but Hemo was
> (yawn...stretch) down more. By time #1 and I got back home we had message
> from CM to reduce the morning Riba one cap. What's up with this?
> den

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Maitake - 10 Jun 2006 19:16 GMT

> hey Den,
> It might have something to do with your weight loss, you could be taking
[quoted text clipped - 8 lines]
>
> hope that helps open the curtains on this for you

Yes, it kind of does. Thanks CJ. (and Grey too. GH I'll be taking your
advice. It's the V.A. so procrit is probably covered. Like any other Govt.
agency headcounts are dollars. More scripts more ducketts. Thanks, I'll get
on asking her the things you mention.) Anyway, I started out on five 250's
(3 in morn two in evening) My wieght was 167 then to 160. Kind of extra
tired, but always a lot to do here so it feels normal. But anyway, on four
now. I didn't know if anyone else had been reduced before or not. Thanks CJ
and Greyhackles you both gave me something to work with. I'll know on my
next visit if the stuff is working or not. (In other news, on I-80
Eastbound Thursday afternoon a couple hours after son and I came through
there was a fiery nine car pile up. Jeesh.)
den.
(typing on fly today...)

> cactus jammies------------------------------------------------

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greyhackles - 10 Jun 2006 23:19 GMT

>> hey Den,
>> It might have something to do with your weight loss, you could be taking
[quoted text clipped - 23 lines]
>>
>> cactus jammies------------------------------------------------

Well, the good news is you're probably at the right dosage for your current
weight.

At 167 lbs, 1250mg/day started you out on the high side of dose/weight. Going
down to 1000mg/day @160 puts you pretty squarely in the middle.

I think I'd still raise the question of using Procrit instead of any further
dose reductions before such questions become timely. Get the topic on the
table and resolved in advance, because you don't want to drop down to 750mg
from here - that'd put you below any standard dose - with either the
weight-based or fixed dosage regimens.

And keep an eye on your labs. Again, while hemolytic anemia from the Ribavirin
is clearly the more prevalent condition, IFN does cause its own share of
anemia. If your hemoglobin doesn't stop falling with the Riba dose reduction,
your doc may be shooting at the wrong target...

Cheers

/greyhackles

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greyhackles - 09 Jun 2006 20:41 GMT

>Ah...week 4/5 visit yesterday. Mostly uneventful cept took #1 with me.
>(That's always a blast) Anyway at first visit I had dropped 7 lbs and Hemo
>was down. At this visit weight was holding steady but Hemo was
>(yawn...stretch) down more. By time #1 and I got back home we had message
>from CM to reduce the morning Riba one cap. What's up with this?
> den

First thought is "Here we go again - dose reduction instead of battling the
anemia with Procrit". But CJ raises a valid point - if the doc had you on a
higher weight-based dosage than currently indicated.

So what's your current weight, and how much Riba were you originally
prescribed?

Another potential problem with your CM: how does he/she know the anemia is
being caused by the Ribavirin (ie: hemolytic anemia) and not due to marrow
suppression caused by the Interferon? While it is true that most anemia cases
on anti-HCV therapy are due to the Ribavirin, there's still a large enough
population affected by the IFN to justify a differential analysis via blood
tests to at least make sure the right drug is being reduced. A first-order
determination can be made with a single test.

I'd get on my high horse, call the CM, and find out if you are covered for
Procrit (aka Epogen), and if so, ask the CM why s(he) is opting for dose
reduction instead.

Bottom line: you want to take at least 80% of the correct dosages at least 80%
of the time for at least the first 24 weeks to be solidly in the running for
SVR...

Cheers

/greyhackles

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