20gm meal or snacks/ incivek dosing

[rebecca10]

Does any one else have any menu items containing 20 gm fat?  Chooosing to eat fat is new to me.

As far as my opinion on incivek dosing:  I believe getting as close to every 8 hours is important because of the duration of action of the drug.  If there are periods when the blood drug levels are below effective treatment drug resistance can result as well as subptimal viral killing.  So, thus we are harming our chances as well as those in the future.  Not a good scenerio.  And of course taking with fat is essential for complete absorption thru the gut.  The controlling factor is what's absorbed in getting results which over rides how much you put into the gut.
Ribaviron has a longer (half-life) duration of action as therefore can be taken every 12 hours.  As the half-life of a drug reduces the importance of keeping on schedule increases.
We all want the best results from our therapy.  I hate the idea of going thru this regimen and getting suboptimal results so... for me I am going to be as strict as any human being can be following protocol.  Varying 1/2-1 hour is not a deal buster but still opens the door to possible sub-optimal therapy.
I agree each MD has different personal protocol they like.  As a drug is on the market longer, new ways of administration become evident--but this is all new so who is to say what is best?  My MD was part of the Univ of Cincinnati that participated in the incivek trials.  My MD stands by a 5X dosing day with 6am incevik with meal and 8am ribaviron.  this was what this study followed, and with great results--so of course my MD believes in following what has been proven.  that is not to say that we will find other protocol just as effective.

As a fellow Hep C therapy patient and pharmacist my basic advice is:  Make sure you eat the 20GM of fat with incivek and get as close to every 8 hours as humanly reasonable, don't miss doses. Get as close to every 12 hours for the ribaviron as possible.  I will choose to separate incivek and ribaviron.

Another pharmacy 'pearl of information' is that some drugs can be given (for instance a 3 dosing/day drug) three times broken up while awake such as 8-2-8 but some require strict every 8 hour dosing.  Some examples of the ones requiring strict every 8 hours are antibiotics, antivirals (incivek) and antifungals.  This is due to the importance of keeping a minimum level of the med in the blood(kill level and kill time) at all times. Blood levels below 'kill levels' allows for the virus to replicate as well as 'morph' and produce resistance strains.  It is possible these strains could be produced during a 3month therapy.  So be as ridgid as possible-respect your MD advice (unless evidence to the contrary) and allow yourself to be human and not sweat 'the small stuff'.  Allow yourself to be human if you gett off timing or meals.  STRESS IN NOT A FRIEND to those on or off therapy.
Hope this helps.

Any 20GM

[asle]

Hi.
I just finished the Incivek part of 48 weeks of triple therapy treatment,  and all the literature and advice I received stated that Incivek should be taken 3 times a day, every 7-9 hours, with every 8 hours the desired time frame. It must be taken 20-30 minutes after a snack or meal containing 20 grams of fat is consumed.
Unless someone here on the forum has differing information or experiences, I do not know of this every 12 hours dosing.
Good luck with your treatment.

[CanHepa]

I just started on Incivek & Pegasys.
My very experienced gastroenterologist and RN told me to take my pills for both on a twice per day schedule. Therefore I take half of my pills after breakfast and the rest after dinner. (This seems to be the latest thing).
I think that trying to keep track of dosages and snacks 3 or 4 times a day thing would drive me crazy.

(Not suggesting of course that anybody change their schedule just on my advice; but do ask your doctors if every 12 hours would be okay).

[CanHepa]

Be careful with flax seeds. They have high levels of iron and that is not suggested for most people with a damaged liver.

[gopkrs]

Food Portion Fat (g.)

French toast

Frozen 1 slice 5.0
Homemade 1 slice 6.7

Pancakes and waffles

Waffles, frozen 2 (2.5 oz.
each) 7.0
Plain pancakes 4 (4") 7.6
Buckwheat pancakes 4 small 8.0

Granola 1 cup 33.1

Tartar sauce 1 Tbsp. 8.0
Cottage cheese, 4% fat 1/2 cup 4.7
Blue cheese 1 oz. 4.9
Ricotta, part-skim 1/4 cup 4.9
Feta 1 oz. 6.0
Monterey Jack, light 1 oz. 6.0
Mozzarella,
whole milk 1 oz. 6.1
Swiss 1 oz. 7.8
Brie 1 oz. 7.9
Ricotta, whole-milk 1/4 cup 8.0
Monterey Jack 1 oz. 8.6
American, processed 1 oz. 8.8
Colby 1 oz. 9.1
Cheddar 1 oz. 9.4
Cream cheese, regular 1 oz. 9.9
Low-fat, 2% 1 cup 4.7
Cream, heavy, whipping 1 Tbsp. 5.5
Whole, 3.3% 1 cup 8.2
Evaporated whole 1/2 cup 9.6
Strawberry shortcake 1 slice 8.9
Pound Cake (1 oz.) 1 slice 9.0
White Cake, with chocolate icing 1 slice 11.0
Milk chocolate, with almonds 1 oz. 10.1
Milk chocolate, with peanuts 1 oz. 10.8
Cookies and brownies

Gingersnap 1 0.6
Vanilla wafer 1 0.9
Fig bar 1 1.0
Chocolate chip 1 2.2
Doughnuts

Plain 1 (2 oz.) 10.8

Vanilla ice cream, premium 1/2 cup 11.9
Pastries

Apple turnover 1 oz. 4.7
Eclair, with custard and icing 1 13.6
Cheesecake 1 slice 16.3
Pies

Apple 1 slice 13.1
Custard 1 slice 14.0
Blueberry 1 slice 15.0
Chocolate cream 1 slice 15.1
Pecan 1 slice 27.0
Chocolate pudding 1/2 cup 4.0
Tapioca pudding 1/2 cup 4.0
Rice pudding, with raisins 1/2 cup 4.1
Vanilla pudding 1/2 cup 5.0
Custard, baked 1/2 cup 7.5
Corn or safflower oil, soft 1 tsp. 3.8
Mayonnaise

Low-calorie 1 tsp. 1.3
Regular 1 tsp. 3.7
Oils

Olive 1 tsp. 4.5
Vegetable 1 tsp. 4.5
Florida avocado 1 med. 15.4
California avocado 1 med. 30.0
Hamburger, extra lean 3.5 oz. 16.0
Hamburger, lean 3.5 oz. 18.4
Salami 3.5 oz. 19.9
Italian sausage links (3.5 oz.) 11/2 17.2
Bologna (3.5 oz.) 4 slices 19.7
Loin roast, lean and fat 3.5 oz. 21.5
Chop, lean and fat, broiled 3.5 oz. 27.0
Sausage patties (3.5 oz.) 4 30.9
Sausage links (3.5 oz.) 8 32.4
Chow mein noodles 1 cup 11.0
Duck

No skin, roasted 3.5 oz. 11.1
With skin, roasted 3.5 oz. 28.2
Cashews, oil-roasted 1/2 cup 31.4
Cashews, dry-roasted 1/2 cup 31.8
Pistachios, dry-roasted 1/2 cup 33.8
Almonds, dry-roasted, whole 1/2 cup 35.6
Peanuts, oil-roasted 1/2 cup 35.7
Sunflower seeds, dried 1/2 cup 35.7
Spanish peanuts, dried 1/2 cup 35.9
Filberts (hazelnuts) 1/2 cup 36.0
Pecans 1/2 cup 36.6
Persian/English walnuts 1/2 cup 37.1
Brazil nuts 1/2 cup 46.4
Macadamia nuts 1/2 cup 49.4
Salmon, cooked 3.5 oz. 7.5
Scallops, breaded, fried 3.5 oz. 11.4
Shrimp, breaded, fried 3.5 oz. 12.1
Onion ring, fried 1 3.0
French fries, frozen 10 pieces 4.4
Hash-brown potatoes, frozen 1/2 cup 9.0
Homemade Potato salad, (eggs and mayonnaise) 1/2 cup 10.3

[gopkrs]

39917.9 in reply to 39917.7  

Fatty foods:
20 grams of fat in;
3 TABLESPOONS OF PEANUT BUTTER
1 LARGE AVOCADO
1/2 CUP NUTS
2 1/2 TABLESPOONS OF OLIVE OIL
3 TABLESPOONS OF BUTTER
1 CAN OF SARDINES
2 OZ OF CHEESE
4 OR 5 SLICES OF BACON
2 CUPS OF WHIPPED CREAM
1 CHEESE OMLET
1 SLICE OF QUICHE
1 BAGEL WITH CREAMED CHEESE
2 1/2 TABLESPOONS OF ALMOND BUTTER
2 1/2 ANCHOVIES IN OIL
1 SERVING OF TAKE OUT CASHEW CHICKEN
1 SERVING OF CHOP SUEY WITH PORK
1 CUP CHOW MEIN WITH PORK
7 OZ FRIED RICE WITH EGG
1 CUP KUNG PAO CHICKEN
3/4 CUP TERIYAKI CHICKEN
2 OZ BANANA CHIPS
1 CUP BAKED BEANS WITH WIENERS
3 OZ BOTTOM ROUND STEAK (BRAISED)
3 OZ POT ROAST
3 OZ BROILED OR HAMBURGER MEAT
2 BUTTER MILK BISCUITS
2 CHEESE BLINTES
1 OZ BRAZIL NUTS
2 SERVINGS FRENCH VANILLA INSTANT BREAKFAST

[B1essed]

Ma'an!!  I just started this interferon program last night 3/29/13).  Trying to shovel down 1 quarter of a bagel with 4 T of peanut butter almost made me lose it.  Also, it's hard for me to picture the 'size' of a serving (e.g., cheese) that's equivalent to the necessary 20 gms.  Reading your post is DEFINITELY the ticket, and I can't wait to see more (but yours had the actual foods and measurements that I needed to 'visualize').  I so appreciate your post.  I look forward to seeing more.  If you have more suggestions for this 'rookie,' please share.  Thank you so much.

[has2bthe1]

Just wanted to add in a few bits of information that may help someone in their quest to finish the program with some eating tips.

I am finding that to stay balanced in this program that i have to go into the store at least once a week to seek different foods  so my taste buds are not locked into a bland taste. These are some of the things I have learned.

It helps to plan meals in advance and sometimes there are a few things one can do in times of a crunch. Now from what I have read one can fall behind no more than 4 hours on their dosages and after that just move on to the next one. If one falls behind four hours then best to re-balance dosages again until getting back on track. last minute catch up meals I can think of are:

1. 2 Tablespoons of peanut butter are equivalent to at least 30 grams of    
    fat of course depending on brand...well known brands are the ticket

2. 2 Pecan Sandies cookies are 15 grams of fat X 2= 30 grams of fat for
    a night snack....add or without milk

3. Those instant lunches...noodles....Maruchan...are 18% grams of
    fat...in a cup...so one and 1/2 times those are 27 grams of fat

4. 1/2 cup of walnuts...are equivalent to 16 grams of fat...so X 2= 32
    grams of fat

5. 1/2 cup of ice cream = 17 grams of fat...so 1 whole cup equals 34
    grams of fat

6. Ice cream drumsticks are 25% fat...so one of those as a snack works

7. In sandwiches...1 tablespoon of mayonnaise equal 18 grams of fat...for
    me it almost takes one tablespoon of mayo foe each slice of bread..
    for me it about takes 1 tablespoon for each slice of bread....so egg
    sandwiches in the morning with turkey bacon....or those who eat
    regular bacon are safe with a bacon and egg sandwich with or without
    cheese for breakfast....cup of coffee with or without cream and sugar

8. Hersey's kisses...have 18% fat...if 7 of them are eaten......

9. 16 potato chips are 17% grams of fat....you'd be surprised to know that
    eating 24 chips is nothing....

10. Then there are certain soups...like Progresso...broccoli, potatoes and
      cheese have 18% grams of fat....soup and sandwich.....

11. Hershey's chocolate bars...the small ones....5 will get you 17%
     grams of fat...and a glass of milk...Hershey's chocolate in milk?

     Just some ideas to help. Breads are important....eating salads with
meats such as chicken and fish. The salad dressing brings the fat. Then the chicken....and whatever else prepared. salad dressing depending on the brand can bring about 17% or higher grams of fat.

Fried foods, mashed potatoes and gravy are good. Properly mixed shakes are good.

Strawberries, marinated in sugar and water to go over ice cream...or strawberries and whipped cream.

These are just some ideas to help with the other examples above. Hope they help. May add to the list later as I learn more. This was a  problem for me when I first started. then I became a label reader and started going into grocery stores more often, and planning my meals at times. I am making very good progress as my doctor states and I wish  the same for everyone else in their recovery.

For those that have iron issues, Geritol      

[stormy456]

Sorry, but you absolutely need that 20 g.   It's definitely tricky.  We buy the bars at the healthfood store, they're sold in the refrigerator case  next to the probiotics, and Udo's oil.   They really are delicious and travel well.

[pooh55811]

According to the literature, your doctor is mistaken. You need that 20 grams of fat with every dose of Incivek.  The fat is critical for getting the most from your Incivek.

"The usual dose of Incivek is 2 tablets taken 3 times per day, every 7 to 9 hours."

"Take Incivek within 30 minutes after eating a meal or snack that contains about 20 grams of fat. Always take Incivek with food. Examples of snacks that contain about 20 grams of fat include: A bagel and cream cheese, 3 tablespoons of peanut butter, 2 ounces of American or cheddar cheese, 2 ounces of potato chips, a half-cup of nuts or trail mix, or 1 cup of ice cream."

http://www.drugs.com/incivek.html

And this:

"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.rxlist.com/incivek-drug/clinical-pharmacology.htm

[angelina7777]

Where do you get those Flora truffle bars? Whole Foods? About to start treatment on Tuesday and getting really scared. My Dr. said I didn't need 20 Grams of fat??? with the incivek

[micheall]

Wow an old post but great info.Called incivek and debated with them on the 20 grams.Well it looks like I will be doing about 15-20 grams of fatty food,which the body likes to absorb.I already gained 5 lbs in 5t week.I lost 33 the 1st tx,gained about15 the next 6 months,and now gained another 5.I found bagels and peanut butter hard to digest,especially before bed.I changed to high fat ice cream(no problem for an ice cream lover),doughnuts,fatty pudding,home made baked mac+cheese,dropped egg on toast,ritz crackers+peanut butter(not just peanut butter alone),waffles loaded with maple syrup,pop corn,hot chocolate,tuna,pizza,croissants,etc.There is no getting around the fatty foods,so if you have any strength left,exercize.MIKE

[stormy456]

Hi- Best (and healthiest) thing we've found are Flora Truffle bars infused with Udo's oil (Omega 3-6-9) 3 small squares is 21 g and it's good for you.  The Hazelnut ones are particularly yummy.   Easy to take when nothing sounds good.  My husband has a bunch of ideas on his blog under the "Feed Me Seymour" posting - www. hep-free.com.  I think he lays out his entire day with meal ideas.  Seems to be working for him - although at this point (6 weeks) eating anything is a bit of a chore :(

[HippyHal]

Oh, and almond croissants, or regular croissants with butter and strawberry jam are both ove 20. A full cup of granola with whole milk makes it (easier for me in the am as I seem to have "dry mouth". Sausage and egg biscuits, full fat "Mediterranean" yogurt and some almonds get there.

If you have a "Whole Foods" store close by, it has some great healthy alternatives.

I also suggest not buying 20 of something you like right away as (in my experience) your tastes change every couple of days and I was throwing stuff out.

On to my nightly Incivek dose. Peace all!  (and sorry Steeler fans, but way to go Tebow!).  :)

[HippyHal]

My Dr specifically told me to take the RIBA and Incivek together first morning dose. I would not freak out on that one. Obviously check with your Dr (I'm going to ask the question, but am not concerned)

Cheers.

[3rdTimeWinner]

My Dr. told me not to take any supplements with this treatment...(if flaxseed oil is considered a supplement)
please ask your Dr. first!
All the best to all of us :)

I'm glad to have found this forum.

[hrsepwrguy]

stick with 6 am riba dose I take dose 2 when i eat a lite dinner around 6 helps with the insomnia Alatyr mentioned  

[halbev]

Well I glad I read this! because I have been doing the same thing taking I Incivek at 6:00am -2:00pm and at 10:00pm and my Ribavirin at 6:00am and 10:00pm never thought about it, I will adjust it, but I do not think it matters that much with the Riba. They say it stays in your system for 6 months after your last dose. I think I have a little FOG going on here I did 2 Interferon / Riba treatments end to end 6 months before going on Incivek and was UND at week 4 so it cannot matter that much.

[hrsepwrguy]

Your nurse is right

[Alatyr55]

My nurse said the riba didn't have to be taken exactly 12 hours apart.  I've been taking it at around 9 or 10 in the morning and 6 or 7 at night.  The later I take it the worse my insomnia seems to be.  Nurse also said that I should eat before taking the riba but doesn't have to be food high in fat.

[hrsepwrguy]

7 to 9 hrs apart includes the over night time span

[qhb]

I started the Incivek a week ago.  This is my second round of therapy--did the full 48 weeks the first time on the pegasist and the ribovirin and the virus disappeared until 3 months post treatment--so I'm hopeful this time will be better.  I too am battling nausea.  I'm better off eating regular food than sweets.  I tried candy bars and cookies and milk and felt awful.  I like a loaded baked potato with butter, some shredded cheese ( 1 tbsp of butter is 11 grams of fat alone), maybe a little bacon.  For breakfast, a couple of eggs, a slice of toast and butter and a glass of milk get me to my 20 grams of fat and I don't have to choke it down.  I really gagged trying to eat enough peanut butter.  I'm dosing at 7:30, 2:30 and 9:30.  My instructions were to take it every 7 to 9 hours, so I'm opting for 7 hours.  From past experience, I know I will struggle to stay awake until 9:30.  Glad to see what others are doing and experiencing. Don't feel so alone out here.

[avians]

The people who make Incivek are offering help with co-pays. I know this because a very helpful nurse where my meds come from, set me up on the program. I don't know how easy this is but I urge all of you that have issues with your co-pay to contact your insurance co, your Drs. office, pharmacist and the manufacturer if necessary. You need a ref. # from the comapny in order to use it.
I hope this helps someone.
I tried to seperate the incivek and ribo (8hrs-12hrs). I don't have that many alarms.LOL 3 on my watch, 3 on the phone and that confuses me. I'm back to taking ribo with Incivek at 16hrs
I'm still working on this fat thing. I'm starting to gag. I don't feel like cooking so it's mostly what I can cram in my mouth. Lot's of peanut butter.
I do have to say I'm inspired by this group. I must be a total wimp because I could never take this treatment AND work. You are all wonderful and strong and I wish each and every one of you the best. This time...it's going to work!!

[elpasolady]

oh, and as far as fat foods, I too, am leaning more for the healthy nutritious ones as much as possible.
Avocado w/ tomatoes on whole grain bread
Hummus with baked pita chips
whole fat yogurt with fruit
organic peanut butter with flax seeds
cinnamon muffins with cream cheese
homemade almond milk
trail mix
of course, permission to eat ice cream treats is kind of awesome.  I found the haagen das snack bars, coffee almond crunch, yummy
Also, a much healthier option is a Rice Dream ice cream cookie sandwich.  Made with rice milk and all whole grain ingredients....it was really really good, Found it at our local health food store.

[elpasolady]

Well now, I guess we all have some different info and its confusing the dickens out of us.  I researched quite extensively about when to take the Riba. Even on the package insert, it states to be dosed twice daily.  It does NOT say it has to be 12 hours apart.  The phamacist who is supplying my triple therapy meds who has been doing this for 12 years, told me as long as the two doses are 8 hours apart, it's okay.  
With all this in mind, I started on Wed, this week and am taking my morning and mid-day Incivk with my Riba together.  It works well as I  have just eaten my fat grams and both need to be taken with food.  I take them at 6:30 and 2:30.  Of course, my last incivek dose is at 10:30.
I don't think anyone here needs to be too concerned that they are dosing wrong with  the Riba, as long as the Incivek is approx every 8 hours.
Before the Incivek came along only a couple of months ago, , it made sense to space out the Riba more evenly because there weren't any other pills to take,  The Riba has a much longer half life from what I understand and will stay in your body longer, thus the 2x a day dosage.
Does anyoner really know with absolute certainty?  I think not, based on all I have learned.

Good luck to all.....