Medication reduction already

[PJ1966]

I just started treatment and had to go into lab yesterday to get blood redrawn due to a bilirubin spike after one week.  Common according to my doc but he wanted to make sure.  Sure enough the RBC is starting to go low.  He had to reduce my dosage due to low RBC (3.45), hgb 10.3, hct 30.3, RDW 14.5%.  Bilirubin went retest came down to 1.9.  It's getting better since it went up to 4 after one week of tx.  I'm on triple tx and started with 1200 mg daily riba, but doc cancelled my evening dose yesterday so only took 600 mg yesterday.  Today he has me on 300 mg (1/2 pill) until I get my 200 mg pills in the mail which he'll have me take 2 per day.  I'm only on day 16.  My viral load was:
12/5/2011 344933
7/13/2012 371829
7/30/2012 259914  (start of tx)
9/5/2012   284 (one week on tx)
He's hoping I was undetected end of week 2 which was Wed.  I won't get the results for one week so we don't know for sure.  I guess the reduction in riba is okay if I was undetected.  If not, not sure what that means, but the doc said he couldn't take the chance of my blood getting too low.
Platelets are good so far at 229.
I just thought I'd give my results as I just started and am already disappointed on having to reduced meds, but understand the blood issue can get out of control quickly and he didn't want that.  This is my second time on tx but first time was in 2005 and only the interferon/riba.  I had to do procrit a lot last tx so I have had low RBC & WBC before.  So far my WBC is okay.  I was a responder but relapsed.  Hoping for the best.
thanks to all for your support and advice.

[frijole]

i see you are a quilter,  me too.  i put a couple of pics of my quilts in my photos.  I did not have energy to quilt when I treated.

[frijole]

I have to agree with most of the posters in thinking your doctor got a little radical on the riba reduction.  What was your starting hgb anyway?  A 2 point drop can be pretty devastating and you may have had a 4 point drop.  The doctor does have you on weekly CBCs, right?  You need to know when you can increase your riba.  

My insurance company approved the procrit okay (with a little glitch) and later they would not approve it until I had reduced riba.  But as soon as the doc told them I reduced they approved without time to have any results from the reduction.  Insurance companies are way behind on this.

I hope you are able to increase the riba soon.

[PJ1966]

I do have fatigue, dizziness and shortness of breadth.  I'm down & resting.  He called Curascript right away, but they didn't mail it today.  I was pissed off & calling my insurance to see why I must deal with them instead of the company that my doctor wanted to use.  He usually deals with Greater Sacramento Pharmacy and swears by them.  Thanks for everyone's comments.  I'll talk to my doc more about this.  He is an internist at UCSD.  This department treats all Hep C patients.  He completed a clinical fellowship in Addiction Medicine and Viral Hepatitis C at Weill Medical College of Cornell University. His clinical research involves Hepatitis C in opiate dependent patients.  I did talk to him about protocol of anemia and he told me upfront the first line is reduction of Riba.  He wants me fully on incivek for full 12 wks.  Thanks for your comments.  I'll talk to him more.  Appreciate your help.

[pooh55811]

A Riba reduction of 1200 mg to 400 mg would scare me to death, especially at day 16. An incremental reduction from 1200 mg to 1000 mg and starting Procrit would be my option if it was me. I would even take a blood transfusion if necessary. My Hgb dropped to 10.2 and I never reduced anything.

I know this is early in your treatment (day 16) and it appears the doctor is nervous about the Hgb drop, but I still think it is a drastic reduction. He does not even know if you are UND yet. Even being UND does not mean the virus is gone. It simply means the test cannot count find it.

Is this doctor a Hepatologist or a GI or a Primary Care Physician. If it was me, I would discuss this with the doc and if he insists on only 400 mg a day, I would find a Hepatologist who tries not to reduce Riba anymore than absolutely necessary and who uses a combination of treatment (including Procrit and blood transfusions) so one can stay on an adequate dose of Riba. (Actually, that is what I did when my Hgb started to get near 10.  

It is true that they concluded that Riba reduction did not impact SVR, but they were not specific about how much it can be reduced, at what point in treatment it can be reduced, and how long  it can stay reduced.

[can-do-man]

Treatment Outcome T12/PR
N = 363
n/N (%) Pbo/PR48
N = 361
n/N (%)
Overall SVR 79% (285/363)
46% (166/361)
eRVR 58% (212/363) 8% (29/361)
SVR in eRVR subjects 92% (195/212) 93% (27/29)
No eRVR 42% (151/363) 92% (332/361)
SVR in no eRVR subjects
60% (90/151) 42% (139/332)
Outcome for Subjects without SVR
On-treatment virologic failurea 7% (26/363) 29% (105/361)
Relapseb 4% (11/298) 24% (53/220)
Otherc 11% (41/363) 10% (37/361)
----------------------------------
As one can see response was... eRVR 58% (212/363) 8% (29/361).
So a doctor is " guessing, hoping" your und at week 2 yet only 58% was at week 4............

  

[working dog]

i wish i was 10hgb at day 16.......week 4 is a big one to get through