Riba reduction?? Solvadi/Riba GT2

[Mattsmom218]

Hi all, I am still waiting on my viral load (4 wk bloodwork post tx). I rec'd my CBC and my hemoglobin went from 11.4 to 9.6 in two weeks. Well, the physicians assistant wants to cut my Riba in HALF! I told her that I don't feel comfortable doing that without knowing my viral load. I hope to get those viral load results tomorrow. Now I am feeling tired more, out of breath but it's not unmanageable-yet. I'm on 1200 mg Riba and I was thinking maybe just cut back one pill in the morning and one in the evening. The PA assured me that it won't affect SVR. I'm in my 5th week of treatment.

Has anyone done this before? Thank you!!!

[hepc4Sandi]

Glad you only reduced by 1 pill, it should make you feel a lot better right away. My doctor did CBCs a lot to keep an eye on my hemoglobin. I have aFib, and I think the hemoglobin level had an effect on it. I am/was 164 lbs, so my starting level was 1,000 mg a day for the Riba. I still have a partial bottle left.

[Mattsmom218]

No cirrhosis. I'm on treatment for 12 week and finishing up week 5 now. My baseline HGB was 14. Feeling great!!!

[Mattsmom218]

I REC"D GREAT NEWS TODAY!!! NO detected virus after 4 weeks!!! yay!! I am on cloud 9!!! OK, so I only reduced  RIBA by 1 pill so I'm taking 1,000mg. I weigh 185# so I should be fine. I have another CBC next Friday so we will see how this slight reduction affects my hgb. I see my Hepatologist this Friday and we talk more about it and my prognosis. SO HAPPY!!!! ((hugs)) to you all!!! I am so grateful for this forum, you all rock!!

[nursehepc]

I had a 4 point Hgb drop in my first 2 weeks of treatment (14 to 10) on Sovaldi and 1000 mg of RBV. Reduced RBV to 800 mg for the last 10 weeks of the 12 week treatment and was SVR 12 weeks post. I was told when I expressed concern over the RBV reduction that sovaldi-based treatments where RBV was reduced have not shown a decrease in SVR rates and that my quality of life would be alot better with the RBV reduction.

Good Luck. Jo

[JimmyMose]

Best wishes finishing tx and achiving SVR.

What was your hgb baseline before tx start?  11.4 2nd week. 9.6 4th week. Do you have any CAD related desease?   RBV has a half life of 12 days so  provider may have a good reason to reduce dosage.  After you next blood work or two you may be able to increae dose.  You could ask PA to get an opinion from a hepatoligst.  

[jules2551]

Such a controversial issue when most of us were going through triple therapy treatment.  And I know a couple of people on this forum kept stats on the people who failed or relapsed tx and they also reduced their Riba dosage.  The numbers were staggering who failed/relapsed tx due to Riba reduction.  

First I would talk to my Dr and not my PA about this dose reduction.  Sometimes the PA get on their high horse and think they know everything when they don't.  They are still learning.

Also agree with Pooh in asking for Procrit instead of cutting the Riba dose so drastically.  

Good luck! Jules

[pooh55811]

I agree with Can-do-man. It's a very big reduction.

The AASLD is very clear that the Riba should be weight based dosing. If Riba was not important, they would start at a lower fixed dose or not order it at all.

"The PA assured me that it won't affect SVR"

Some medical professionals make unsubstantiated statements. Ask her to show you the studies that prove that cutting the Riba dose in half at 5 weeks into Sovaldi/Riba Tx will not affect SVR.

I recall reading that they did some studies with various doses of Riba and those on the lower dose had lower SVR rates. I am trying to find those studies and will post the link when I find them.

You could also ask them about giving you Procrit to raise the Hgb instead of cutting the Riba dose so drastically.

[can-do-man]

Seems like a huge dose reduction to start out with. If Riba wasn't important then they wouldn't include it. I agree with patra that a slight reduction to begin with would be better.

"The PA assured me that it won't affect SVR"

Then I would ask her why not just start at that dose?

Wishing you the best

[Ekkiemom]

I wouldn't be concerned about the lowering of the dosage. As my Hepa explained to me, these new drugs are so powerful and targeted to the virus you will soon see no Riba used in the very near future.
I had a 200mg adjustment and I feel extremely confident that I will remain UND and sustain viral response
Take it easy and dont worry, ok
Peace to you
Deb

[hepc4Sandi]

I cut back from 1,000 to 600 in the 2nd third of Tx, then was raised back to 800 on the last third of Tx. My hemoglobin responded right away with the reduction. I was told that the Riba does it's heavy hitting on the virus the first part of Tx. I SVR'd too.

You do have a voice in your own Tx. I had to request my doctor to raise the Riba back up on the last third.

Do you have cirrhosis? What is your weight? 12 or 24 weeks? Is your Riba dose proper for your weight?

Good luck.

[patra_]

Hey, I was on Sol/Riba and had a drop to 8.8 in my Hmg.  Dr also proposed lowering the Riba, but only to 1000mg, (taking away 1 pill per day). Was able to avoid the reduction, but I am in a position that I could stay in bed most of the day if I had to, and the ONLY symptom I had was the fatigue.

A number of people had the Riba reduced, some to 1000 from 1200 - some to 800 from 1000 - some who had other complications, to anywhere from 600mg per day, down to 200.  I know that several went on to SVR.  A couple did not, but a few who took their full doseages also didn't achieve SVR.

If you have a hepatology specialist, I would surely ask for his/her take on the doseage.  I am sure others who experienced this will have info for you, too.

not a definitive answer, but only you and your Dr can do that.

Good luck, and Good treating-- and on th SVR!

Pat