What is a good dosage of ribaviron for geno 1 with the new treatment drug Incivek?

[cindyh113]

I have done the peg/riba treatment once. With 1000mg of riba per day. With this new drug Incivek, my dr. has me on 800 riba per day. Is this enough dosage. He said he would increase the amount after the Incivek.

[TeeTom]

Hey John, I am on the incivek triple therapy and in week 7. My dosages are as follows, 7:30 am 3 inciveks and 3 ribbas, 7:30 pm 3 inciveks and 3 ribbas, thats a total of 2250mgs of incivek and 1200mgs of ribba. I take a 180ml shot of interferon at 7:30 am every friday. This is my second tx, I relapsed on the first one with SOC.

[jpinthekeys]

I just wanted to let you know, Went to the doctor on thursday and he was
very glad That thanks to you all Was able to correct the dose to 1200 mg.
I thank god for this forum as I have gotten quite an education.
I think it is very important to be involved in our treatment and ask plenty of questions.
        
       I started with my shot thursday night and the riba and incevek driday morning, I have been drinking about a gallon and a half of water, plenty of fat with incevek. So far today has been the worst with 101-102 fever and taking tylenol for that.

  I will be as active here as possible but I read the posts of the regulars every day,  Again thanks-----John

[cindyh113]

Thank you! Yes, let me know what he says. Wonder if the riba I have would still be good. Left from 2009.

[cindyh113]

Thanks! I will be going for the Loperimide! I have it all including bleeding! My dr. did prescibe a cream which I just started. Doing the baths but will step it up a notch with the details.
I will get with my dr. on the dosage. I do have some left from 09 when I did the tx and would be enough to get me through 12 weeks. Just not sure if it is still any good.

[jpinthekeys]

  
   Thank you all for your in-put.
I will try the doctor however he is only there once a week and although a good doctor, he is the type that is open to correction.
  I do have almost enough riba from the last time to make up the extra 200mg. It is from the peg-intron manufacturer but still ribivirin same as the copegyses, Excuse my spelling.
                 Thanks again for the info

[can-do-man]

Again it goes back to what could be total treatment time, 24 weeks with a 4 week und or 48 weeks if not

[pooh55811]

Sorry for the repetition. I am a slow typist and 2 people got 3 posts in before I finished typing, lol.

[willbb]

Agree...1200 at the very minumum.

[pooh55811]

You said you weigh 200 pounds. If you convert 200 pounds into kilograms, it converts to 90.9 kg (so 100 kg as a round figure).

http://www.manuelsweb.com/kg_lbs.htm

You are well over 75 kg. Therefore, according to the dosing recommendations, your dose is insufficient.

Table 1 PEGASYS and COPEGUS Dosing Recommendations

Genotypes 1, 4 COPEGUS Dose (daily)
<75 kg = 1000 mg      ≥75 kg = 1200 mg

http://www.gene.com/gene/products/information/pegasys/pdf/copegus_pi.pdf

If it was me, I would call the doctor and get the dose increased to the recommended amount. I would want every possible chance for success and I would not want to start out taking a lower than recommended dose.

[can-do-man]

Agree with hrsepwrguy......... 1200 should be your dose

[hrsepwrguy]

IMO being a relapser I would want to be on the full suggested dosage

[hrsepwrguy]

200 lb = 90.7184 kg

So riba protocol for geno 1 would be 1200 mg

[jpinthekeys]

I was reading some of the info here on starting doses of Ribi.
I will be starting my meds monday, so I wont see the doctor again for almost 2 weeks.
I weigh about 200 lb and the starting dose is 1000mg @day.
I was a relapser in 2007, I cleared it early but viral load spiked back up so I am starting the triple with incivek. In your opinion is 1000 enough due to my weight?? I dont want to do anything against dr, orders but do have a few bottles of riba left from last treatment, Anemia was not a issue last go around.
                     Thanks  John

[hrsepwrguy]

pooh55811  
May 17, 2012 .To: catmagic0406.You may not get the anal symptoms. Many do not. Even if you get hemorrhoids and diarrhea, you still may not get the internal "shards of glass" pain. Most don't get that internal pain.

But I got all threee, lol, so here is my list:

Hemorrhoids:
1.  Get Huggies Baby Wipes with Aloe
2.  Clean completely after each BM (get in shower, stiz bath whatever, Huggies wipes) asap
3.  Dry completely -  with hair dryer. Set it on low heat.
4.  Preparation H cream (external)
5.  Preparation H suppositories (interna,l soothing)
6.  Xylocaine cream with hydrocortizone (presciption)
7.  Tucks (if the reactal area is irritated these may burn/sting)

Burning Diarrhea:
1.  Drink plenty of water
2.  Eat at least the 20 grams of fat with each Incivek
3.  Loperimide as needed (at first sign of soft or loose stools) (I took one when I started cramping because I knew the diarrhea was just around the corner)
4.  Keep stools firm (I did this with the Loperimide but others use fiber ... be sure to get fiber that won't bind with the Incivek if you decide to use fiber)
5.  Keep area clean as noted above
  
Skin irritation from burning diarrhea :
1.  Keep area clean
2.  Warm showers or hand held type shower
3.  Sitz baths
4.  Dry with hairdryer
5.  Desitin cream to irritated area (also A&D ointment, Baneal soln., Butt Balm, probably others, to protect, heal, soothe area)
6.  Xylocaine cream with hydrocortizone (presciption)

Internal "shards of glass" pain (which you very well may NOT get):
1.  Keep Stools quite firm with Loperimide (or fiber)
2.  Eat at least 20 gms of fat just before each Incivek dose
3)  Prescription suppositories that help relieve this pain.  

I had the internal shards of glass pain only when I had diarrhea or soft stools. There was zero internal pain if my stools were firm. Topical external remidies will do absolutely nothing for the internal shards of glass pain (caused most likely from internal fissures which are caused by the internal burning diarrhea). For me, the only solution was to keep the stools quite firm. This worked exceptionally well (once I figured it out).

I do not think specific foods will help firm the stools in this situation. I think Loperimide or some firming agent is needed. Getting plenty of fat seems to somehow blunt the external burning a bit. Not sure how that works.

Hopefully your side effects will be mild and maybe you won't get any issues. It is good to be prepared, though.

Hope this helps.

Follow the link for more info

http://www.medhelp.org/posts/Hepatitis-C/Incivek-and-Anal-Dragon-Fire/show/1737083#post_7963120

[can-do-man]

Another thing to touch on is treating time. Depending on your last treatment and liver conditon, if you are und at week 4 then your only looking at 24 weeks if not then 48 weeks thats why its important to knock it down fast as you really want a 4 week und. Tell him you want to give it your best shot now.

[willbb]

Hi cindy..
As you can see from the prescribing protocols above the dosing that was used in trials for Riba was  for<75 kg ( 165 lb. )  1000mg.

Doing 800 mg is not overly underprescribed  for  64kg.(140 lbs) however it is on the lower end of the ideal amount.

Especially given the fact you are a previous non resounder or relspser (you did not mention which )
Personaaly I would want to do re-treatment with the maximum amount of the drug within prescibed limits and for you that would be 1000mg,,

In light of th fact your HGB  has not decreased " below "anemia levels I would tell this doctor that in no uncertain terms I would want to do the treatemt the way it was prescribed in trials and  nowpatients clinically for mazimum effect..


If he is worried about HGB drop then the proper protocol for that is to do CBC's often..

Possibly take him in a copy of the prescribing document that was copied for you above ,,show it to the doctor and tell him you demand he prescribe the proper amount of medication.

Good luck
...Will

[cindyh113]

One more problem. I have diarrhea and hemroids already. Just started this past Sat. Dr. said I was not eating enought fat but I was eating a whole avacado or 3 large spoons of peanut butter each time. It is so bad I am bleeding. Dr. sent in a prescription and doing baths moring and night.

[cindyh113]

He is the only act in town basically. I have doubted the way he did somethings in the past. When I came off the tx the last time my white cell count remained low for a year before I finally found a primary care dr. He made no attempt to refer me to a dr. and it wasn't until I began having some real issues I found a dr. Ended up with lupus.  I weigh 140lbs. The last time I started out at 150lb. Still the insert says geno 1 should have 1000mg.
I not sure how to question him again on this.

[cindyh113]

Are you SVR? I really am concerned 800 might not be enough. I weigh 140lbs. And the last time with peg/riba it was 1000mg. I questioned my dr. to make sure. He said it was because I would become anemic quickly but my red cells were fine the last time, had a low white cell count.

[pooh55811]

I was on Peg., Riba and Incivek for 12 weeks and now am continuing with just Peg and Riba. I have always been on 1200 mg of Riba a day.

I agree with Can-do and Hrsepwrguy that it seems like your doctor is doing it backwards. You should be at the recommended dose for you weight starting at the beginning of treatment. I never heard of starting at a lower dose of Riba while on Incivek and then increasing it after finishing Incivek.

It is my understanding that the idea is to hit the virus with everything you have at the beginnning and knock it out as fast as possible so it cannot develop resistant strains.  

Is your doctor knowledgeable and experienced in treating Hep C patients? If not, you probably want to get a second opinion ASAP.

[Dee1956]

Hi, yes I was on 1000 mg a day with my first tx.  The Incivek tx  is weight based and I was on 800 for that.  Like you I was also concerned I was not on enough, the doc explained
Good luck to you.

[BoceprevirGal]

I am on Triple Tx with Victrelis, and take 1,200 mgs of ribasphere (ribaviran) a day. I dont have a problem with that dosage, and I weigh about 165 lbs, and I'm 5'8''

[hrsepwrguy]

DOSAGE AND ADMINISTRATION
2.1 INCIVEK/Peginterferon Alfa/Ribavirin Combination Treatment
The recommended dose of INCIVEK tablets is 750 mg (two 375-mg tablets) taken orally 3 times a day (7-9 hours apart) with food (not low fat) [see Clinical Pharmacology (12.3) and Patient Counseling Information (17.4)].
For specific dosage instructions for peginterferon alfa and ribavirin, refer to their respective prescribing information.

http://pi.vrtx.com/files/uspi_telaprevir.pdf

The daily dose of COPEGUS is 800 mg to 1200 mg administered orally in two divided doses. The dose should be individualized to the patient depending on baseline disease characteristics (e.g., genotype), response to therapy, and tolerability of the regimen (see Table 1).

Table 1 PEGASYS and COPEGUS Dosing Recommendations

Genotypes 1, 4 COPEGUS Dose (daily)
<75 kg = 1000 mg      ≥75 kg = 1200 mg

http://www.gene.com/gene/products/information/pegasys/pdf/copegus_pi.pdf

I agree with can-do it would seem your doc is going at it backwards

[can-do-man]

Dosage is based on one's weight and then reduced once one beomes und IF needed, Besides in the trials they always used at least 1000. Lower dose riba to start out with is a first, plus it didn't work out to well in prior trials.......... Sounds like he's doing it backwards.

Best to you