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Hepatitis C Main Forums => On Hepatitis C Treatment => Topic started by: rkevins on May 07, 2016, 12:27:02 pm

Title: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on May 07, 2016, 12:27:02 pm
Hi

I’m starting a 12-week course of Harvoni on Friday the 13th.

I'm curious what others think about:

—I’ve been taking Milk Thistle for years. Recently started taking Turmeric. I’m thinking I’ll just take a break from them while on Harvoni.

—Any info links to good diet choices? Should my regular diet be modified?

—Which foods are especially bad to eat? Eggs, fried foods, sugar products like chocolate, ice cream, molasses?

—I have been using the nicotine patch after having smoked for 40 years and ‘stopped’ many times. Is the patch ok to use?

—Which pain medications are allowed? Tylenol is ok but not Ibuprofen?

best
rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: brie41 on May 07, 2016, 02:28:06 pm
Hi rkevins,

  Welcome!!  I know I had to meet with my Doctor a few weeks before starting to go over all medications and things to avoid.  Less is best.  They told me to not even take my calcium chews.  Drink plenty of water throughout the day and try to take your med at the same time everyday.  I set my phone alarm for that.  As far as diet goes, I think you can't go wrong with eating as healthy as possible.  Some of us literally have no side effects.  I had some the first few weeks, but nothing terrible.  Some fatigue and mild headaches.  I have felt great since then and only have 3 more days left on a 8 week treatment.  You are in good hands here!!  Brie
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: KimInTheForest on May 07, 2016, 04:56:10 pm
Hi rkevins, and welcome to the forums and to the Harvoni journey!

As for your questions, if it were me, I would stop taking milk thistle or other supplements during treatment just to ensure the drugs are able to work as intended. I don't know that milk thistle presents a problem in that regard. But why risk it when treatment is relatively short and so expensive?

As for your list of foods, some people experience pretty severe heartburn while on Harvoni, and some of the foods on your list are known for triggering heartburn - fried foods and chocolate for sure. I am not sure about the others. I had never experienced heartburn before Harvoni, and when my first bout came, I thought I was experiencing a heart attack and would have to drive myself to emergency in middle of night. But I slowly figured out it was heartburn. Very painful.

One thing to be especially careful with is tums or similar antacid. Don't take it 4 hours either side of harvoni.

Good luck! :)

kim
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Lynn K on May 07, 2016, 06:57:27 pm
If you do not have cirrhosis all pain meds are fine it is just that those with cirrhosis are at increased of bleeding internally. Tylenol is fine as long as you do not exceed 2000mg per day.

Other than tums etc the other types of acid reducers are also a problem ie Pepcid AC Tagamet Prilosec and nexium as some examples if you take any type of acid reducers there are very explicit metrication as to how to take with Harvoni. For example if you take Prilosec it must be taken at the same time with Harvoni on an empty stomach.

I get a lot of heartburn because I have  hiatial hernia with GERD. I normally take Prilosec but gave up taking it for my 24 week treatment. Suffered through a lot of heat burn let me tell ya.

Good luck on treatment
Lynn
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on May 07, 2016, 08:23:46 pm
Thanks Brie41, Kim and Lynn for your replies!

I'm very happy for this opportunity and will do my best to make the most of it.

I'd love to forego the patch, but that will be the toughest part.

I'm a bit surprised my doctor didn't schedule an appt to go over everything; I'm looking for resources on the web, and this place is a great start.

Thanks again.

rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: morab on May 11, 2016, 06:08:00 pm
rkevins
I have had gastro problems while on the drug. The things that bother my digestion so far are meat, especially beef, acidic drinks like lemonade.
I am eating a fresh farm egg fried with toast every morning with no problems
I am also drinking a milk shake made with chocolate ice cream almost every day.
Both of these things seem to settle well with me.
I have found that small amounts of food at one time works best in avoiding the severe bloating, gas etc. I was getting the first 2 wks of treatment.
Hope this helps.
Morab
PS my GI specialist did not go over anything with me prior to or after starting treatment, I am finding this rather strange so am counting on my GP for everything here to the EOT. good luck! keep asking questions here..
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on May 11, 2016, 10:40:40 pm
Thank you, morab, for the reply! Hearing your tale is much appreciated. It's good to hear others' experience. The little things are big!

best
rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Paddy-O on May 12, 2016, 03:07:22 pm
The pharmacist I met with for pre-treatment consultation (who has been involved in dispensing Hep C meds for over 600 cases) did mention supplements for the liver such as milk-thistle. He advised against such items during treatment.
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: morab on May 12, 2016, 05:19:37 pm
rkevins
Tomorrow is you big Day 1 starting treatment, wishing you the best on your journey!
One food item I did change was the pasta, which I love. I switched to gluten free brown rice pasta, less bloating and you still get to have that pasta when you want it.
Keep us posted,
we are all in the same boat.
Morab
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on May 12, 2016, 06:15:56 pm
Hi Morab,

Sorry, delivery date changed so I will start Sunday.

Thank you for your best wishes and diet info.

best
rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on May 14, 2016, 08:42:54 pm
Hi,

I'm starting Harvoni Sunday and must choose when to take it. I'd prefer mornings with breakfast, thinking that, if problems with bloating, gas, etc arise, being in an upright position during the day is better than being prone for the night a few hours after taking it.

What is your experience or suggestion for morning/evening?

A complication is I take Fosamax (70mg) once a week (osteo issues). I could try taking Fosamax in the evening, but since I often eat breakfast 3-4 hours after rising, maybe I could take Fosamax immediately upon rising, and Harvoni with breakfast 3-4 hrs later.

Any opinion?

regards,
rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: morab on May 14, 2016, 10:33:14 pm
I take mine after breakfast at around 9 AM for that reason.
Although you might ask a few others as I notice on this site most seem to take it at bedtime to sleep through the/ if any side effects.
Good Luck welcome to the club!
Morab
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Lynn K on May 14, 2016, 10:43:08 pm
Just whatever time you can consistently remember to take it at the same time every day is best. Harvoni can be taken with or without food. If you find you don't like the time you chose you can move it to a different time over the course of a day or two.

I work second shift and took mine at my first break at 5 pm which would be like 9 am for day workers

Consistancy is what matters most
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: J.R. on May 15, 2016, 02:12:48 am
My journey was uneventful. Outside of a "headbuzz" for 1-2 days when I first started treatment. Taking Harvoni felt like I just added another vitamin pill to my daily regiment. Oh, and I took mine when I awoke in morning.  No side effects at all
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: gnatcatcher on May 15, 2016, 03:02:27 am
I took mine at 6 a.m. with 8 ounces of water; breakfast was 2 or more hours later simply because I try not to eat breakfast before 8 a.m. No difference in methane production while I was on the Harvoni (and only very few, very mild intermittent side effects).

As for timing your weekly Fosamax, best to check with your doctor or pharmacist.

-Gnatty
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on May 15, 2016, 11:08:50 am
Thanks, Ever'body, for your help!

I just dropped the first tab, 11am. 83 more times to go.

Here's to hope.
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: brie41 on May 15, 2016, 12:01:33 pm
Good luck to you!!!  I think the most important thing is try to take it at the same time everyday.  I have a crazy work schedule so I had to choose after dinner.  I did find that I was very thirsty for about 5 or 6 hours after taking my pill.  Needless to say many visits to the bathroom when I would have liked to be sleeping!  I would have preferred to take it during the day time, but it was fine in the end.  Never forgot either as it was right after dinner!  Brie
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Baxter on May 16, 2016, 12:55:15 am
I just take mine between around 10 AM and noon. My wife's disabled and I'm her caregiver, so my schedule is unpredictable. I also have to travel for business or run up to our other house about 100 miles from here to mow the lawn and take care of the pool, so sometimes I'm not even home until midnight. One night last week I didn't get home until 3 AM, and it's always a couple-few hours before I can finish up household chores and get to bed.

So, I get up anywhere from 6 AM to 11 or 12. If I'm up early, I wait until 10 to take it, if I sleep late I pop it as soon as I get up. I drink a glass of grape juice to get the stomach acid primed, then 10 or 15 minutes later wash the pill down with some grapefruit juice. About 15 minutes after that, I have a couple of boiled eggs and some cheese. Feels like it's working, but I'll know more in a day or two. My 8 week labs should be back by Monday or Tuesday, and I'm crossing my fingers for the Magic Zero.
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on May 16, 2016, 09:26:50 am
@ Brie & Baxter—thank you!

Day one was pretty easy. Pill taken just before breakfast.

Experienced minor gas which I'm hoping will end soon, otherwise could be a problem going to work.

Any medication recommended that doesn't stymie Harvoni?

Again, quite easy day.  Your posts have been a big help.  :)

best
rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: FutureThinker on May 16, 2016, 11:45:37 am
Lots of water will help with many things with the Harvoni, rkevins, including gas/constipation/headaches.  Antacids are to be avoided with your Harvoni, I think 4 hours before and after -- look at your pharmacist's info or on the folded Harvoni info sheet for specifics on that. 

I finish my treatment tomorrow (!!!!!!) and it really has been uneventful.  Quite a surprise, have to say, for such a powerful drug, doing so much destruction inside these viruses, to barely feel anything at all. I do hope your course is also event - free! FT
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Lynn K on May 16, 2016, 12:01:11 pm
As far as acid control if it is something like tums or rolaids yes no closer than 4 hours before you take Harvoni or 4 hours after you have taken it so stay out of that 8 hour window.

If it is something like Tagamet or Pepsid or any other H2 antagonist at the same time as Harvoni and 12 hours after Harvoni (which would also be 12 hours before your next dose).

Finally if the med is a PPI (Proton-pump inhibitor) like Prilosec it should be taken at the same time as Harvoni but on an empty stomach.

Good luck!
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on May 17, 2016, 09:25:03 am
Hey, congrats to you, FutureThinker, and your FutureLife! I hope it is long and prosperous.

I hope the same for me (and everyone).

And thanks to you and Lynn for your recent tips!

Constant watering the garden has been the most demonstrable effector so far, often I've felt a headache like a shadow beast from a bad movie waiting for an opportunity to jump in but have kept it at bay due to the tip about drinking.

All other symptoms have subsided.

glug-glug-glug,
rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: FutureThinker on May 17, 2016, 11:40:58 am
Just stay close to a bathroom (ha) while you are glug-glug-glugging!  I just took my last pill, with a prayer.  I think I'm going to decrease my water intake a bit, due to my first sentence, maybe by 2 cups.  I've never been good about water intake, so now that I'm "in the habit", want to keep it, just maybe cut back a little.

Keep us posted, rkevins! The future is bright, FT
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: gnatcatcher on May 17, 2016, 04:10:55 pm
FT, congrats on completing Tx. As soon as I did, I cut back my fluids by 2 cups/day -- it sure was nice to wake up just once/night again, instead of two or three times.
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Luna7 on May 17, 2016, 05:04:07 pm
Yayyy Congrats FutureThinker! 
All the best...
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: FutureThinker on May 17, 2016, 09:01:00 pm
Gnatty, I'm retired but I am a bit tired of running to the bathroom all day...... and at night! So will cut back as of tomorrow!

Thanks, Luna -- I almost don't believe it, will feel a bit weird tomorrow a.m. not revolving my morning around that pill! But I am ready for the next step -- fingers crossed! FT
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: AussieRosa on May 18, 2016, 06:54:11 am
Congrats on getting that final pill down, FT. I have to say, I cut my fluids back right away too. I really appreciated those uninterrupted sleeping hours again. Best of luck for SVR.
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Philadelphia on May 18, 2016, 07:03:28 am
I did a similar thing. I enjoy my mostly uninterrupted sleeps again.
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: brie41 on May 18, 2016, 11:01:30 am
Congrats FT on finishing up your treatment!  Wishing you the best!  I also cut back on drinking so much water at night but really making an effort to drink more than usual.  I used to get a lot of tension headaches and now they are gone!  Sleeping better for sure too.  Brie
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: FutureThinker on May 18, 2016, 11:36:32 am
I, too, have found that the higher water intake seems to help a lot of things -- regularity, less gas, skin more supple (? wishful thinking?).  Hydration is also supposed to be related to energy levels, so there's another reason to stay close to where I've been on intake! FT
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: morab on May 18, 2016, 11:51:38 am
Congratulations FT!
rkevins hang in there!
Morab
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on May 18, 2016, 10:28:04 pm
Good to hear from a bunch of folks, and glad to hear so many doing good!

One of us, sadly, isn't so bright: I don't know how it happened but I went to work today without having taken my pill, didn't even think of it till I returned, so I was about 9 hrs late taking it (8pm). So stupid!

My plan is to take a couple days reducing the 9 hr difference by 3 hrs till on schedule again. Maybe not so awful.

Still, very irksome how the brain can play games with one. How could I not even think of it, all day I acted as if I had taken it, then came home and saw Wed.'s pill still there. Tres bizarre. But now I will have my phone's alarm set.

Which brings up another question: Taking the pill while away from home and increasing the chance of (gulp) losing it. Has anyone lost a pill? Yikes. Hope I never do!!!

best,
rkevins

Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Lynn K on May 18, 2016, 11:34:05 pm
I kept an empty Harvoni bottle at my desk at work and would bring in my week supply on Monday as I was taking mine at work.

I think we all get a little OCD counting pills every couple of days (if not every day) to make sure the count is right
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on May 25, 2016, 10:58:03 am
Hi

I hope others still in treatment are experiencing something close to mine: Into my second week doing quite well, am very happy, I know the horror stories from other treatments, this is close to miraculous.

Been drinking over a gallon of water/day. Initially in response to others' suggestions, but also felt it kept headache at bay. So I drank whenever it seemed like it was gaining sway. Worked well.

Haven't felt the headache's shadow for a few days now. Felt really great Monday, drank less water and, I don't know if it was a result or a coincidence, but I woke up Tuesday not feeling so great. Not really bad, just tired.

Upped the dose of water and back on track feeling very good today.

@Lynn—Good idea re bottle at work. Thanks.

best
rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: FutureThinker on May 25, 2016, 12:50:05 pm
I found that being consistent with the high water intake was key in feeling good.  FT
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: brie41 on May 25, 2016, 04:14:08 pm
Hi RKevins,

 I am also a bit OCD to say the least so I printed out blank calendars and checked off after each pill was down the hatch.  I also set my phone alarm but always remembered because it was right after dinner.  I found I was thirsty for at least 5 to 6 hours after taking it and would wake up and have to guzzle almost a whole water bottle.  It really makes such a big difference in how you feel.  Hang in there! Brie
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on May 25, 2016, 04:45:57 pm
Yo, FT and Brie,
Thx for the replies, you're both absolutely right, water/hydration is the key.
best
rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on June 10, 2016, 11:45:25 am
Hi Folks,

Just checking in. I hope all still in the course are doing well with it, and the same to those who've finished.

I am doing quite well, nearing the end of my 4th week and blood test, and am surprised and very happy to have such minimal side effects.

One question to fine tune things, but not really such a biggie.

I take my Harvoni in the mornings, either before or after eating. One reason I'm not consistent, the other being I'm not much of an early breakfast kinda guy, is I'm not really sure when is best as far as having maximum acid to digest, if that makes much of a difference. I can see before breakfast because the acid in your stomach hasn't been used, tho maybe after is best since acid may be generated to digest what's just been eaten.

Yes, you can see my worries are minor, but if anyone has an opinion I'd be happy to see it.

All the best to everyone and thanks for your many responses!

best
rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Baxter on June 10, 2016, 01:34:19 pm
Hah! My thinking is exactly the same as yours. I take it in the morning with either grapefruit juice or grape juice, to add a little boost to the acidity in my stomach. Not sure whether it makes a difference or not, but I do it anyway. Ledipasvir needs gastric acid to be absorbed, and eating a moderate to high-fat meal with your dose slightly increases the peak plasma levels of the sofosbusvir. So, I'll have grape or grapefruit juice along with a piece of cheese and/or a couple of eggs.
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Lynn K on June 10, 2016, 09:48:23 pm
Per the prescribing information sheet for Harvoni

https://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/harvoni/harvoni_pi.pdf

2.1 Recommended Dosage
The recommended dosage of HARVONI is one tablet taken orally once daily with or without food [see Clinical Pharmacology (12.3)].

Effect of Food
Relative to fasting conditions, the administration of a single dose of HARVONI with a moderate fat (~600 kcal, 25% to 30% fat) or high fat (~1000 kcal, 50% fat) meal increased sofosbuvir AUC0-inf by approximately 2-fold, but did not significantly affect sofosbuvir Cmax. The exposures of GS-331007 and ledipasvir were not altered in the presence of either meal type. The response rates in Phase 3 trials were similar in HCV-infected subjects who received HARVONI with food or without food. HARVONI can be administered without regard to food.
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on June 29, 2016, 08:50:43 pm
Hello,
Checking back in, my 4-week blood test, like many others, came back undetectable.

Great news and very happy to be continuing my course. I hope all other on or about to begin the protocol have a very successful ride.

One problem, twisted my ankle a bit at work, I feel it swelling. Besides putting it up, I was hoping to take some ibuprofen to ease the inflammation.

I took the Harvoni around 11am.

I want to take 2-4 200mg tablets of Ibuprofen 2 times before going to bed around 1am.

Reasonable?

Thanks and good luck to all!!

rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Lynn K on June 29, 2016, 08:57:08 pm
unless you have liver cirrhosis you should have no concerns taking Ibuprofen as long as it is per the instructions for dose and frequency.

How much and how long can you take ibuprofen?
Do not take more than your recommended dose. An ibuprofen overdose can damage your stomach or intestines. The maximum amount of ibuprofen for adults is 800 milligrams per dose or 3200 mg per day (4 maximum doses). Use only the smallest amount needed to get relief from your pain, swelling, or fever.

With liver cirrhosis can be a concern so they should not take pain meds that can cause bleeding like aspirin or other NSAIDS. For people with cirrhosis Tylenol less than 1200mg/day is recommended
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on June 29, 2016, 09:01:51 pm
Hey Lynn

Thanks for your prompt reply! You should have a tip jar.

Just kidding, but I really want to thank you and others who share their experience, knowledge and time with folks like me. Bless you for that!!!

So I can even take ibuprofen in the vicinity of time I take my Harvoni? Just asking in case I might need to tomorrow.

best
rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Lynn K on June 29, 2016, 09:10:36 pm
Well you could call your doctor or pharmacist or the Harvoni help line but in my non medical opinion I don't see a problem

Hope your ankle feels better soon and remember
RICE  Rest, Ice, Compression and Elevation :)
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: brie41 on June 30, 2016, 03:30:39 pm
Hi Rkevins,

Hope your ankle feels better soon!  I always took my Harvoni right after dinner and it seems to have worked just fine so far!  Hang in there!  Brie

Baxter,

Congrats on your undetected status!!  We are in the same boat and lets plan to stay that way!!  Brie
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: morab on June 30, 2016, 06:58:54 pm
rkevins
congrats on the 4 week UD! That is what I got also! I have a little over a week to go on tx and will be so glad to see that last pill taken!
I still have side effects, yet they change from one day to the other.
May we all keep on truckin' and reach SVR
Morab
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: AussieRosa on July 01, 2016, 03:35:57 am
Morab, you're close to the finish line now. Glad to hear you've had a relatively easy treatment. I'll be looking forward to reading about your SVR results pretty soon.
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on July 03, 2016, 01:25:38 pm
Hi
Thanks for the replies, everyone!
Maybe because my liver damage is not so severe, but after the first couple I've had nearly zero negative side effects and one positive side effect: I feel awfully damned good! 'Lucky' may be another, actually.
Great to hear you're at the end, Morab!
Thanks again!
rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: rkevins on August 19, 2016, 09:48:54 am
Hi

Finished my course with harvoni, got back an "undetectable" screening and am very happy.

I want to thank everyone who helped me along the road and wish all the best to those who try this fabulous course of treatment.

It was very easy for me, but there were a couple small things that I'm not even sure if it was the Harvoni or stopping cigarettes or what, but was curious how long it takes for the Harvoni to get out of one's system and therefore any side effects it might cause would subside and then I can take stock of where I am and what is causing what.

Thank you all very much!! Happy trails to you... ( ;) )

rkevins
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: FutureThinker on August 19, 2016, 12:50:02 pm
CONGRATS on your EOT lab report!!!! Now for the "big" test we all (patiently) wait for, 12 weeks EOT to see if we get the coveted SVR12 status.  I will find out if I get it on Monday.

One of our moderators, Lucinda, posted in the recent past that the Harvoni was in our systems for 11 days post.  All the best!!!!  The future is bright, FT
Title: Re: Starting 12-week course of Harvoni next week; some questions
Post by: Lynn K on August 19, 2016, 11:50:51 pm
Borrowed this from another post by Phil last year

https://forums.hepmag.com/index.php?topic=2730.0

As a general rule the majority of any medication will clear the system in 5 to 6 half-lives. For Harvoni, with a half-life of approximately 48 hours, that means 10-14 days or so. At 14 days < 1% of a medication with a half-life of 48 hours will remain. Understand this is not an exact science.

At 48 hours/2 days after stopping Harvoni, 50% remains, at 4 days, the second half-life, half of 50% or 25% remains, 6 days 12.5%, 8 days 6.25%, 10 days half of 6.25% and so on. Every 48 hours half of the remaining medication is cleared/eliminated.