Harvoni and Milk Question

[Mixer]

 Just started 12 weeks of Harvoni and was reading the no milk thread but that was almost 2 years ago, has there been any new guidelines on this since then

Thanks Mixer

[gnatcatcher]

Mixer, I missed that thread, but I drank/drink 3 cups of skim milk per day before, during, and after my 12-week Harvoni treatment. This was done with the knowledge of the CNP supervising my treatment, and the Harvoni worked fine (and cured me).

Now if you mean milk thistle, someone else will have to respond. That's not something I've ever tried.

HTH,
Gnatty

[Mixer]

 
 Yes I meant milk as in Organic Skim Milk or Almond Milk mostly for my cereal in the morning and maybe a little in the evening with desert. I think milk thistle is a definite no.

We all equate milk with calcium and anti acids and with have a lot of calcium are a no

[gnatcatcher]

Okay, now I understand your concern: antacids. Table 4 of the Harvoni prescribing information (folded paper with tiny print that came with your bottle) mentions "Antacids (e.g., aluminum and magnesium hydroxide): It is recommended to separate antacid and HARVONI administration by 4 hours." The term "milk" in "Milk of Magnesia" (which contains magnesium hydroxide) doesn't have anything to do with cow's milk or almond milk.

They are talking about pharmaceuticals, not food. There are three definitions of the word "milk":
1. the fluid secretion of the mammary gland forming the natural food of young mammals.
2. any whitish milklike substance, e.g., coconut milk or plant latex.
3. a liquid (emulsion or suspension) resembling the secretion of the mammary gland.
HARVONI's Table 4 is concerned with definition 3.

I also regularly eat about an ounce of raw almonds per day and did so while I was on Harvoni.

Gnatty

[Mugwump]

FYI about Harvoni;
The ledipasvir component is best absorbed on an more acid stomach. So strong ant-acids are a no no during the ingestion phase after taking Harvoni about 4hrs prior to and 4hrs after taking the pill. If you are on medication for some conditions that require strong antacids it is crucial that the doctor is aware of this.

It is really important if your primary care physician is not completely up to speed on Harvoni that they read the documentation that is readily available and inform their patients better than what we are seeing in some circles!

It is shocking how poorly some doctors study the documentation of very important medications. They seem to rely far too much on specialists to inform their patients about the details then the specialists are usually too rushed to go into all the details.

I see no real problems with what you are taking with the pills if it eases your stomach. As long as you have a fairly normal acid balance you should not effect the ingestion of the med.

I was really lucky in this regard and the people that I saw in the specialist clinic were well informed themselves and clued me in first before sending me off on my own with a medication that costs an arm and a leg.

[Lynn K]

As far as antacids it is the hydroxide component that combines with the hydrogen in acid to reduce acid. Some have magnesium hydroxide some use calcium hydroxide. Some may use others.

And anyway there is no admonition in the prescribing information to limit drinking milk. Just some folks worried about calcium for the same reason you asked.

I took my Harvoni and ate cereal with milk many times. I commonly drink a lot of milk don't really like soda. Still cured.

But the best person to ask is your doctor who prescribed your medicine or the pharmacist who provides your prescription. You could also contact the Harvoni help line.

I got this number from Gilead's web site

"If you require further assistance, speak with a HARVONI Educator at 1-844-READY41 (1-844-732-3941), or contact your Hep C Specialist."

[Mixer]

Just got off the phone with the pharmacy and they said milk was fine that the calcium in milk is totally different than it is in antacids. I also asked about vitamins and most all were ok but my calcium supplement and my milk thistle. Oh and I asked about Advil and she said there were no interactions with Advil and Harvoni but like anything taking a lot of Ibuprophen in general not a good thing but I don't use it that often

[dragonslayer]

Why no milk thistle?   My interaction checker turns up nothing.

[Mixer]

 I was assuming that because when you take milk thistle a 1/2 hour before meals it coats your liver to block out toxins.....maybe it blocks the medication too..... don't know that is just a assumption

[Gaj]

According to the Mayo Clinic:

Cirrhosis (liver scarring)

Multiple studies from Europe suggest benefits of oral milk thistle for cirrhosis. In studies up to five years long, milk thistle slightly improved liver function and decreased the number of deaths in people with liver disease. Although these results are promising, most studies have been poorly designed. Better research is necessary before a strong conclusion can be made.

http://www.mayoclinic.org/drugs-supplements/milk-thistle/evidence/hrb-20059806

Which implies that it is effecting the liver in some way but as they say, more research is required as the reasons for the improvement don't seem to be fully understood yet.

I suspect that your interaction checker, like all the ones I've used, may not actually state there are no problems but rather doesn't list Milk Thistle? These checkers are more geared towards medication interactions but also include well known supplement problems but not necessarily all of them so I think caution is advisable with any supplememts during treatment. A recent example is where the latest research by the makers of Daclatasvir has resulted in them issuing a caution against consuming Taurine as found in many ernergy drinks, etc. as it may reduce the effectiveness of the medication.

So during the period of treatment it is advisable to stop using Milk Thistle. These new HCV meds usually result in marked improvements in liver function anyway and you can always recommence the Milk Thistle after completion of treatment if you feel it is beneficial.

[Mixer]

That was my thought I will resume when treatment is over

[dragonslayer]

Here's the interaction checker I used:

http://www.hep-druginteractions.org/checker

Its a hep drug specific checker and the result of checking was 'No Interaction Expected'.

When going through treatment, I suspended most of my supplements including milk thistle just to place it safe.. But the fact is, we really have no scientific evidence that milk thistle is contraindicated while taking harvoni that I am aware of, nor does it appear as a contraindication on any package insert.

Therefore, Im kind of surprised the pharmacy told the op that she should not take milk thistle. 

[Gaj]

Thanks DS, that is one of the checkers I use but didn't try it because I was fairly sure it didn't include Milk Thistle last time I looked (over a year ago so my bad). I suspect they may have updated it since.

I would still advise caution regarding using supplements during treatment as they, along with anything we ingest, still need to be processed either by our livers or the enzymes they produce and I think that the less load we place on these processes during treatment the better.

[dragonslayer]

Thanks Gaj.. I agree with you; thats why I suspended its use during treatment.. What I was harping at was the pharmacy giving the information to not take it to the op.. .  I dont want my pharmacist singling out things not to take when its not based on a pkg insert or some kind of evidence... Generally, that's as far as they will go: 'follow the pkg insert'.  Which Im fine with, btw..