Acid reflux

[debham]

Good morning all,
I've been having a terrible time with acid reflux they say it's ok to take tums ect. 4 hrs after you have taken your Harvoni. But I really don't want anything to get in the way of this treatment. Has anyone found a good way to ease their acid reflux besides these meds that intereact with the tx for hep c?

[SIXFOOTFOUR]

I use Tums due to peptic ulcers but since being on Harvoni I am carful to not use it 4 hr before or after taking the medication.

You can take Prilosec (omeprazole) with th Harvoni at th same time if that works for your reflux

[ponygirl]

I have reflux. I was RXed 40 mg Omeprazole for the past 6 years. My gastroenterologist and specialty pharmacist said" One 20 mg omeprazole is OK. Must be taken at the same time as Harvoni. Tums can be used 4 hrs after and before Harvoni. And I am RXed Ranitidine, instead of the 2nd 20 mg Omeprazole to be taken 12 hrs after the Harvoni. More than 20 mg Omeprazole has been shown in studies to decrease effectiveness.

Other recommendations I got from Gastro. No constricting pants. Do not slouch. And all the other standard reflux food recommendations.

And I have personally found REAL licorice, (the black kind with licorice and molasses ) to be effective and my doc approved it.

[Lynn K]

Just wanted to add the omeprazole per the prescribing information has to be taken on an empty stomach with the Harvoni.

So say first thing in the morning and don't eat for awhile maybe a half hour

[Ledoc01]

I'm a little nutty perhaps with my approach but:
I wait 4 or 4.5 hours after taking the Pills (Harv and Omep)before I eat.

When I was trying to figure this out I looked into the effect of food on the stomach pH and it seems I remember it could go up 4 or 5 points during digestion.
I may have tat wrong but... lol...I figured I'd go on the extreme caution side.

The thing that concerned me was this line <i>"Ledipasvir is practically insoluble ( < 0.1 mg/mL) across the pH range of 3.0–7.5 and is slightly soluble below pH 2.3 (1.1 mg/mL"</i>

 that "practically insoluble" thing bugs me.

Anyway, since the Harvs it their absorption thing at around 4.5 hours I thought I'd give it as much help as I can    It just makes sense to my pea brain to keep the pH as low as possible while the pills assimilate.

On a side note: I think if I could eliminate the sides which I'm convinced come as a result of my reflux issues this would mostly be a relative cakewalk.

I was on 40mg Omeprazole for a long time..then I started having a lot of pain and which nobody was figuring out (I didn't think they were trying too hard as they seem to attribute a lot of stuff to the HCV/Cirrhosis) but changing to 60mg Dexilant mellowed things out. The 20mg of Omeprazole now is all but useless.
I think it's worst about an hour to 1 1/2 hours after I take the pills when it feels like somebody poured molten metal directly into my gut.

I'm trying not to whine too terribly much though..I watched a special about cancer treatments on kids....that was good for perspective.

Hopefully we'll all clear. I only have till 5-17 to finish my 12 weeks of straight Harvoni.

my VL was 2.7 mil at the start and at the 4 week mark I was detected <12

That was with the Abbott assay

ciao and best to all :-)



 

[Lynn K]

I went with extreme caution as well, no Prilosec for 24 weeks of tx with Harvoni. Just Tums late at night to put out the fire in my throat.

Ten days to go and man do I miss my Prilosec

[pl1952]

You can take 20 mg. of Prilosec (omeprazole) with Harvoni simultaneously on an empty stomach.  I take mine upon waking and an hour late I eat breakfast..

[ponygirl]

My gastro says I have to eat with my Ribavirin which I have to take with my Harvoni and omeprazole.

[Lynn K]

why are you taking the Harvoni with the riba that is not required.

Does your doctor know you are planning on taking Harvoni and omeprazole with food?

Taking Harvoni and omeprazole per the prescribing information they can only be taken at the same time on an empty stomach or you risk not having as much of the Ledipasvir being absorbed and reducing the effectiveness of the medicine.

I have opted to not take omeprazole for the 24 week duration of my treatment. If you can I would suggest you consider doing the same and not taking omeprazole.

But of course consult with your doctor.

EDIT:
Just wanted to clarify my intent was to say why are you taking Harvoni and Ribavirin at the same time they don't have to be taken at the same time except for convenience. But as the Ribavirin has to be taken with food that would preclude taking the Prilosec. If you need to take Prilosec you have to take with Harvoni on an empty stomach or don't take Prilosec at all.

[Lynn K]

http://www.drugs.com/drug-interactions/harvoni-with-omeprazole-3567-16903-1750-0.html

Depending on the dose, omeprazole may interfere with the absorption of ledipasvir and reduce its effectiveness. Talk to your doctor or pharmacist if you have any questions or concerns. You may need a dose adjustment of omeprazole to safely use both medications. You should take omeprazole simultaneously with the dose of ledipasvir on an empty stomach. Contact your doctor if your symptoms worsen or your condition changes. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

[davidsconfused]

why are you taking the Harvoni with the riba that is not required.

Does your doctor know you are planning on taking Harvoni and omeprazole with food?

Taking Harvoni and omeprazole per the prescribing information they can only be taken at the same time on an empty stomach or you risk not having as much of the Ledipasvir being absorbed and reducing the effectiveness of the medicine.

I have opted to not take omeprazole for the 24 week duration of my treatment. If you can I would suggest you consider doing the same and not taking omeprazole.

But of course consult with your doctor.

I gave up omeprazole before I started Harvoni. One omeprazole lasts me for a little over three days so it was not worth the risk, although I would have gave it up anyway. All I'm taking antacid wise is generic Tums with an eight hour window I can't take them. It's not fun, but  HCV is worse.

[GLCII]

One of the things I've always use, and it's natural, is Baking Soda. 1 teaspoon in a glass of water usually does the trick. The baking soda will neutralize the acid to take that burning feeling away.

http://everydayroots.com/heartburn-remedies

[Lynn K]

Hi GLCII

Baking Soda AKA Sodium bicarbonate is A chemical compound with the formula NaHCO₃

The bicarbonate part of this chemical is an acid neutralizing agent as much as Tum or Rolaids which their formula is CaCO3 or calcium carbonate.

With that in mind if you are using Baking Soda as an acid neutralizer the same admonition relative to Harvoni will still apply in the same way as any other antacid which can only be taken no closer than 4 hours before to 4 hours after taking Harvoni to avoid refusing the effectiveness of the medicine by resucing the absorption of Ledipasvir.

Also Baking Soda (sodium bicarbonate) contains sodium which most of use use too much of and can be a problem for people with cirrhosis who need to reduce sodium intake.

Just because something is found in nature does not make it a safe choice for all. Good old salt aka NaCl is also found in nature. In the sea and in our blood but too much salt is not good for us because of the sodium content same as for baking soda sodium bicarbonate.

If you are considering taking anything always discuss with your doctor

[KimInTheForest]

Thank for the tip about using real licorice to help with acid reflux, ponygirl. I will try that if I am having a problem with reflux.

I am surprised that you have to take your harvoni & riba at same time. I am starting harvoni+riba next week (for 12 weeks), and I had planned to take harvoni first thing in morning (maybe 9 am) on empty stomach or nearly empty. (Someone on these forums mentioned that taking it with a tiny bit of food, some apple slices or something, will start your stomach acid going, which is useful for increasing absorption of the ledipasvir.) And then I was going to take my ribavirin 2-3 hours later with a bowl of oatmeal or something similarly substantial, since riba on empty stomach will create nausea.

Does anyone here see anything wrong with this plan? My Dr is also saying to take the harvoni & riba together each morning. But i think I will have an easier go of it in terms of side effects and efficacy if I separate them by 2-3 hours. I think doctors just advise patients to take them at same time for convenience - they want to make sure we don't forget taking pills...

Kim

[Lynn K]

Per the prescribing information sheet that comes with your prescription you can take the Harvoni with or without food so you could have breakfast and take Harvoni and Ribavirin together with breakfast if you want.

[KimInTheForest]

Per the prescribing information sheet that comes with your prescription you can take the Harvoni with or without food so you could have breakfast and take Harvoni and Ribavirin together with breakfast if you want.

Thanks Lynn My "logic" keeps telling me that Harvoni on a full stomach will not be as well absorbed. But since the prescribing info says otherwise… Maybe I need to have more faith. I am aware of becoming obsessive about doing everything "just right" so this will work. I have created long lists of protocols for myself during the 12 weeks of what I will and won't eat, what to have on had for possible sides, etc. I should probably just relax and let it work its magic.

kim

[GLCII]

Hi Lynn

Thanks I didn't see all that. I looked up baking soda, at wikipedia.org, before posting but didn't see CaCO3. Although I did see Na2CO3 as sodium carbonate. I also didn't read na2CO3 or sodium bicarbonate in the Harvoni PDF and I've read that too many times since strating Tx. I just never made that conection with what you said. My bad and I apologize. It wasn't my intention to give bad advice. It's just something I use when and if I get really bad heartburn that Tums or Rolaids won't help and I know it's a natural substance/mineral.  I haven't had heartburn or reflux. Atleast not yet anyway.

[Lynn K]

Yeah they just say antacids which most of us think Tums etc but the issue is anti acid so anything that reduces stomach acid.

Chemically speaking the CO3 molecule of the either sodium or calcium carbonate reacts with the hydrogen positively charged ion of HCl (H+ Cl-) hydrochloride acid aka stomach acid. The H+ ion is the thing that make acid acidic so the H+ reacts with the CO3- and thus lessens the acid level in your stomach. It s not the calcium or the magnesium causing the acid reduction rather the anion CO3- that reduces the cation H+ which reduce stomach acid levels.

Ok chemistry lesson done

[ponygirl]

Lynn. Thanks for that info. I was taking the meds as my specialty pharmacist advised. Omeprazol, Ribavirin, and Harvoni together AM and Ribavirin and Ranitidine PM.

My doc called today and said she is going to stop the Riba altogether and just do Harvoni for 24 weeks because there is no research that indicates that 600 mg of Ribavirin increases the efficacy of the Harvoni for the 12 week course. I need to take the 1000mg, which gave me severe depression and severe anemia and erratic heartbeats (arrhythmia and tachycardia) all of those symptoms got better at a decrease to 600mgs of Ribavirin.

That said. I should now be able to take the Harvoni and omeprazole on an empty stomach, which should help with the absorption. I can't stop the omeprazole because I start getting esophageal spasms that send me to the ER. They replaced my second dose of omeprazole with ranitidine (at 2am when I get off work), which does not effect the Harvoni.

Thanks for all the great info you provide Lynn.

[Lynn K]

Hi glad that is cleared up in your advantage

this is the prescribing info sheet for Harvoni see table 3 page 6

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


Antacids (e.g., aluminum and magnesium hydroxide)

It is recommended to separate antacid and HARVONI administration by 4 hours.


H2-receptor antagonists (e.g., famotidine) (from me this is also your ranitidine)

H2-receptor antagonists may be administered simultaneously with or 12 hours apart from HARVONI at a dose that does not exceed doses comparable to famotidine 40 mg twice daily.

Lynn again Ranitidine (trade name Zantac) is a histamine H2-receptor antagonist so it can only be taken at the same time and EXACTLY 12 hours after Harvoni. So if you intend to take Ranitidine at 2 AM when you get off work that would mean you have to take your Harvoni an 2 PM on an empty stomach with the Prilosec. Alternately take the Ranitidine 12 hours EXACTLY after you took the Harvoni when ever that is.

Proton-pump inhibitors (e.g., omeprazole)

Proton-pump inhibitor doses comparable to omeprazole 20 mg or lower can be administered simultaneously with HARVONI under fasted conditions.

Sorry you have so many stomach issues but we have to be very careful how we take any acid reducer.

Good luck

[ponygirl]

I have been taking them like you said, just without the fasting because of the Ribavirin, but If I get the call tomorrow at 11 am the my Insurance approves the 24 weeks, well I can fast tikk the cows come home.

[Lynn K]

Just an empty stomach lol

Would not personally suggest waiting for the cows

[debham]

Thanks for all the input. I take my harvoni at 10:30 AM my reflex usually bothers me during the night. I get up and take tums this helps some. I can hang in there for 7 more weeks. That's it just 7 more weeks. I'm so happy they have come up with a TX that works. And I pray to the Dear Lord it works for me. I have been feeling better I think. You know sometimes the mind is a powerful thing. Like the little locomotive going up the hill " I think I can I think I can" and it did.

[grateful908]

Hello All... I'm very confused. I too was having problems. I called Gilead directly and they STRONGLY recommended that I DON'T TAKE ANY TYPE OF ACID REDUCER. They did recommend CARAFATE. Completely safe with Harvoni. Can anyone enlighten me??? PS: I'm only on day 7. Chris (grateful908)

[KimInTheForest]

Hello All... I'm very confused. I too was having problems. I called Gilead directly and they STRONGLY recommended that I DON'T TAKE ANY TYPE OF ACID REDUCER. They did recommend CARAFATE. Completely safe with Harvoni. Can anyone enlighten me??? PS: I'm only on day 7. Chris (grateful908)

I would like to know the answer to this too, since I am, upon occasion, taking baking soda in warm water about 12 hours apart from Harvoni if I have bad heartburn. Maybe it is a case of Gilead's Patient Information Sheet for Harvoni (which says don't take antacids 4 hours either side of Harvoni) not being as current as their over-the-phone information. Maybe Gilead has revised its position to: No antacids ever. Would be nice to know this since Drs and nurses everywhere are following the advice on the Patient Information Sheet.

kim

[Lynn K]

While Prilosec, Pepcid, and tums etc. are allowed per the prescribing information,

see table 3 page 6
http://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/harvoni/harvoni_pi.pdf

Antacids 4 hour window on either side

Prilosec or similar at the same time as Harvoni on an empty stomach only

Pepsid AC or similar at the same time and 12 hours apart from.

Anything that reduces stomach acid can effect the absorption of the ledipasvir component of Harvoni so if you don't have to take an antacid it would be something you might consider avoiding taking if you can.

My nurse suggested I not take any prilosec that said I had been taking so I toughed out the 6 months without it.

I think the idea the Gilead nurse you spoke with was to avoid it if you possibly can. I doubt they are changing the treatment information sheet at this point.

Not sure if Carafate raises pH levels like antacids do I was able to find it is available by prescription and is used in the short-term (up to 8 weeks) treatment of active duodenal ulcer.

I would recommend you discuss any medication questions with your treating physician.

Good luck on treatment

[KimInTheForest]

I continue to worry about milk since milk is a temporary reducer of stomach acid, and I usual have milk in my tea and sometimes with cereal in the morning around pill time. For a while I tried to avoid all milk until later in day for this reason - but there is not much else I can get down me in the mornings than those foods. And so my diet fell apart at that point, and that partly contributed to my appetite suppression and weight loss. Would hate to think I am compromising my chances of cure because of milk in morning tea or on oatmeal. Almond milk and stuff like that are not viable substitutes for me. Like 'em fine in a glass on their own, but not in my tea or cereal. Just whole goat's milk. Opinions?

kim

[Lynn K]

They did not say to avoid milk only acid suppressing medicines so I would expect the effect is not significant for milk.

I drink a lot of milk I basically live on cereal and I just made SVR 4

[KimInTheForest]

That really heartens me to hear that, Lynn - your SVR4 and with your substantial milk consumption. Thank you. And congrats!

kim

[Lynn K]

found this about milk

http://www.sharecare.com/health/gerd/can-milk-soothe-acid-reflux

Drinking milk is a common home remedy, and it can cause some short-term relief. Overall, however, the calcium in milk makes the stomach produce more acid, which exacerbates the original problem.

So in reality drinking milk actually increases stomach acid like any other food we ingest  we produce stomach acid to digest the food that is milk

[KimInTheForest]

True - I think I had seen something like that too - milk produces more acid in long run. But of course what we are concerned about with Harvoni is short-term/immediate acid reduction, which that item would seem to corroborate. It was actually reading something like that that got me worried in first place. Still, you are a fine example of positive outcome for heavy milk drinker.

kim

[grateful908]

Sorry I didn't post sooner... I did get a call back from Harvoni. They listened to the recording, and they said I was given info to a different question - in other words, I was wrong, they were wrong. Follow the instructions in the fact sheet and we should be fine.
  I apologize. I hope I didn't make anybody crazy over this-besides myself. Chris aka grateful908

[KimInTheForest]

Thanks Chris for keeping us up to date on your communication with Gilead. Sounds like all is good then if we steer clear of that 4-hour window either side of harvoni.

best to you!
kim

[grateful908]

Hi Kim... I read your post in the RA forum. I to was diagnosed with RA, but never really had any symptoms.Like most of the people in the RA forum, My left big toe is in severe pain. Also my left thumb Is the same, I can't bend it. My left elbow hurts but nothing like the toe & thumb. Why do you think it's affecting us all IN THE SAME PLACE??? That seems kind of strange to me. What do you think

[KimInTheForest]

 

Hi Kim... I read your post in the RA forum. I to was diagnosed with RA, but never really had any symptoms.Like most of the people in the RA forum, My left big toe is in severe pain. Also my left thumb Is the same, I can't bend it. My left elbow hurts but nothing like the toe & thumb. Why do you think it's affecting us all IN THE SAME PLACE??? That seems kind of strange to me. What do you think

Hi Chris. I think that was another Kim in the RA forum. There is more than one of us here. I don't have RA. But I have noticed there is an RA discussion going here somewhere. Some people felt their RA has worsened on Harvoni… I myself have not had any joint pain before or during treatment. However I do know that arthritis-like joint pain can be a symptom of Hepatitis C itself and chronic liver dysfunction.

Left big toe and thumb sounds to me more like gout - and I think that too is an issue with Hepatitis C - build-up of uric acid or something. IMportant to avoid foods that gout sufferers are told to avoid...

best to you,
kim

ps. person posting in RA forum is "Kim". that's why I went with 'KimInTheForest" when I signed up - because Kim was taken.

[grateful908]

My bad.... Sorry. I get used to first names- whatever they may be... I received some EXCELLENT information from Lynn K. A Global Moderator. I don't know what that is, but she is very precise and to the point. As far as the gout, I've eaten salads, yogurts,fruits only for the last 8 days... Before Harvoni, I was known to eat a lot of seafood. I can almost say 99% sure it isn't gout. But Thank You. Good Nite KimInTheForest   

[ricpark]

Started 6 wk today of Harvoni + Ribavirin, my routine is around 5am, fasting Harvoni everyday + omeprazole 20mg every other day (can get by with a tums or 2 at bedtime on day with no omeprazole, hoping less omeprazole is better). Wait 1 hr coffee, another 1Hr (total 2hr from Harvoni) bowl of raisin bran and a banana plus multi vitamin and magnesium supplement and ribavirin. Second dose of ribavirin with dinner.

[dearprudence]

hi folks, I am on vpak and riba and was prescribed 20mg prilosec on empty stomah in a.m. - was waking up in the middle of the night with reflux and am now taking 20mg before bed as well. solved the problem. Don't know if you can do this with harvoni.
Good luck all!