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Author Topic: reduced dose Harvoni.....  (Read 10066 times)

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Offline Mr. Bob

  • Member
  • Posts: 37
reduced dose Harvoni.....
« on: July 03, 2015, 12:50:15 am »
Was in to see the Doctor/Hepatologist at 10 weeks after 2 undetectables <15 told him I was having moderate side effects brain/vision/fatigue/etc and I was concerned about any long term side effects and asked if it was okay to take half dose Harvoni "split pill' he said okay?

RJ
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Offline sabre

  • Member
  • Posts: 77
Re: reduced dose Harvoni.....
« Reply #1 on: July 04, 2015, 09:26:06 am »
There is no guarantee that if you half dose, your side effects will be lessened. Nor is there a guarantee that any potential long term effects of the drugs will be diminished by half dosing. The protocol for your treatment has been established based on some pretty high level thinking and testing. In my opinion, your doctor is sadly mistaken to say that it is okay to split the tablets.

I think that it's also been determined that the coating on the tablets plays some sort of role in how the medication is delivered and/or absorbed.

If it were me, I'd just soldier through the sides. You've come this far...

Good luck.
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Infected 1980 / Diagnosed 2008
GT 1 / Treatment naive / VL 190,000
Biopsy 2008: stage 0 grade 1
Fibroscan 2015: F2 mild fibrosis
Chronic kidney disease (due to HCV) / Proteinuria

12 weeks Harvoni began on 03/28/2015
End of treatment: 06/19/2015
Labs on 06/17/2015: Undetected
Labs on 09/21/2015: Undetected (SVR12)

Offline GLCII

  • Member
  • Posts: 127
Re: reduced dose Harvoni.....
« Reply #2 on: July 04, 2015, 10:16:34 am »
I agree with sabre

Splitting the pill in half is like splitting a winning hand in black jack except with higher stakes. You never split a winning hand. Any dealer would tell you that as should any doctor. Why take that chance. You already know it's working. Maybe you should talk to your doc about some B vitamins.
Logged
Pre Tx (VL 12043488) ALT 52/ AST 39
Harvoni Start Date 03/12
2 Week in Tx Results HCV RNA Detected, less than 15 IU/mL. ALT 19 / AST 19
4 Weeks in Tx Results HCV RNA Not detected. ALT 21 / AST 18
12 Week in Tx Results HCV RNA Not detected. ALT 17 / AST 19
--------------------------------------------------------------
Post 12 Week EOT Tx ALT 19/ AST 19 (Undetected)
Post 24 Week EOT Tx ALT 19/ AST 15 (Undetected)

Offline Mr. Bob

  • Member
  • Posts: 37
Re: reduced dose Harvoni.....
« Reply #3 on: July 04, 2015, 11:17:33 am »
The coating on the tablet coating is nothing special ,same  as on regular pills.
I don't like the principles of a one size fit all pill  100lb to 300lb  person
« Last Edit: July 04, 2015, 12:01:31 pm by Mr. Bob »
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Offline sabre

  • Member
  • Posts: 77
Re: reduced dose Harvoni.....
« Reply #4 on: July 04, 2015, 01:44:25 pm »
I'm not saying Harvoni falls into this category, but Enteric coatings on pills prevent stomach acid from dissolving them to facilitate absorption in the small intestine.

Also:
The American Medical Society and American Pharmacists Association oppose mandatory tablet-splitting and recommend against splitting tablets that are modified-release, combination products, un-scored, film-coated, friable, or dose-critical.

Since Harvoni is a 'combination product' I'd assume that there is a potential that more ledipasvir would be in one half than sofosbuvir, and vice versa. While one can argue that it would balance out overall, it does not balance out in a 24 hour period.

I wouldn't risk it, Mr Bob.
Logged
Infected 1980 / Diagnosed 2008
GT 1 / Treatment naive / VL 190,000
Biopsy 2008: stage 0 grade 1
Fibroscan 2015: F2 mild fibrosis
Chronic kidney disease (due to HCV) / Proteinuria

12 weeks Harvoni began on 03/28/2015
End of treatment: 06/19/2015
Labs on 06/17/2015: Undetected
Labs on 09/21/2015: Undetected (SVR12)

Offline Barto425

  • Member
  • Posts: 17
Re: reduced dose Harvoni.....
« Reply #5 on: July 04, 2015, 03:31:50 pm »
I agree. From what I've read anyway. Like someone said "you've gone this far" why risk it. I wish someone could answer this for me......I'm due to start Harvoni/Ribavirin in a week or so. If the VA doesn't bail out on me. Knowing the side effects of Ribavirin and being that I also could take Harvoni for 24 weeks instead of Harvoni/Ribavirin for 12 weeks.....why not prescribe just the Harvoni? Yes it's double the treatment time but less side effects.
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Offline nolacs22

  • Member
  • Posts: 12
Re: reduced dose Harvoni.....
« Reply #6 on: July 04, 2015, 03:59:30 pm »
I agree with Sabre, stick to your original therapy. Moreover, the side effects are nothing like they were before now, deal with it if you want to get better. :-*
Let your Doctor handle it  :)
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Offline KimInTheForest

  • Member
  • Posts: 1,972
  • Believe in yourself
Re: reduced dose Harvoni.....
« Reply #7 on: July 04, 2015, 04:28:55 pm »
Quote from: Barto425 on July 04, 2015, 03:31:50 pm
I wish someone could answer this for me......I'm due to start Harvoni/Ribavirin in a week or so. If the VA doesn't bail out on me. Knowing the side effects of Ribavirin and being that I also could take Harvoni for 24 weeks instead of Harvoni/Ribavirin for 12 weeks.....why not prescribe just the Harvoni? Yes it's double the treatment time but less side effects.

It's double the cost. Harvoni is the world's most expensive pill - $1,125/pill (although various pharmacies & insurers are negotiating modest discounts with Gilead). Insurers cannot afford to give people 24 weeks when they can achieve the same cure rate for 1/2 that price by adding ribavirin. I am finishing my 9th week (out of 12) of Harvoni+Ribavirin. Have not had any major problems. Yes, my hemoglobin has dropped due the Riba-induced anemia. But I am living with it, am not in any discomfort, am happy and enjoying my life.

best,
kim :)
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Kim Goldberg (Nanaimo, BC)
1970s: Contracted HCV (genotype 3a)
2015: Cured with Harvoni + ribavirin (12 weeks)
MY STORY: https://pigsquash.wordpress.com/2016/01/28/undetectable-my-hep-c-story/

Offline Barto425

  • Member
  • Posts: 17
Re: reduced dose Harvoni.....
« Reply #8 on: July 04, 2015, 04:44:28 pm »
Oh thanks for the reply. I thought it may have had to do with money. Well anyway I just hope to be starting soon. Since we'll be on the same meds...you're my new best friend! LOL
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Offline KimInTheForest

  • Member
  • Posts: 1,972
  • Believe in yourself
Re: reduced dose Harvoni.....
« Reply #9 on: July 04, 2015, 04:52:45 pm »
Quote from: Barto425 on July 04, 2015, 04:44:28 pm
Oh thanks for the reply. I thought it may have had to do with money. Well anyway I just hope to be starting soon. Since we'll be on the same meds...you're my new best friend! LOL

A few of us currently on Harvoni+Riba are chatting and sharing lab results & side effects over here: http://forums.hepmag.com/index.php?topic=2700.0

cheers,
kim :)
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Kim Goldberg (Nanaimo, BC)
1970s: Contracted HCV (genotype 3a)
2015: Cured with Harvoni + ribavirin (12 weeks)
MY STORY: https://pigsquash.wordpress.com/2016/01/28/undetectable-my-hep-c-story/

Offline Barto425

  • Member
  • Posts: 17
Re: reduced dose Harvoni.....
« Reply #10 on: July 04, 2015, 06:00:19 pm »
Thank you.
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Offline GLCII

  • Member
  • Posts: 127
Re: reduced dose Harvoni.....
« Reply #11 on: July 04, 2015, 07:47:58 pm »
Mr. Bob

Some of us might have taken a bigger dose, given the option. It's a hard virus to kill and there's many of us on here who have tried more then once to do it. Some of us are on our fourth attempt. I'd hate to see you go through anguish of failing treatment due to not using it as recommended by Gilead. Cutting the dose might wear on you mentally, if you fail the Tx. But I always say do what you think is best for you.

If you do cut the dose, keep us informed on your progress. It will be interesting to see how it works at half the strength.

Good Luck.
Logged
Pre Tx (VL 12043488) ALT 52/ AST 39
Harvoni Start Date 03/12
2 Week in Tx Results HCV RNA Detected, less than 15 IU/mL. ALT 19 / AST 19
4 Weeks in Tx Results HCV RNA Not detected. ALT 21 / AST 18
12 Week in Tx Results HCV RNA Not detected. ALT 17 / AST 19
--------------------------------------------------------------
Post 12 Week EOT Tx ALT 19/ AST 19 (Undetected)
Post 24 Week EOT Tx ALT 19/ AST 15 (Undetected)
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