Welcome, Guest. Please login or register.
March 28, 2024, 06:21:53 am

Login with username, password and session length


Members
  • Total Members: 6307
  • Latest: golfer
Stats
  • Total Posts: 55125
  • Total Topics: 4851
  • Online Today: 91
  • Online Ever: 1314
  • (June 22, 2016, 05:23:42 am)
Users Online
Users: 0
Guests: 71
Total: 71

Welcome

Welcome to the Hep Forums, a round-the-clock discussion area for people who have Fatty Liver Disease, Hepatitis B, C or a co-infection, their friends and family and others with questions about hepatitis and liver health. Check in frequently to read what others have to say, post your comments, and hopefully learn more about how you can reach your own health goals.

Privacy Warning: Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If this concerns you, then do not use a username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.
  • The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own physician.
  • All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.
  • Product advertisement (including links); banners; and clinical trial, study or survey participation—is strictly prohibited by forums members unless permission has been secured from the Hep Forum Moderators.
Finished Reading This? You can collapse this or any other box on this page by clicking the symbol in each box.

Author Topic: Harvoni and antacids  (Read 18811 times)

0 Members and 1 Guest are viewing this topic.

Offline pansy

  • Member
  • Posts: 40
Harvoni and antacids
« on: March 01, 2016, 06:24:15 pm »
Hello all.

I am due to start my Harvoni treatment tomorrow.
My question is, on the Harvoni site, it says antacids are OK, but to take 4 hours before Harvoni.
I am in Japan, my doctor here is telling me to take all pills
(prednisone, 1mg, stomach bactor and antacid,) AND Harvoni, together, in the morning.

He is a good doctor, a liver specialist, but
I told him the Harvoni site instructs us to separate antacids by 4 hours.
The dr tells me to do the "American" way.

I'm getting a WTF moment, and anxiety is causing my blood pressure (which is usually fine) to rise, 150 /90...

Any help or advice would be appreciated.
I am alone here, and I have anxiety about the side effects...

I want to be free of this disease, diagnosed in 2002, but I'm nervous about strong medicines!

Thank you!
« Last Edit: March 01, 2016, 06:27:07 pm by pansy »
Diagnosed 2002, geno: 1a.
Treatment naive.
Started Harvoni 3-3-2016
ALT: 78 AST:60 VL  = 6.3
3-17- 2016 (2 wks Harvoni)
ALT: 16  AST: 21 VL = 2.2
3-28-2016  (4 wks Harvoni)
ALT: 17  AST: 21 VL = Undetected
4-14-2016 (6wks Harvoni)
ALT:17 AST:22 VL = Undetected
4-25-2016 (8 Wks Harvoni)
ALT=18 AST= 21 VL=Undetected
5-9-2016 (10 Wks Harvoni)
ALT=16 AST=25 VL=Undetected
Finished Meds 5-25-2016
5-30-2016 (12 wks Harvoni)
ALT=18 AST=24 VL=Undetected
6-27-2016  (4Wks EOT)
ALT=19 AST=24 VL=Undetected

Offline gnatcatcher

  • Member
  • Posts: 1,372
Re: Harvoni and antacids
« Reply #1 on: March 01, 2016, 09:25:56 pm »
Hi again, Pansy. It is exactly this sort of situation when two experts conflict (and I can't possibly satisfy both) that sends my blood pressure soaring, too. I'd go with Gilead and separate the Harvoni and the antacid by 4 hours -- it was Gilead that ran all the clinical trials that showed what does and doesn't work well. Chances are, your Japanese doctor won't ask you exactly what time you took everything; you'll probably only be asked IF you took everything.

Most people have an easy time on Harvoni. I did, and I wish the same for you.

Gnatty
9/29/71 transfusions
HCV genotype 1a
7/09/15-9/30/15 Harvoni

Before treatment:
Viral Load 9,490,582
FibroScan 19.5 kPa [F4]
ALT 262
AST 217
ALP 183

Most recent:
VL still UNDETECTED (SVR 102)
FibroScan 7.6 kPa [F1-2]
ALT 15
AST 20
ALP 85

Offline pansy

  • Member
  • Posts: 40
Re: Harvoni and antacids
« Reply #2 on: March 01, 2016, 09:43:54 pm »
Thank you, so much, for your reply, Gnatty.

I'm going to go "the American way", which happens to also be Gileads.
I've downloaded the pdf you earlier suggested.

Thanks again, for your kind reply.

pansy
Diagnosed 2002, geno: 1a.
Treatment naive.
Started Harvoni 3-3-2016
ALT: 78 AST:60 VL  = 6.3
3-17- 2016 (2 wks Harvoni)
ALT: 16  AST: 21 VL = 2.2
3-28-2016  (4 wks Harvoni)
ALT: 17  AST: 21 VL = Undetected
4-14-2016 (6wks Harvoni)
ALT:17 AST:22 VL = Undetected
4-25-2016 (8 Wks Harvoni)
ALT=18 AST= 21 VL=Undetected
5-9-2016 (10 Wks Harvoni)
ALT=16 AST=25 VL=Undetected
Finished Meds 5-25-2016
5-30-2016 (12 wks Harvoni)
ALT=18 AST=24 VL=Undetected
6-27-2016  (4Wks EOT)
ALT=19 AST=24 VL=Undetected

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,543
  • Get tested, get treated, get cured, fight Hep c!
Re: Harvoni and antacids
« Reply #3 on: March 01, 2016, 10:59:25 pm »
Hi Pansy and welcome,

It all depends on what antacids we are talking about.

If you are talking about Tums or Rolaids or similar yes take them no closer than 4 hours before Harvoni or 4 hours after Harvoni.

If you are talking about H2 antagonists like Tagamet, Pepsid, Zantac or similar those would be taken at the same time as Harvoni and exactly 12 hours after and 12 hours before your next Harvoni dose.

Finally if you mean PPI's (Proton-Pump Inhibitors) like Prilosec (omeprazole) Prevacid (lanosoprazole) or Nexium (esomeprazole) or similar those need to be taken at the same time as Harvoni on an empty stomach.

All this can be found on the Harvoni prescribing information sheet table 4 page 9

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

The American way gotta like that lol

Good luck on treatment
Lynn
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline pansy

  • Member
  • Posts: 40
Re: Harvoni and antacids
« Reply #4 on: March 02, 2016, 12:22:34 am »
Hi, @Lynn K,

Thank you for your reply.
Being the drugs are in Japan, I had to research further, to find the active ingredient in the meds I am currently taking.
The one in question is called  Gaster B, active ingredient Famotidine.

So, it is not actually an antacid, after all, and my dr. was correct.

I will see him in the early morning tomorrow, before I take it, I will discuss with him further.

Thank you, for your info, and help!

pansy
Diagnosed 2002, geno: 1a.
Treatment naive.
Started Harvoni 3-3-2016
ALT: 78 AST:60 VL  = 6.3
3-17- 2016 (2 wks Harvoni)
ALT: 16  AST: 21 VL = 2.2
3-28-2016  (4 wks Harvoni)
ALT: 17  AST: 21 VL = Undetected
4-14-2016 (6wks Harvoni)
ALT:17 AST:22 VL = Undetected
4-25-2016 (8 Wks Harvoni)
ALT=18 AST= 21 VL=Undetected
5-9-2016 (10 Wks Harvoni)
ALT=16 AST=25 VL=Undetected
Finished Meds 5-25-2016
5-30-2016 (12 wks Harvoni)
ALT=18 AST=24 VL=Undetected
6-27-2016  (4Wks EOT)
ALT=19 AST=24 VL=Undetected

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,543
  • Get tested, get treated, get cured, fight Hep c!
Re: Harvoni and antacids
« Reply #5 on: March 02, 2016, 12:26:24 am »
Yes Famotidine is a H2 antagonist the US name is Pepcid.

Copied from the prescribing information sheet:

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.

So like your doctor said take your famotidine at the same time as Harvoni the US way :)
« Last Edit: March 02, 2016, 12:28:22 am by Lynn K »
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline gnatcatcher

  • Member
  • Posts: 1,372
Re: Harvoni and antacids
« Reply #6 on: March 02, 2016, 04:49:13 am »
Lynn, many thanks for being so thorough. I had already (in another, earlier thread) sent Pansy the link to the PI, but my life is so hectic right now that I hadn't re-read the antacids section. My bad.
« Last Edit: March 02, 2016, 07:56:19 am by gnatcatcher »
9/29/71 transfusions
HCV genotype 1a
7/09/15-9/30/15 Harvoni

Before treatment:
Viral Load 9,490,582
FibroScan 19.5 kPa [F4]
ALT 262
AST 217
ALP 183

Most recent:
VL still UNDETECTED (SVR 102)
FibroScan 7.6 kPa [F1-2]
ALT 15
AST 20
ALP 85

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,543
  • Get tested, get treated, get cured, fight Hep c!
Re: Harvoni and antacids
« Reply #7 on: March 02, 2016, 05:10:52 am »
No worries

I just wanted to make sure what kind of acid reducer she was asking about. It is so easy to get confused by the acid reducer instructions and so important to get it right.
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Harvoni and antacids
« Reply #8 on: March 02, 2016, 09:49:07 am »
Hi,
Good luck on your treatment!! I had a dull headache for three days and nothing else but feeling really better after about 12 days.  I had MAJOR stomach issues with reflux, horrible dyspepsia, etc. that began suddenly about 3 years ago-a year before my liver enzymes skyrocketed and led to my HCV diagnosis.  The GI couldn't figure out what was up. Endoscopies, reflux monitoring, nothing abnormal could be found.  I was not under undue stress and had never had a stomach issue in my life.  I ended up on Pepcid, Prilosec and a compounded medication for dyspepsia.  I ate the blandest of foods, went totally vegan and still had to eat one day and be sick and fast the next, so I could sleep. That went on for two years. I lost 50 lbs and was not obese to start with. I stopped all medications except the absolutely necessary blood pressure pill when I started my generic harvoni.  The DAAs, were and are, so new that nobody really knows what affects what to any certain degree except the clinical trials findings, that were small and fast tracked.  The body of knowledge is now growing by leaps and bounds, but it will take time before things become really clear about interactions.
To make a long story longer, the first couple of weeks without the digestive medications were rough, but after that, nothing.  I was, and am, able to eat whatever I want.  So, Lynn's advice is spot on. Exactly what is recommended.  Hopefully, you will find, like me, that chronic dyspepsia is an EHM of HCV.
Good Luck in you Virocide!
Coach Mike
« Last Edit: March 02, 2016, 09:57:17 am by Coach Mike »
Genotype 1a, Biopsy:11/2014: F-1, Tx Naive
Fibrosure, 7/20/15: F-1-2
Pre tx v/l: 1,600,000, ALT: 75, AST: 48
Started generic sofosbuvir & ledipasvir: 10/23/15
4 wk labs: 11/19/15, ALT: 21, AST: 16, V/L:  UND
Started 8 week Harvoni tx: 11/20/15
8 wk labs, 12/15/15, ALT: 15, AST: 13, V/L: UND
4/11/16 12 week EOT-Undetected
7/5/16 SVR 24

Offline FutureThinker

  • Member
  • Posts: 711
  • Onward and upward!
Re: Harvoni and antacids
« Reply #9 on: March 02, 2016, 01:02:28 pm »
LynnK, your knowledge base on the subject of HCV never ceases to amaze me!  Thank God you are on this site, along with Lucinda and the other moderators, providing a sense of calm and logic to this very complicated disease.

Pansy -- I am on day 8 of Harvoni and doing very well, actually feel better than I've felt in a very long time. Please join me and several others who recently started   Harvoni under the "Boarding the Harvoni Train" post, to join us on this journey! I took a window seat and am finding the scenery to be quite nice.  Best of luck to you and look forward to hearing how you're doing --- Future Thinker
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline lporterrn

  • Member
  • Posts: 1,969
  • LucindaPorterRN
    • LucindaPorterRN
Re: Harvoni and antacids
« Reply #10 on: March 02, 2016, 07:21:15 pm »
Hi,
Lynn is right on the timing. And yes, it has to do with the class of antacid. However, yesterday I heard a compelling presentation for those who can, try to keep antacid use to the lowest doses possible. I realize that sometimes you just have to take them, but the lower doses taken at the appropriate times have better SVRs.
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
https://www.hepmag.com/blogger/lucindakporter

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,543
  • Get tested, get treated, get cured, fight Hep c!
Re: Harvoni and antacids
« Reply #11 on: March 02, 2016, 07:26:54 pm »
My doctor did ask me if possible to not take Prilosec while on treatment. As I have a hiatial hernia and fairly frequent reflux let me tell you it was a long 24 heartburn filled weeks.

I just took Tums at night well away from Harvoni when I couldn't sleep for the burning in my throat.

And when I finished Harvoni first thing I did to celebrate was take a Prilosec :)
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline lporterrn

  • Member
  • Posts: 1,969
  • LucindaPorterRN
    • LucindaPorterRN
Re: Harvoni and antacids
« Reply #12 on: March 02, 2016, 10:01:07 pm »
Lynn, most people ask if they can have a tiny bit of champagne - leave it to you to celebrate with Prilosec!
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
https://www.hepmag.com/blogger/lucindakporter

Offline FutureThinker

  • Member
  • Posts: 711
  • Onward and upward!
Re: Harvoni and antacids
« Reply #13 on: March 03, 2016, 05:06:47 pm »
"Different strokes for different folks!" lol   FT
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,543
  • Get tested, get treated, get cured, fight Hep c!
Re: Harvoni and antacids
« Reply #14 on: March 03, 2016, 06:45:25 pm »
What can I say I sure know how to party :)
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline FutureThinker

  • Member
  • Posts: 711
  • Onward and upward!
Re: Harvoni and antacids
« Reply #15 on: March 03, 2016, 06:59:49 pm »
LOL, all I can say is thank goodness we can laugh about this!!  Thanks again for all your help on this site, FT
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline JimmyK

  • Member
  • Posts: 18
Re: Harvoni and antacids
« Reply #16 on: March 05, 2016, 10:06:20 am »
Greetings,

Wife began Harvoni x 12 weeks this morning. She will be taking Omeprazole at the same time in fasted conditions first thing in the morning simultaneously as per the dosing guidelines in Table 4.

I will return to the Doctor Tuesday the 8th and will be requesting Harvoini x 24 weeks and doing the same routine.

Regards

JimmyK
Gen 1a HCV PCR Q 3880000, ALT 94 AST 58, F2
Tx 1 Viek/Rib x 12 SOT 10/15/15 Breakthrough_Treatment Stopped 12/29/15

Tx 2 Harvoni x 12, SOT 04/15/16, EOT 07/07/16, UND week 4 and 12. EOT + 4 Weeks 08/04/16 will repeat HCV RNA to determine status due to NS5A and NS3 findings at EOT TX1 12/29/15. (M28T and Q80K,D168Y)
Considered an "interesting" case. Update EOT + 4 Weeks HCV RNA came back UND. On to 09/29/16 for SVR 12.

Offline JimmyK

  • Member
  • Posts: 18
Re: Harvoni and antacids
« Reply #17 on: March 05, 2016, 11:15:40 am »
Greetings,

One thing I was trying to seek out data on is how the term "fasted conditions" is properly interpreted in Table 4 of the dosing guidelines.

Duration?  20 minutes?, 30 minutes? 60 minutes?

What about other medications that do not interact negatively and can be taken? Even though they are allowed are they part of the fast?

Coffee? Tea? Quantity of water?

Of course I understand the best practice would no doubt be nothing for an hour, but my question is if there is any data on the subject?

Many Thanks all the Hep C Warriors!

JimmyuK
Gen 1a HCV PCR Q 3880000, ALT 94 AST 58, F2
Tx 1 Viek/Rib x 12 SOT 10/15/15 Breakthrough_Treatment Stopped 12/29/15

Tx 2 Harvoni x 12, SOT 04/15/16, EOT 07/07/16, UND week 4 and 12. EOT + 4 Weeks 08/04/16 will repeat HCV RNA to determine status due to NS5A and NS3 findings at EOT TX1 12/29/15. (M28T and Q80K,D168Y)
Considered an "interesting" case. Update EOT + 4 Weeks HCV RNA came back UND. On to 09/29/16 for SVR 12.

Offline lporterrn

  • Member
  • Posts: 1,969
  • LucindaPorterRN
    • LucindaPorterRN
Re: Harvoni and antacids
« Reply #18 on: March 05, 2016, 11:59:09 am »
You can read some of the data in the package insert. Optimal is an hour before eating and at least 2 hrs after (3 is better), but the big issue isn't the perfectness of the fasting condition - it is the taking the omeprazole and Harvoni together.  So if you have to skimp on the time and go to 30 to 45 mins, there shouldn't be a problem. You can take both at bedtime if you aren't a night time snacker. Water, tea, coffee all should be fine. As for other meds, this may interest you: http://www.hep-druginteractions.org/
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
https://www.hepmag.com/blogger/lucindakporter

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,543
  • Get tested, get treated, get cured, fight Hep c!
Re: Harvoni and antacids
« Reply #19 on: March 05, 2016, 12:03:02 pm »
I found something about fasted to mean 1 hour before or 2 hours after food water is ok and I assume  coffee and tea no cream or sugar.

That was part of the reason I went without Prilosec just too hard to figure out when was safe and I did not want to risk treatment failure.
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline FutureThinker

  • Member
  • Posts: 711
  • Onward and upward!
Re: Harvoni and antacids
« Reply #20 on: March 05, 2016, 12:34:19 pm »
JimmyK, welcome to this forum! You may want to join the conversation under "Boarding the Harvoni Train tomorrow morning", as JR, Just Breath, Pansy and I (FutureThinker) all just started Harvoni in the past 2 weeks or so.  I'm on day 11. All the best to you and your wife, and the future is bright! FT
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline pansy

  • Member
  • Posts: 40
Re: Harvoni and antacids
« Reply #21 on: March 07, 2016, 12:16:27 am »
Hello!

Day 4 blood tests

My AST & ALT in normal range!
I have to wait to know the viral load, but results are already visible!
My LF tests haven't been in normal range for quite some time, until now!

Drinking water all d time, still creatinine slightly high.
Feh.
I feel good, no discomfort so far.
Blood pressure is 130/88.

One thing I learned today:
I will not use those "stick your arm in" bp machine types, ever again.
I thought it would pinch my arm off, and it caused the reading to be very high.
After a manual bp test, pump with wrap around the arm, I was VERY relieved to know bp is fine...

Short of this small bump in the road, a good dr visit.


pansy
Diagnosed 2002, geno: 1a.
Treatment naive.
Started Harvoni 3-3-2016
ALT: 78 AST:60 VL  = 6.3
3-17- 2016 (2 wks Harvoni)
ALT: 16  AST: 21 VL = 2.2
3-28-2016  (4 wks Harvoni)
ALT: 17  AST: 21 VL = Undetected
4-14-2016 (6wks Harvoni)
ALT:17 AST:22 VL = Undetected
4-25-2016 (8 Wks Harvoni)
ALT=18 AST= 21 VL=Undetected
5-9-2016 (10 Wks Harvoni)
ALT=16 AST=25 VL=Undetected
Finished Meds 5-25-2016
5-30-2016 (12 wks Harvoni)
ALT=18 AST=24 VL=Undetected
6-27-2016  (4Wks EOT)
ALT=19 AST=24 VL=Undetected

Offline FutureThinker

  • Member
  • Posts: 711
  • Onward and upward!
Re: Harvoni and antacids
« Reply #22 on: March 08, 2016, 11:52:54 am »
WOW!!!!  Isn't it unbelievable that this little pill can do so much good in so little time?????  I am amazed.  I'm on day 14 and feeling good, esp. when I get a good night's sleep. I have to wait until 3/23 for my first labs, but I FEEL like my LFT and VL must be normal or at least a whole lot better! Maybe we should be calling this the "Magic Bus" vs. the Harvoni Train, because it seems like magic! It's just unbelievable the difference I feel from this time last month.  We are so blessed these DAAs have come into the medical market --- now we just need to get them priced better so more people around the world can be cured.  The future is bright ---- FT
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Harvoni and antacids
« Reply #23 on: March 08, 2016, 12:44:24 pm »
Happy for you!
Studies show, in most case, the vast majority of the virus is essentially destroyed by the second week. Your enzymes would be in the normal range now.
Hard to believe anyone with HCV would ever be denied such an effective, side effect free tx.
Hard to believe a government would allow a company to price something so wonderful so high.
So high Veterans are being denied tx.
Especially when Gilead has been spending $99 of every $100 on advertising and $1 on research.

From the CDC:
http://hepatitiscnewdrugs.blogspot.com/2016/03/cost-keeps-hcv-care-out-of-reach.html

CM
« Last Edit: March 08, 2016, 01:25:45 pm by Coach Mike »
Genotype 1a, Biopsy:11/2014: F-1, Tx Naive
Fibrosure, 7/20/15: F-1-2
Pre tx v/l: 1,600,000, ALT: 75, AST: 48
Started generic sofosbuvir & ledipasvir: 10/23/15
4 wk labs: 11/19/15, ALT: 21, AST: 16, V/L:  UND
Started 8 week Harvoni tx: 11/20/15
8 wk labs, 12/15/15, ALT: 15, AST: 13, V/L: UND
4/11/16 12 week EOT-Undetected
7/5/16 SVR 24

Offline malou

  • Member
  • Posts: 57
Re: Harvoni and antacids
« Reply #24 on: March 08, 2016, 01:41:20 pm »
FT like you, I began feeling wonderful at about day 4 and it has continued.  I am on the last two pills now of week 10 and so I have two more weeks of treatment after that.  Please be sure to share your good news!  ML
HCV 1996- Work Exposure ER nurse
GT 1a
Non-responder to Interferon in 1997
ALT 73 AST 21 F1-2
Applied to Insurance for Harvoni 12-15
Denied 12-3-15  Told I would never qualify for Harvoni because I was not 'ill'.
Started Twinvir (Bengladesh Harvoni) on 1/1/16

After 4 weeks ALT 23, AST 15, HCV-RNA UNDETECTED
After 8 weeks:AST 23, AST 11, HCV RNA UNDETECTED
6 weeks post treatment, undetected.

Offline JimmyK

  • Member
  • Posts: 18
Re: Harvoni and antacids
« Reply #25 on: March 08, 2016, 03:11:55 pm »
Hey Y'all,

Back from meeting with Doctor today. He is requesting Harvoni x 24 weeks this time. I will be using Omeprazole fasting conditions first thing in the morning at the same time.

He suggested that I do not hold back on eating something in rather close proximity but not Cereal with Milk due to Milk being an alkaline. He said he wanted to ensure an acidic environment.

The PPI and Harvoni has little data but it is known that the acidic environment is required. He feels the simultaneous taking of the two together is kind of a "chicken or the egg" scenario.

Getting closer to the goal.

JimmyK
Gen 1a HCV PCR Q 3880000, ALT 94 AST 58, F2
Tx 1 Viek/Rib x 12 SOT 10/15/15 Breakthrough_Treatment Stopped 12/29/15

Tx 2 Harvoni x 12, SOT 04/15/16, EOT 07/07/16, UND week 4 and 12. EOT + 4 Weeks 08/04/16 will repeat HCV RNA to determine status due to NS5A and NS3 findings at EOT TX1 12/29/15. (M28T and Q80K,D168Y)
Considered an "interesting" case. Update EOT + 4 Weeks HCV RNA came back UND. On to 09/29/16 for SVR 12.

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,543
  • Get tested, get treated, get cured, fight Hep c!
Re: Harvoni and antacids
« Reply #26 on: March 08, 2016, 06:14:40 pm »
I believe the reason for the simultaneous administration of Harvoni and omeprazole is because it takes a period of time for the omeprazole to do its job of acid suppression.

By the time the omeprazole has reduced the acid levels in the stomach the ledipasvir component of Harvoni would have been digested completely by then.

Good luck with treatment
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline JimmyK

  • Member
  • Posts: 18
Re: Harvoni and antacids
« Reply #27 on: March 08, 2016, 06:40:32 pm »
I believe the reason for the simultaneous administration of Harvoni and omeprazole is because it takes a period of time for the omeprazole to do its job of acid suppression.

By the time the omeprazole has reduced the acid levels in the stomach the ledipasvir component of Harvoni would have been digested completely by then.

Good luck with treatment

Greetings.

You are absolutely right it does take time. His concern is in the case of PPI's you are not really suppressing acid as much as it's production. In other words in the absence of acid there is a need to produce some for ledipasvir to be properly taken in. His question is what triggers the production in the absence of food?

JimmyK  and I am going to take Harvoni along with Omeprazole followed closely by a hunk of toast with butter on it.  LOL
Gen 1a HCV PCR Q 3880000, ALT 94 AST 58, F2
Tx 1 Viek/Rib x 12 SOT 10/15/15 Breakthrough_Treatment Stopped 12/29/15

Tx 2 Harvoni x 12, SOT 04/15/16, EOT 07/07/16, UND week 4 and 12. EOT + 4 Weeks 08/04/16 will repeat HCV RNA to determine status due to NS5A and NS3 findings at EOT TX1 12/29/15. (M28T and Q80K,D168Y)
Considered an "interesting" case. Update EOT + 4 Weeks HCV RNA came back UND. On to 09/29/16 for SVR 12.

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,543
  • Get tested, get treated, get cured, fight Hep c!
Re: Harvoni and antacids
« Reply #28 on: March 08, 2016, 06:52:52 pm »
I believe there is always acid in the stomach. So when you take Harvoni there is acid there. But say you had taken omeprazole 4 hours earlier the production of acid had been suppressed by then so the concern is it will effect the absorption of ledipasvir. By taking at the same time there would be the normal acid levels always present in the stomach.

from U.S National Library of Medicine

The normal volume of the stomach fluid is 20 to 100 mL and the pH is acidic (1.5 to 3.5). These numbers are converted to actual acid production in units of milliequivalents per hour in some cases. Note: Normal value ranges may vary slightly depending on the lab doing the test.

I have read that an empty stomach means no food for 2 hours prior or 1 hour post taking a medicine that is to be taken on an empty stomach. I am thinking the followed closely by butter and toast is not a terrific plan and would discuss that with your doctor, pharmacist or the Harvoni help line.
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline JimmyK

  • Member
  • Posts: 18
Re: Harvoni and antacids
« Reply #29 on: March 09, 2016, 09:13:19 am »
Hi Lynn,

Your response is great and I thank you for it. I believe my Doctors concern is the lack of data regarding PPI's and Harvoni. There are unknowns that he is not comfortable with.

The "..normal volume of stomach fluid.." you mention is of course accurate but for those that take PPI's daily it is doubtful they would fall under the definition of "normal". This creates an unknown.

I would assume in that Omeprazole is an OTC medicine there is likely folks that take it that would fair well on other types of suppression such s a Zantac product.   

The question is related to individuals and what their volume would be 24 hours after taking a PPI. I imagine it is possible that in some cases the volume is still greatly suppressed below the normal volumes mentioned and in others no so much.

My Doctor is concerned that if still suppressed first thing in the morning , what is there to trigger an acid response brought on by such things as a piece of toast if the stomach remains empty prior to the new dose of Omeprazol taking effect?

Due to the variance across individuals with regard to acid production it leaves some guess work producing the unknowns he is concerned with.

At any rate each of us here are blazing the path those behind us will follow. It is a noble Crusade we are on and The Dragon is going down.

Regards

JimmyK
Gen 1a HCV PCR Q 3880000, ALT 94 AST 58, F2
Tx 1 Viek/Rib x 12 SOT 10/15/15 Breakthrough_Treatment Stopped 12/29/15

Tx 2 Harvoni x 12, SOT 04/15/16, EOT 07/07/16, UND week 4 and 12. EOT + 4 Weeks 08/04/16 will repeat HCV RNA to determine status due to NS5A and NS3 findings at EOT TX1 12/29/15. (M28T and Q80K,D168Y)
Considered an "interesting" case. Update EOT + 4 Weeks HCV RNA came back UND. On to 09/29/16 for SVR 12.

Offline FutureThinker

  • Member
  • Posts: 711
  • Onward and upward!
Re: Harvoni and antacids
« Reply #30 on: March 09, 2016, 11:54:29 am »
Thanks Coach, as usual, always enjoy your valuable input.  I am very hopeful this very smooth ride continues and leads to the goal -- SVR! I just want to see more people get treated, and soon, now that I've experienced how dramatic (and that is exactly what it's been -- dramatic) an improvement this drug provides.  Anticipating the approval of the Gilead drug in June to see how they price it...... let's hope they learned something! FT
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,543
  • Get tested, get treated, get cured, fight Hep c!
Re: Harvoni and antacids
« Reply #31 on: March 09, 2016, 08:55:06 pm »
well in my laypersons mind I would go with the recommendations of the research scientists who recommend on an empty stomach per the prescribing information sheet.

Even with having taken Prilosec if on regular treatment for acid reflux taking Prilosec every day the reason we take at 24 hours the dose is losing effectiveness in acid prevention. Also while eating does increase acid production HCl acid is always present in the stomach at some level.

But anyway if the experts believe and recommend that Prilosec should be taken at the same time as Harvoni on an empty stomach that is what I would go with.

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

Excerpt table 4 page 9

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

Or with what my doctor suggest that if I could go with out taking any acid reducers for the duration of my treatment that would be the best and safest option to insure a successful treatment especially as I could little afford to fail at this point being a 4 time treatment failure and having cirrhosis for 8 years.

But hey it's your treatment so whatever your doctor believes to be the best plan.
« Last Edit: March 09, 2016, 09:04:48 pm by Lynn K »
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

 


© 2024 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.