Ribavirin and hemolytic anemia
Common Questions and Answers about Ribavirin and hemolytic anemia
rebetol
From what I have always heard the priority is reduce ribavirin 1st, Procrit 2nd and transfusion last. But it is up to the doctor and his experience.
Has the Procrit helped at all?
Of course it will take time for the reduced dosage of ribavirin to take effect.
Hang in there! I hope that can get back up soon!
I had anemia that was procrit dependent going into treatment - anemia of unknown or chronic disease (possibly an auto-immune hemolytic anemia as it turns out). I did treat with ribavirin and interferon, and I had a lot of difficulties with anemia. Early on, I began taking 40,000 units of procrit (well, epogen in my case) twice a week. It really didn't touch the anemia. I had blood transfusions every 10 to 14 days while treating and I had a successful treatment and I am now SVR.
Nonetheless, the new drugs (Incivek or Victrelis) still must be given in conjunction with pegylated interferon and ribavirin. Thus, anemia from Hepatitis C treatment remains a prominent concern.
About Anemia
Anemia develops from abnormally low levels of red blood cells or hemoglobin. Severe anemia means that a person's blood cannot carry enough oxygen to meet the needs of the body's tissues.
Hemolytic anemia is to a condition in which red blood cells are destroyed faster than the body can make enough new ones to replace them. Ribavirin can cause hemolytic anemia. The likelihood of anemia increases with higher doses of ribavirin.
Symptoms
The most common symptoms of anemia include shortness of breath, fatigue, pale skin, chills, rapid heart rate, depression, and reduced quality of life.
s disease or diabetes often have anemia caused by poor vitamin B absorption (pernicious anemia), and yet others have iron deficiency anemia (most common) which is from not enough iron in your diet...(there's hemorrhagic anemia caused by blood loss also) If you don't have an explainable reason for your low labs, I'd ask for a redraw...Too much iron can be very hard on the liver and spleen...But not enough can be damaging as well...
My experience (48 weeks of treatment) was that side effects varied, some would come and go, others were with me throughout. The worst for me was the hemolytic anemia. I had to have a transfusion at week 6 and took the rescue drug, Procrit, for 40 weeks. The anemia causes exhaustion, dizzyness and extreme shortness of breath. The good news is that the anemia indicates that your ribavarin dose is not too low.
The volume of distribution of ribavirin is large (2000 L/kg) and the length of time the drug is trapped varies greatly from tissue to tissue. The mean half-life for multiple doses in the body is about 12 days, but very long-term kinetics are dominated by the kinetics of RBCs (half-life 40 days). RBCs store ribavirin for the lifetime of the cells, releasing it into the body's systems when old cells are degraded in the spleen.
http://en.wikipedia.
i agree with you completely. I frankly think that it can be discontinued--speak to the transplant team about this. you make a good point about the glycosylated hemoglobin level.
The kind of anemia from treatment drugs like ribavirin is hemolytic anemia which means red blood cells are destroyed and you have less of them to carry oxygen to your various tissues and organs. Low iron anemia is when you don't have enough iron in your system to carry adequate oxygen. Iron is what oxygen binds with in the blood, that's why it's red. With hemolytic anemia no amount of iron will help since the problem is not the iron but the lack of red blood cells.
Ribavirin is weight based so if his weight says he should be on 1400 a day, then that is what he should be on (unless he develops hemolytic anemia). To me, it sounds like the doc is tinkering with the med dosage and thinks that because your husband is currently Undetectable that your husband no longer needs 1400 mg a day. If that is the case, and it was me, I would be alarmed that the doctor does not know the recommended Hep C med regimen protocol.
About 50% of people treating with boceprevir develop hemolytic anemia compared to about 28% of people who are on ribavirin and interferon alone. Hemolytic Anemia (red blood cell destruction which reduces the hemoglobin in your blood is the main side effect from boceprevir. This is not the same as iron poor blood anemia.
When your hemoglobin is low your body doesn't get enough oxygen and it can cause a person to feel very week and sometimes disoriented.
Neupogen stimulates white blood cell production and Procrit or Epogen boosts red blood cells = increased hemoglobin in hemolytic anemia which is the anemia induced by ribavirin, primarily. Ribavirin prematurely destroys RBCs and that's why we can become anemic. Neupogen won't help that problem but Procrit or Epogen will.
The anemia associated with ribavirin most often occurs as a dose-dependent hemolytic anemia, typically developing within the first 4 weeks of therapy. With use of higher doses of ribavirin (1000-1200 mg/d), hemoglobin levels frequently decline by 2-3 g/dL, as seen in this case. In addition to causing hemolysis, ribavirin can also down-regulate the number of erythropoietin receptors.
Is there anyone out there currently on a DAILY regimen of ribavirin AND interferon? I am a caregiver for a friend who is currently on this regimen and it's difficult to find any information on side effects etc. for a daily treatment. I n addition, he is starting bi-weekly Neupigen as well, and the side effects seems to be getting worse. Thanks in advance.
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