ribavirin anemia

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!

Do you know any tx for anemia caused by ribavirin other than 1) procrit or 2) greatly reducing ribavirin intake for patients on telaprevir, with pegasys, and ribavirin that will increase hemoglobin levels?

For the management of anemia, ribavirin dose reductions should be used (refer to the prescribing information for ribavirin for its dose reduction guidelines). If ribavirin dose reductions are inadequate, discontinuation of INCIVEK should be considered. If ribavirin is permanently discontinued for the management of anemia, INCIVEK must also be permanently discontinued. Ribavirin may be restarted per the dosing modification guidelines for ribavirin.

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.

Have any of you seen the new study out of Johns Hopkins regarding comparing the two Pegs? Apparently they also looked at lowering the dose of ribavirin (and interferon) when anemia occurs and found that actually improved the success rate of SVR when compared to people who toughed it out and stayed with the same dose. I was floored when I read this and wish I knew enough to know just how good this study really is. I have a lot of respect for Dr. Sulkowski.

com/hepatitis-c/hepatitis-c-topics/hcv-treatment/3583-easl-ribavirin-dose-reduction-and-epo-both-work-for-managing-anemia-in-patients- Reducing the dose of ribavirin and adding erythropoietin are both good options for managing anemia in hepatitis C patients treated with boceprevir (Victrelis) triple therapy, according to study findings presented at the 47th International Liver Congress (EASL 2012) this week in Barcelona.

No, the anemia from HCV therapy is distinct from say, iron-deficient anemia. Ribavirin causes ‘hemolytic anemia’; red blood cells are destroyed more rapidly than they can be replaced by your body. This occurs naturally anyway; normally they have a lifespan of roughly 100 days, but the HCV drugs hasten this process. Other forms of anemia occur on the other end of spectrum; red cells aren’t produced rapidly enough, for instance.

2 Treatment and Management of Anemia During the telaprevir clinical program, hemoglobin was monitored and RBV reduced in accordance with PEG-IFN/RBV prescribing information. If ribavirin was permanently discontinued for the management of anemia, telaprevir was also to be permanently discontinued. If telaprevir was discontinued for anemia, patients may have continued treatment with peginterferon alfa and ribavirin.

The addition of boceprevir to peginterferon/ribavirin is associated with more anemia than is seen with peginterferon and ribavirin alone.[Boceprevir PI] This can be managed with ribavirin dose reduction and, if required, erythropoietin, with no apparent loss in treatment efficacy. The additional decrease in hemoglobin seen with use of boceprevir is approximately 1 g/mL over that seen with peginterferon and ribavirin alone. Anemia resolves with discontinuation of boceprevir.

Researchers also found that in the third of study participants whose ribavirin dosage was reduced as a result of anemia, cure rates actually improved to as high as 52 percent, whereas in those whose ribavirin dose stayed the same, cure rates were lower, at 37 percent.

My question is this-I have gotten anemia each time I took peg interferon and ribavirin.Once by themselves and another time with incivek.I am scared that I could get bounced from this trial because of becoming anemic.Does the ribavirin without the peg interferon possibly lower my chances of getting anemic.Does anybody have any experience of having been anemic in the past from treatments and went on to a new treatment that included ribo but no peg and didn't have any anemic problems?

I am not confirmed yet that I have the hepatitis yet. I've been waiting since August 20th and then went to the gastro doctor last week and he is running the appropriate tests. Bill, I was told years ago that I had pernicious anemia and now I'm testing postive for anemia too. My anemia levels were HCG 11.2 low and RBC 4.02 low which isn't horrible but low. I keep thinking that the tests must be coming in soon!

Just started treatment for Hep C. This is my 3rd day taking Sovaldi and Ribavirin. No side effects, yet. Just curious, if anemia sets in, when would that be? Is it two weeks into treatment?

I don't think that the mechanism of ribavirin induced anemia is known. We do know it accumulates in red cells. But when does that happen? is it in the bone marrow where the cells originate or does it happen later on? I am not saavy enough to understand much about this.

Billy, If you doc reads the ribavirin package insert directions it says that for anemia the standard protocol is to reduce ribavirin to 600 mg per day if hemoglobin <10 g/dl, first. If < 8.5 g/dL interrupt dose. Then see if hemoglobin level rise. In the clinical trial most patients did rise. Only 4% stopped treatment owing to anemia. So your doc is changing from 1000 mg to 0 mg. This was never done during clinical trials. So there is no data on the outcome.

The updated AASLD guidelines refer clinicians to the drugs’ labeling, or detailed package insert, for information on managing side effects, although the guidelines authors do provide their own guidance on managing anemia. Anemia is a common side effect from ribavirin and the HCV protease inhibitors. During hepatitis C treatment, if anemia develops, people are either treated with a red blood cell growth factor, such as Procrit (erythropoietin), or given a lower dose of ribavirin.

I am concerned about possible anemia from the ribavirin. I know there must be more tests done, and as this is only my first week on treatment, I really wont know anything until later. But as this is a great place to learn from the real experts, I would like to have my P's and Q's together before I get to the doctor.Again, this is my first week, 10 hours following my first Peg inj. I became pretty feverish, to the point of destruction, but I made it through.

Unfortunately, ribavirin can cause hemolytic anemia; his is due to the premature destruction of red blood cells. The choices are either dose reduction of ribavirin, or intervention with Procrit (or other Epo formulas).

it’s primarily the riba that is responsible for hemolytic anemia we experience. Not all of us get anemia so badly that it requires intervention; I don’t have an exact number, but I suppose approximately 30% require dose reduction or Procrit to manage. A call to the treating doctor himself is probably in order; explain your problem to him directly to give him the opportunity to respond.

Thallasemia and hcv treament with ribavirin is a tough situation. A few people here have also faced the issue. Some have relied on intermittant transfusions along with EPO with mixed results. Don't throw in the towel quite yet. If you advising doc is not very expereince with HCV treament you might try to find one that is and have him team up with a hematologist to approach the issue. You also might look into this for further research: http://www.hivandhepatitis.

Ribavirin anemia

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