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Hep C Discussion Forum -> On Treatment -> Drug Interactions - Interpreter needed
Post Info TOPIC: Drug Interactions - Interpreter needed
Tig


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Drug Interactions - Interpreter needed
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Thanks Gary! I didn't read that in the Sofosbuvir (Sovaldi) literature. I've been following it's use since becoming a member here and your mention of the subject was the first I've heard  the term "Pg-P inducers". You're right of course that the newness of the drug itself and the inevitable discoveries of it's uses and interactions, are worth investigating. Knowledge is power!

Tig

@Susan, TY!



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Tig

67yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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suziq


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Hi Tig and All,

I have NO idea why apples were on the list.  Think that is a question only Merck can answer.  Maybe a lab rat ate an apple and didn't reach SVR, so Merck decided guinea pigs (clinical trial participants) shouldn't eat apples.  Maybe they will do trial where one arm is allowed apples.LOL

I just decided to go with the flow and didn't eat apples just in case it was really relevant. If I reach SVR, then giving up apples for 18 weeks was no big deal. My 4 week post treatment labs are next Tuesday.  I was UND at EOT. Still playing the waiting game for SVR.

SuziQ



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Geno 1A  Age 82 Treatment naive Cirrhotic Told I had liver disease in 1966. Diagnosed as Hep C 1999.Started Merck clinical trial with Riba on 9/9/2013 Week 1 and 2 <25  Weeks 4, 8, 12,16,18 UND.  EOT Jan 14,2014  EOT +12 UND   JULY 1 2014 EOT+24= SVR
hepcsurvivor


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Tig56 wrote:

@Susan, 

Apples? Can you explain what is considered potentially harmful in them? I love apples too and was never told anything at all about food limitations during treatment. I bought several little deli apple pies (individual serving size!) to eat with my morning medications. If apples are going to impact my SVR rate, my goose is cooked! Or should I say my tree may have just toppled? However, all of my quantitative VL tests showed UND throughout Tx, so any problem would be achieving SVR. If that's the case, I'm going to play George Washington and chop down an apple tree instead!

@ Gary,

I looked at that FDA reference LT provided and it appears that the link Sherry left previously lists them and others as well, but the additional description helps. I'm curious though, because this term "Pg-P inducers" isn't one we hear a lot about, what gave you cause to be concerned with this class of drugs? I'm curious and would appreciate knowing what brought you to this interest. Thanks....

Hi Tig, 

The new drug I am taking (Sovaldi) has a drug interaction warning against Pg-P inducers. Sovaldi just came out so thats probably why you have not heard of this. 

I wanted to learn more about the subject in general and thanks to the helpful links here I know a little more now. Thank you!

Gary

 

 

 

 



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Genotype 3A. Failed Peg and Ribivarin about 2006. Currently UND after 1 month Sovaldi and Ribavirin.
Tig


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@Susan, 

Apples? Can you explain what is considered potentially harmful in them? I love apples too and was never told anything at all about food limitations during treatment. I bought several little deli apple pies (individual serving size!) to eat with my morning medications. If apples are going to impact my SVR rate, my goose is cooked! Or should I say my tree may have just toppled? However, all of my quantitative VL tests showed UND throughout Tx, so any problem would be achieving SVR. If that's the case, I'm going to play George Washington and chop down an apple tree instead!

@ Gary,

I looked at that FDA reference LT provided and it appears that the link Sherry left previously lists them and others as well, but the additional description helps. I'm curious though, because this term "Pg-P inducers" isn't one we hear a lot about, what gave you cause to be concerned with this class of drugs? I'm curious and would appreciate knowing what brought you to this interest. Thanks....

Tig



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Tig

67yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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suziq


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Hi LT

I just think Merck was super strict.  I was not allowed apples (or juice) pomegranates, grapefruit ,orange marmalade (oranges ok) and something else I can't remember.  I had an apple pie in celebration after I finished my trial.  Maybe it tasted so good because it had been forbidden. I missed mince pie at Christmas.

I could not take my berberine, a supplement I use for diabetes.  My blood sugar went up some, but is back to normal since I'm back on berberine.  I just followed the rules and didn't ask why. Not sure that my coordinator knew why anyway. I'll see if the apple pie after tx caused problems when I go in for my 4 week EOT labs next Tuesday.

Finally I have quit having stomach pain.  It was listed as a side effect of the meds. 

SuziQ 



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Geno 1A  Age 82 Treatment naive Cirrhotic Told I had liver disease in 1966. Diagnosed as Hep C 1999.Started Merck clinical trial with Riba on 9/9/2013 Week 1 and 2 <25  Weeks 4, 8, 12,16,18 UND.  EOT Jan 14,2014  EOT +12 UND   JULY 1 2014 EOT+24= SVR
LTChaos


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The only thing they really warned me about was St. John's Wort.    They said it shouldn't be taken at all.  I still call & ask about anything new I will be taking, and they did say B12 was OK.



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GT 2  VL on 10/23/13 7.2 Million; AST 55;ALT 79;AFP 3.2; Started 12 weeks Riba/Sovaldi 2/2/14 - Results Undetectable at 12 weeks!  
suziq


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On my clinical trial, I was told to take one iron pill (to offset ribavirin) and one B12.  ANYTHING else ( over the counter vitamins,etc) could be considered non-compliance.  I did take my diabetes and blood pressure meds--approved as ok during trial. I was allowed antihistamine and Aleve as needed.  They checked my ferritin regularly to be sure I was ok with the iron. It did go up some with iron, but not dramatically.  NO antacids were allowed.  I had a card with me for any emergency treatment.  They were to call before prescribing anything.  Now that some new drugs are on the market, I'm not sure that all physicians are knowledgeable about interactions. 

SuziQ



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Geno 1A  Age 82 Treatment naive Cirrhotic Told I had liver disease in 1966. Diagnosed as Hep C 1999.Started Merck clinical trial with Riba on 9/9/2013 Week 1 and 2 <25  Weeks 4, 8, 12,16,18 UND.  EOT Jan 14,2014  EOT +12 UND   JULY 1 2014 EOT+24= SVR
hepcsurvivor


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Tig56 wrote:

Hi Sherryl,

Welcome to the forum! I'm not entirely sure where the servers are for the forum, but we like to consider ourselves as an International Welcoming Forum. Did you set your local time zone in your profile settings? That may be why your date stamp was off. Regardless of the time, all comments are posted immediately for all to see, no delays here!

Thanks for your tip, it's all appreciated. If you would like to introduce yourself and tell us a little about yourself, please do. We have a thread established in the New Members Section. We'd love to hear more. This is a great group of kind and knowledgeable people, I think you'd enjoy it. Take care!

Tig

Thank you Sherry, this is the easiest one to understand yet!

The only thing lacking is knowing which drugs interact with P-Glycoprotein in a bad way (ie that encourages the Pgp "pump" to pump out protease inhibitors).

How could you tell if a given drug falls into the above category and so should be avoided?

Edit/P.S. I just found this in fda.gov and tables 

Table 3. In Vitro CYP Inducers, 

Table 6.  Classification of In Vivo Inducers of CYP Enzymes(1) 

Table 12. Examples of In Vivo Inhibitors and Inducers of Selected Transporters

List out the drugs that are PgP inducers.

Thank you,

Gary



-- Edited by hepcsurvivor on Thursday 6th of February 2014 02:25:01 PM

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Genotype 3A. Failed Peg and Ribivarin about 2006. Currently UND after 1 month Sovaldi and Ribavirin.
Cinnamon Girl


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Sherryl wrote:

Whoa, I just did a double-take; we're in a different time zone (how could it be the 6th on a post when my clock says it is still the 5th)!

OhhhhK, I edited this 8 hours B4 U see it, forum is in Europe, England Mayhaps?

Hi Sherryl, welcome from me too.  Sorry for the confusion over time zones!!

As Tig said, this is an international forum but as the forum was initially started by a group of people from the UK, and yes you`re right, England, then the default time zone setting is English. 

You have the option to change your time zone settings in your User Details though, if you haven`t done so already.



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Jill 

(71 yo, lives in UK)

Was Gen 3a, 

24wks Peg Ifn/Riba, Sep 2010 - Mch 2011

UND @ Wk.4, UND @ EOT, 

SVR Nov 2011 --> Still UND @ EOT + 4 yrs.

 

 
Tig


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Hi Sherryl,

Welcome to the forum! I'm not entirely sure where the servers are for the forum, but we like to consider ourselves as an International Welcoming Forum. Did you set your local time zone in your profile settings? That may be why your date stamp was off. Regardless of the time, all comments are posted immediately for all to see, no delays here!

Thanks for your tip, it's all appreciated. If you would like to introduce yourself and tell us a little about yourself, please do. We have a thread established in the New Members Section. We'd love to hear more. This is a great group of kind and knowledgeable people, I think you'd enjoy it. Take care!

Tig



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Tig

67yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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Sherryl


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Whoa, I just did a double-take; we're in a different time zone (how could it be the 6th on a post when my clock says it is still the 5th)!

OhhhhK, I edited this 8 hours B4 U see it, forum is in Europe, England Mayhaps?

Anyways, Hullo, Folks, and here is another link that may help:

www.treatmentactiongroup.org/tagline/2000/july/whats-about-p-glycoprotein



-- Edited by Sherryl on Thursday 6th of February 2014 07:17:03 AM



-- Edited by Sherryl on Thursday 6th of February 2014 07:22:24 AM

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hepcsurvivor


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Hi Folks,

Thanks for the replies and helpful info. smile

Gary



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mallani


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Hi Gary,

It's pretty simple. Avoid any drugs that are P-gp inducers! Don't take anything until approved, but this applies to everyone on Rx. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Tig


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Intestinal induction of Pgp: is known to limit the oral availability of certain drug compounds and give rise to detrimental drug-drug interactions.

Following is another link to its description.

http://www.ncbi.nlm.nih.gov/pubmed/18703021

Tig



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Tig

67yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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Michelle22


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Don't know if this link will help, it is still kind of technical but it goes into detail about how the whole thing works

www.jci.org/articles/view/6663

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hepcsurvivor


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Hi Guys,

The Documents for Sovaldi have a Drug Interactions warning:

Drugs that are potent intestinal P-gp inducers (e.g., rifampin, St. Johns wort) may alter the concentrations of sofosbuvir (Sovaldi).

Is there anyone here that can have a stab at explaining what "intestinal P-gp inducers" means?

I realize this is a pretty tough question. If it's too hard that's fine. But we do have some pretty well educated folks here...smile

Gary



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Genotype 3A. Failed Peg and Ribivarin about 2006. Currently UND after 1 month Sovaldi and Ribavirin.
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