I have recently seen a patient get significant side effects from Daclatasvir due (we suspect) to his daily Paw Paw habit. These disappeared with a small dose reduction, but reappeared with increasing the dose.
At 68 kg weight was not the issue, but a careful history revealed he eats Paw Paw every day, and Dr Google came to the rescue turning up this new page:
Damn, pawpaws have been really yummy this season. I quit them shortly after starting tx after seeing the same linked article in another thread.
I hope lychees are ok, they're good now too. In moderation, they have decent amount of Vitamin C which is also contraindicated.
It would be great to have a sticky for common foods, vitamins and herbals to avoid during treatment, and recommend any that are helpful. IIRC, gingko, ginseng and St Johns Wort have been mentioned. Drug interactions can already be searched.
M 61yo HCV+ ~ 30 yrs Gt1a F2 VL 223,000 ALT 54 AST 42 Tx start Sof/Dac 17Dec15.
SVR4 at 7Apr16 ALT 22 AST 22
SVR12 at 9Jun16 ALT 23 AST 25
Thank you so much for taking the time to check this problem out for me, James. It's been just over a week now without any paw paw and my sides continue to be no where near as bad as what they were. It's a shame it took 5 months of suffering to find out that eating this fruit was probably the cause of all my problems; having the Daclatasvir build up in my system. At least I should now be able to cruise through the final few weeks of tx in peace.
Big thanks also to Sylvia Price for all her wonderful info she passed on and also for contacting you to raise this issue.
Great people! Great forum!
Gen 3a 30yrs plus
Sorry to further dampen things BillyM - red meat (saturated fats) is very hard work for the liver to process; you eat that and probably feel very bloated and tired and need a Siesta to get through it
How about fish and brown rice with steamed carrots, broccolini, baby corn, snow peas, with a spoonful of coconut milk and lime juice ..mmmmm
Brown rice is far better for you than white - brown only has outer hull removed and hence saves most of the nutrients, white is stripped down so badly it actually has to be fortified with vitamins to be sold here.
Brown rice has protein, fibre, very minimal fat and no other sugars than tiny amount of sucrose; all the Vitamin B complex, minerals - magnesium, manganese, selenium, phosphorus, copper, zinc, iron, calcium, chromium; and NO vitamin A, C, D, E!
Fish will give you protein and omega 3 (depending on type e.g. Salmon is higher), easy to digest; carrots - betacarotene -converts to Vitamin A in your body; broccolini - protein (surprised?) fibre, calcium, potassium, betacarotene, B6 and folate, Vitamin C and other trace minerals.
Awesome, I feel hungry just talking about it
Nevertheless, the fact is we no longer can get the Recommended Daily Allowance of our nutrients from food as our grandparents did. Our soils are depleted by overfarming and pesticides; our produce is stored for weeks and months in refrigeration before it reaches our shelves; buying things cut up rather than whole depletes nutrients through oxidation (exposure to air) and the way we cook can further reduce things. Sickness, stress and poor diet/appetite further depletes our bodies and makes us deficient and more time indoors means lack of sunshine and vitamin D. Living in the UK - apparently widespread deficiency of Vitamin D.
Everything works synergistically so taking some supplements without others can be a waste of time because they can't be assimilated in the body. It really is hard to work out what's best for us individually .....
QLD Australia ☀️
G3a HCV 35 yrs Tx naive
Started Sof/Dac 13/01/16
13 Feb'16 VL UND
Now, the following is just anecdotal with no science behind it, probably as much about moderation as CYP3a4 inhibitors:
About 3-4 weeks ago my sides seem to be increasing somewhat, nothing real bad but I just wasn't feeling that great any more, nothing I could really put a finger on, just a little bleah! Then 2 weeks ago I was reading one of Greg's posts on his blog and he included Grapes in the list of items that were potential CYP3a4 inhibitors that should be avoided when on Daclatasvir. My first thought was "nup, grape seed oil is an inhibitor but not grapes". A very quick google confirmed that I was correct so I grabbed another handful of grapes out of the fruit bowl. Hey, it's grape season and they're $3-4 a kilo and I like grapes so there is always a bunch in the bowl and I graze as I walk past throughout the day, probably 5-6 times a day, at least 1/4 to 1/3 kg a day!!! Ohh.....wait! Maybe time for some more research? Well I still couldn't find anything specific but grape seeds used to make the oil come from grapes and grape skins contain resveratrol which has some effects as a 3a4 inactivator www.ncbi.nlm.nih.gov/pubmed/11125847.
Anyway, nothing definite but I decided that this year I could probably live without gorging myself on grapes. The slightly toxic effects I was feeling seem to have gone now too. Maybe it was related, maybe it wasn't? Maybe I was just eating too many grapes? I don't know but thought I would include here just in case others were eating a lot of grapes and had sides.
And on the moderation thing, I suggest you do as I say rather than follow what I do!
G3a since '78 - Dx '12 - F4 (2xHCC)
24wk Tx - PEG/Riba/Dac 2013 relapsed
24wk Tx - Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx - 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 - 22/06/17 UND
SRV12 - 27/07/17 UND
SVR24 - 26/10/17 UND
Similarly early in treatment I was eating way too many raspberries-big season just going on and on- I was also on riba at the raspberry stage but I felt so ill, I blamed it all on the meds. But I had the impression at the time, I wasn't just flushing red in face but an unnatural sort of purple! A relative just sent me a photo and it is clear- I was turning into a raspberry right when I was weakest. I suppose the moral would be nothing in excess, but I'm tempted to say add raspberries to the fruits to reduce or avoid.
Genotype 3 30 years, 2x treatment interferon/ribavirin non responder. Cirrhosis 17 years. Fibroscan, decompensating, 40 down to 22 by 29/3/16- now down to 6.5, normal, no cirrhosis. Started Buyers Club Sof/Dac 14 Nov 15. SVR 12 29/0716
CYP3A4 Inhibitors and Daclatasvir - Fruits
7 years 6 months ago #12857