Hello all again,
I'm about to start treatment and I would like to know if you could help me with some questions.
I've just got Viekira Pak + Ribavarine and this is the way it was prescribed for genotype 1b for 12 weeks with f3/f4 suspicion that no one knows for sure:
2 pills in the morning after breakfast of ombitasvir 12,5mg, veruprevir 75mg, ritonavir50mg plus 1 pill of dasabuvir and 2 pills of ribavarine 250mg
1 pill of desabuvir 250mg plus 2 ribavarine pills at night after dinner.
- My first question is: Shouldn't the morning pills and night pills be the same? I mean taking 2 pills of ombitasvir, veruprevir and ritonavir also at night instead of just taking dasabuvir with 2 pills of ribavarine?
- My second question is: I have extrasystole due to my anxiety and it happens at the ventricle level, so it's a ventricular extrasystole. I now extrasystoles are benign but since this is the ventricular kind, can't Ribavarine mess with my heart rhythm inducing for instance a ventricular tachycardia? Can I have a heart attack since I'm 36 years old with a BMI of 42?
- Speaking of 42 BMI, can't this mess up with treatment? I know I've asked this before and I was assured by doctor James that it wouldn't, but my hepatologist said that this could make my treatment fail and I could acquire resistance to the drugs. She insisted on that over and over and over. I'm not diabetic, my fat liver is around degree 1 or 2 in ultrasound but "Discrete diffuse fat" on MRI but my insulin resistance is around 39 with a 9.69 Homa index which is crazy high.
Is this possible? From what I've read, resistance is due to the kind of the virus with some individual characteristics not weight, but I've also read some studies that when they studied treatments in retrospect, excessive weight was one of the causes that made it happen. Can someone shed some light on this because I don't want to screw this up.
- Now the main question: I take esomeprazol 20mg (here called Nexium) and I've read that might be an interaction between one of the substances in Vikiera and Esomeprazol. Can I still continue taking esomeprazol before breakfast, wait 30 minutes, taking my breakfast and then taking Vikiera?
Also, how far apart should be the first dose in the morning and the dose in at night. I'm asking this because I don't have fixed hours for breakfast and dinner. Sometimes I take breakfast at 6 and have dinner at 6pm or 8pm, so I would like to take everyday at the same time. What would you suggest?
Here's what it was written on the medication interaction site recommended here at the forum and I have absolutely no idea what it means:
Summary: Coadministration has not been studied. Esomeprazole is a substrate of CYP2C19 and CYP2C9 and concentrations may decrease due to induction of CYP2C19 by ritonavir. Exposure of omeprazole, a model CYP2C19 substrate, decreased by 40-50% with ombitasvir/paritaprevir/ritonavir + dasabuvir. Use higher doses of esomeprazole only if clinically indicated. Description:
Coadministration has not been studied but is expected to decrease concentrations of esomeprazole due to induction of CYP2C19 by ritonavir. If clinically indicated higher doses of esomeprazole may be needed.
Viekirax Summary of Product Characteristics, AbbVie Ltd, January 2015.
Exviera Summary of Product Characteristics, AbbVie Ltd, January 2015.
I apologize for all these questions, but I don't want to screw this up.