TOPIC:

Hi, i anticipate a treatment with sof/led soon, and am wondering if there are any dietary considerations one should be aware of. What I am wondering is: will my super healthy liver cleansing fruit and veg smoothies flush out medication before it has done it's thing?

Welcome Tomas,

I probably wouldn't wash the pills down with your SHFV smoothies just in case as there are probably a lot of sugars and acids in them. Sof/Led and also Sof/Dac can be taken with or without food depending on preference. If you have either with food I would suggest a light, reasonably bland meal to get them absorbed into your bloodstream as quickly as possible. I take my Sof/Dac with a couple of sips of water in the morning then go for a 45 min walk to the shop to pick up milk and paper. So when I sit down to breakfast the drugs are pretty much absorbed already. But some find they need to have them with a bit of food.
You may want to have a look in the Experts Corner area of the site where there is a bit of info about vegetarian diets etc if you are on one.

However, I should warn that many of us find that once on treatment our careful, healthy diets go out the window! We can't help ourselves and start eating things we haven't had for years. I suspect part of this is that our bodies go into repair mode and we need extra protein and healthy fats to support that. Listen to your body and give it what it wants in moderation.....seems like a reasonable excuse to me?

This is an interesting question. We've established that Dac interacts with several very common food stuffs...most notably grapefruit. Is there any similar issues with Ledipasvir? I've looked around but so far all I can see is pharma contraindications for Led.
My intuition would say the meds would work better on an easily digestible, not too heavy and fatty diet. Just because there would be less clogging in the liver to penetrate.

Don't know about the Led interactions as I just checked Dac which I need.

My understanding with Sof, Led and Dac is that you want to get them into the bloodstream and from there to the liver as quickly as possible so either on their own or with a light, low fat, easily digestible meal is best. This is why I take mine prebreakfast allowing time for them to be absorbed. I also take Ribavirin which should be taken with food and preferably with fat to better absorb it. So I have those after breakfast which is cereal and full fat milk (that's new!) and again after the evening meal which I make sure has some fat either in the meal or as an extra. But that is just for Riba.

apparently, Seville oranges are a no-no along with the grapefruit.

I use limes a lot too, in my morning hot water. When i'm not using the grapefruit off my tree.

The Gilead team concluded that ledipasvir/sofosbuvir may be taken without regard to meals. They advised that ledipasvir/sofosbuvir may be taken with an H2-receptor antagonist "at a dose that does not exceed famotidine 40 mg twice daily." A proton pump inhibitor dose comparable to 20 mg of omeprazole can be taken with ledipasvir/sofosbuvir or up to 2 hours after ledipasvir/sofosbuvir.

Eat, drink and massacre those little shits........
Mike

In fact I'm sure the hot water with citrus added every morning (two pints!) is what has kept my liver functions normal.

Oh dear - I haven't got a clue what you mean Mike

Do you mean you can eat anything and everything or just that you don't need to eat a meal with the meds?

Not sure ! but I read something about the drugs needing stomach acid to distribute through the body -
More details please mgalbrai

Thanks for your kind and considered response.

Sounds like some conscientious timing is all that is required.

I'll probably take my pill with a double espresso and a bite of dark chocolate, 30 minutes before breakfast.

Bristol-Myers Squibb who invented Daclatasvir recommended against Grapefuit and Seville Oranges and marmalade containing either during the trials I participated in. The instruction was that Navels and Valencias would be fine. They made no mention of limes or lemons so presumably they are not an issue. I haven't read Gilead's instructions about meals but the rest of it relates to them being suitable for use with prescription antacid type products at up to certain levels for control of gastric reflux.

Otherwise avoid 'potent' inhibitors and inducers and if in doubt and you eat "a lot" of something like soy or miso or really anything else that you have concerns about it is probably best to at least reduce it particularly within a few hours of your medication, leave it out, or seek advice from above two companies or your specialist. Keep in mind that everyone who takes these medications reports finding their liver functions improving considerably and very quickly as well as the huge majority clearing the virus. So you may want to consider whether it is wise during treatment to use other additional methods of improving liver function which won't clear the virus but could effect the medication.

And check the drug interaction charts which also contain the "big" known food and herb items like grapefruit and St Johns Wort.

Hope that helps.

I am sorry. I was at school when I found the earlier info on Harvoni and food and drug interactions. I can't find that article now. This is what came with my "factory" Harvoni.

www.gilead.com/~/media/files/pdfs/medici...patient_pi.pdf?la=en


Mike

There was a thread a few days ago which addressed some of the food interactions with one of the main metabolising enzymes.
fixhepc.com/forum/questions-and-answers/...ith-daclatasvir.html

In particular was an included link to this pertinent article which mentioned other foods to be cautious of or avoid -
www.ganfyd.org/index.php?title=Inhibitors_of_CYP3A4

I would love to hear from Dr James on foods while on treatment, and an FAQ would be most helpful.