I take Protonix and it interacts with Harvoni. What to do?

This topic has 6 replies, 3 voices, and was last updated 5 years, 10 months ago by Dr James.

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28 December 2018 at 3:17 am #28870
Oregondaisy
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- Acolyte
@oregondaisy
I can’t stop Protonix. I had the gastric sleeve surgery which means I had 85% of my stomach removed.
Without Protonix, I have extreme pain in my remaining stomach.

How can I take my Harvoni now?

Thank you!
28 December 2018 at 6:20 am #28872
Dr James
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- Guardian Angel
@fixhepc
Hello Oregondaisy,

If you must take Protonix it should be the lowest dose possible and taken only in the morning about 1 hour after the Harvoni.

It would be better for you to take Sofosbuvir + Daclatasvir rather than Harvoni as the absorption of Daclatasvir is not impacted by antacids (unlike the Ledipasvir in Harvoni).

It is unusual, but possible to add Daclatasvir to Harvoni to deal with this problem.

YMMV
28 December 2018 at 7:45 am #28873
Oregondaisy
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@oregondaisy
I already purchased the medication. I have already paid for it. I don’t imagine it can be returned.

I normally take Protonix at bedtime, around midnight.

Do I need to have my dr. send in another prescription to add to what has been sent to me? I have a 12 week supply of HEPCVIR L

What should I do?
28 December 2018 at 3:19 pm #28875
Mar
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- Guardian Angel
@mar
Hello OregonDaisy, Dr James was not suggesting that you return Harvoni generic at all, you definitely need to take it, he was suggesting that you add another medication (Daclatasvir) to your Harvoni treatment. This will enable you to take antacids, such as Protonix, without worrying about potential medications interactions. You do need a prescription for Daclatasvir if you decide to get it, please let us know if you need help with that.

The alternative would be to take the lowest possible dose of Protonix 1 hour after taking Harvoni, and hopefully everything will go smoothly. If you prefer to take Protonix at night, you can take Harvoni at night too with a late dinner (instead of in the morning), then take Protonix 1 hour after that.

Making the world a better place – one patient at a time.
29 December 2018 at 12:25 am #28876
Oregondaisy
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@oregondaisy
I don’t understand why it would not be better to separate the Protonix by 12 hours. Wouldn’t it be better to I take my Protonix at bedtime and Harvoni in the morning?

I will give my credit card number to fixhepC to get the new additional medication if I am able to get it through you. Please let me know if I need to have my doctor send in an additional prescription.
29 December 2018 at 1:11 am #28877
Mar
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@mar
Hello OregonDaisy, FixHepC can supply Daclatasvir medication, and a prescription is needed to be able to supply it to you. All details will be sent to you by email

Making the world a better place – one patient at a time.
29 December 2018 at 8:50 am #28879
Dr James
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@fixhepc
Hello OregonDaisy,

The peak of the effect of the Protonix is about 1-2 hours after taking it. After that the blood levels fall and the acid starts to return. So, your stomach is most acidic more or less the moment you take the next dose.

By taking the Harvoni 1 hour before, you give it the most acidic environment possible, and what amounts to a 1 hour “head-start” on the effect of the Protonix.

This is what happens to stomach acidity over the course of the day with twice daily dosing of a PPI.

You may notice that meals see the pH of the stomach reliably rise.

Anyway what we should do it make a time to have a chat about using Daclatasvir, make sure there is nothing else you are taking that might cause issues, and then make a plan.

YMMV
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