Dr James - FixHepC

Forum Replies Created

Viewing 15 posts - 1,861 through 1,875 (of 1,968 total)

← 1 2 3 … 124 125 126 … 130 131 132 →

Author

Posts
17 October 2015 at 2:39 am in reply to: Joy To the World #2364
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
It may be helpful for you to read http://fixhepc.com/blog/item/17-lismore-liver-clinic-now-able-to-see-patients.html

The Lismore Liver Clinic nurses have been given official permission to monitor patients on treatment.

It’s great to see government stepping up on this.

YMMV
16 October 2015 at 12:51 pm in reply to: generic harvoni in india #2322
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
Gilead’s APIs are made in Jordan. The tablets are made in Ireland.

YMMV
16 October 2015 at 12:43 pm in reply to: Sofosbuvir Daclatasvir #2321
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
We have seen quite a lot of their product from at 6 different batches (when last I looked) and it has been consistently good in terms of closely matching our reference standards.

YMMV
16 October 2015 at 12:57 am in reply to: DAAs as prophylaxis? #2310
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
There is a discussion about resistance here http://fixhepc.com/forum/experts-corner/164-resistance-and-treatment-failure-mechanisms.html

Yes you could do that if the price was affordable.

Yes you would expect to select for resistance to these agents, but this may not be a major issue for a variety of reasons.

Personally I would suggest retreatment with a “longer and stronger” approach adding a third DAA and doubling the original treatment duration.

Sofosbuvir resistance has already been seen http://www.medscape.com/viewarticle/818806_5

YMMV
15 October 2015 at 11:12 pm in reply to: Nadia’s journey #2297
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
Hi to Nadia (I’m homesickalien from the hepcuk forum) & all those doing generic Sof/Dac treatments. Fascinating to follow this thread and see what side effects you are all having – I hope to be joining you soon once the Buyers Club has got me my meds.
Good luck!

YMMV
15 October 2015 at 11:07 pm in reply to: Hello from UK, need help please #2296
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
I had a 30 min video appointment with Dr Freeman last week, which was extremely helpful. Clearly the situation with the Buyers Club is very new, and evolving all the time. I’m hopeful that I will be able to get 12 weeks of Sof/Dac through the Club in the near future, but I’m not counting any chickens.
The attitude of my Consultant & my Doctor disappointed me, when I mentioned generics they both reacted as if there was a really bad smell…more interested in doing things by the book than in getting me well.
In the meantime I’m avidly following all those who are doing Sof/Dac treatment on the ‘Nadia’s Journey’ thread.
Best wishes to all.

YMMV
15 October 2015 at 2:18 pm in reply to: Sofosbuvir Daclatasvir #2284
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
We have been doing accelerated stability testing on this and it seems fine.

Do not worry, as soon as medications arrive in stomach they mix freely anyway.

YMMV
15 October 2015 at 12:47 pm in reply to: Are these S100 medications? #2279
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
That is great news. Having GPs able to prescribe could rapidly deliver treatment to all those that need it. I would be sad to see the rationing evident overseas repeated here.

YMMV
15 October 2015 at 12:44 pm in reply to: NMR which spectra #2278
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
1H for both should be fine. Mass spec is a nice confirmation.

The ledipasvir spectrum is roughly twice as complicated as originally reported at 300 MHz and besides our stuff here: http://fixhepc.com/blog/item/16-testing-provisions-patient-safety.html the only other place I know of that is easily accessible has the real spectrum reported is here: http://worlddrugtracker.blogspot.com.au/2013/12/ledipasvir.html

1H NMR (400 MHz, DMSO-^, δ): 12.29 (s, 0.1H), 12.19 (d, J=4.0 Hz, 1H), 12.14 (s, 0.2H), 11.85 (s, 1H), 8.10 (s, 0.1H), 8.08 (s, 1H), 8.01 (s, 0.1H), 7.963 (m, 1H), 7.955 (s, 1H), 7.89 (d, J=6.4 Hz, 1H), 7.87 (s, 1H), 7.83 (dd, J=8.4, 2.4 Hz, 1H), 7.79 (dd, J=7.2, 2.8 Hz, 1H), 7.78-7.90 (misc., 0.9H), 7.70 (s, 1H), 7.61 (d, J=8.4 Hz, 1H), 7.55 (s, 1H), 7.51 (dd, J=8.8, 1.6 Hz, 1H), 7.44 (m, 0.1H), 7.31 (d, J=8.4 Hz, 1H), 7.21 (d, J=8.4 Hz, 1H), 6.91 (d, J=8.0 Hz, 0.2H), 6.77 (m, 0.2H), 5.34 (d, J=7.6 Hz, 0.1H), 5.20 (dd, J=8.0, 5.2 Hz, 1H), 5.18 (m, 0.1H), 4.88 (s, 0.1H), 4.67 (d, J=6.4 Hz, 1H), 4.55 (s, 1H), 4.17 (dd, J=8.0, 8.0 Hz, 1H), 4.10 (m, 0.2H), 4.01 (dd, J=8.4, 8.0 Hz, 1H), 3.97 (m, 0.1H), 3.82 (d, J=9.6 Hz, 1H), 3.77 (s, 0.2H), 3.71 (d, J=9.6 Hz, 1H), 3.554 (s, 3H), 3.548 (s, 3H), 3.43 (s, 0.4H), 3.20 (d, J=7.6 Hz, 0.3H), 2.77 (s, 0.1H), 2.66 (s, 1H), 2.41 (d, J=8.8 Hz, 1H), 2.22 (dd, J=12.4, 8.0 Hz, 1H), 2.13 (m, 0.4H), 2.08 (s, 6H), 2.05 (dd, J=13.2, 5.2 Hz, 1H), 1.99 (m, 2H), 1.92 (m, 1H), 1.77 (m, 2H), 1.61 (m, 0.3H), 1.56 (m, 1H), 1.46 (d, J=9.2 Hz, 1H), 1.33 (d, J=10.0 Hz, 0.1H), 0.97 (dd, J=6.4, 2.0 Hz, 3H), 0.93 (d, J=6.8 Hz, 3H), 0.88 (d, J=6.4 Hz, 3H), 0.87 (d, J=6.4 Hz, 3H), 0.80-1.05 (misc., 2H), 0.70 (m, 1H), 0.59 (m, 2H), 0.54 (m, 1H), 0.33 (m, 0.1H). HRMS-ESI+: [M + H]+ calcd for C49H5506N8F2, 889.4207; found, 889.4205.

The 13C for ledipasvir is a basket case.

YMMV
14 October 2015 at 5:44 pm in reply to: Retreatment options #2262
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
Yes, Sof/Dac for 24 weeks would be a good option. You probably have some Riba resistance now.

Albert Einstein defined insanity as doing the same thing again and expecting a different result. I would not repeat Sof/Riba for longer, but would go longer with stronger. You could add Riba to the Sof/Dac if you wanted and it would probably increase your chances of success by some small percentage.

YMMV
14 October 2015 at 4:54 pm in reply to: What a doctor needs to know to write a script #2261
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
You should ask for (this is 12 weeks treatment)

Sofosbuvir 400 mg od x 84
Dalcatasvir 60 mg od x 84

OR (Harvoni generic components)

Sofosbuvir 400 mg od x 84
Ledipasvir 90 mg od x 84

If you need 24 weeks ask for the same as above + 1 repeat

If you need Riba you need 1000 mg daily if < 75 kg and 1200 mg daily if > 75 kg

Ribavirin 1000 mg daily in 2 divided doses x 84 days
Ribavirin 1200 mg daily in 2 divided doses x 84 days

YMMV
13 October 2015 at 2:10 am in reply to: script for 12 or 24 ? #2202
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
Without knowing your precise details, or what you’re taking (? +/- Riba) here are the rules of thumb:
- If you are < F4 12 weeks should do
- If you are F4 then 12 weeks + Riba might do
- If you are F4 then 24 weeks of Sof/Led (GT1) of Sof/Dac (GT1-6) is guideline compliant.
Please check our Genotype Specific Treatments page.

YMMV
12 October 2015 at 5:46 pm in reply to: Emilio’s Place #2196
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
I would suggest a VL at 4 weeks into treatment. It will probably be zero (nice to know) and proves you’re not taking sugar tablets (nice to know).

YMMV
12 October 2015 at 4:24 pm in reply to: Resistance and Treatment Failure – Mechanisms #2193
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
In the phase 1 trials a pharmaceutical company does the first human testing to establish dose. Typical trial size is 50 people. Hypothetical doses might have been

50
100
200
400
800
1600
3200

And results might have been

50 Fail
100 Partial
200 Works
400 Works
800 Works Mild Sides
1600 Works More Sides
3200 Works Major Sides

So we pick 400 mg as a good dose to get effect, but no sides

Now we move on to Phase 2 trials in 200 people to prove effect at selected dose in ~ 200 people.

Then if that works we do Phase 3 in ~ 3000 people (we know it works) to harden up the numbers and look for unexpected sides.

Then the cash register starts ringing with FDA/TGA approval based on Phase 3 results.

YMMV
12 October 2015 at 4:18 pm in reply to: Reorganising the discussion forum #2190
Dr James
- Topics: 264
- Replies: 1,968
- Total: 2,232
- Guardian Angel
@fixhepc
Private Messaging now appears as an item on Forum Drop Down Menu

YMMV
Author

Posts

Viewing 15 posts - 1,861 through 1,875 (of 1,968 total)

← 1 2 3 … 124 125 126 … 130 131 132 →