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Ah, so eating the pawpaw on my kitchen bench and the miso (soy extract) in my fridge gives me a higher dose of Dac for free! Maybe I should tuck in until I get bad sides! ick:' />
Just found another webpage on “Inhibitors of CYP3A4”, which lists red wine, garlic, pawpaw and other tropical fruit:
http://www.ganfyd.org/index.php?title=Inhibitors_of_CYP3A4
I’m becoming more and more convinced that the drug interactions info we’re relying on is far from complete. I’ve got two pawpaws ripening on my kitchen bench and usually have a raw garlic clove with my veggies in the evening. Very glad I’ve discovered this info.
My suggestion is that we Google “CYP3A4” with any food we eat a lot of, just to make sure, especially those that may be non-mainstream in Europe and the US whose foods seem to dominate the lists (e.g. grapefruit is typically listed but not pawpaw which is more common where I live).
Thanks for the thoughts, Sonix. For me though your post is an example of not being cautious enough. The Wikipedia page on CYP3A4 lists Valerian, Gingko Biloba, Milk Thistle (how many of us take that!) and Piperine (= black pepper) as “inhibitors” of CYP3A4. I’m sure these lists are not exhaustive either. Have a look at this site, for example:
http://www.ganfyd.org/index.php?title=Inhibitors_of_CYP3A4
I think I’ll cut and paste this into the other thread I’ve started on Dac interactions.
Food for thought?
Thanks Mike. Love the pic and the avatar!
Hi GAJ & zhuk, thanks for helpful replies. Just to make sure, I’m going to avoid everything on the substrate list – easy for me as I don’t drink coffee or tea! You’d have to think that caffeine must be okay, considering that the majority of people on the trials were probably drinking it if not told to stop.
I’m definitely going to steer clear of all citrus fruits – these days there are so many new and tweaked varieties of fruit, it’s hard to say I’m going to eat this kind of orange and not that one.
Here is an article by Medicins Sans Frontieres that says exactly the opposite on China and sofosbuvir to the Reuters article linked in the post above:
http://www.doctorswithoutborders.org/article/china-rejects-gilead-patent-hepatitis-c-drug-sofosbuvir
MSF says that: “Doctors Without Borders/Médecins Sans Frontières (MSF) has learned that the Chinese patent office has just denied Gilead Science’s request for a key patent on the hepatitis C drug sofosbuvir.”
Interesting that the MSF and Reuters articles were written on the same day, June 19.
I’d trust MSF over Reuters. Mesochem’s website openly advertises their generic sofosbuvir – an easy target for Gilead legal action if they have the China patent. The evidence tells me Mesochem’s sofosbuvir is legal and I suspect some deliberately planted misinformation may be involved in the posted Reuters article. Anything to discourage people from buying from a non-Gilead source.
The article states that Gilead does hold a China patent for sofosbuvir. If that is the case, how can Mesochem make and sell its generic sofosbuvir for a bargain price?
Given that the doctors I’m asking to write a script, in the town where I live, probably won’t have written a private script for these medications, I’m wondering if they might need some guidance as to exactly what to put on it. Given that I’ve failed boceprevir / interferon / ribavirin, and didn’t tolerate it well at all, it looks like the best regime for me is probably Sof + Dac 12 weeks. Mesochem looks like my preferred supplier through the Buyers Club. So what should the doctor put on the script for Mesochem – “12 weeks”, a certain number of grams for each, something else?
I have to say the discussion forum is working very well for me as it is. A bit of browsing and I feel I’m finding everything I need.
I’m still a bit confused on this topic. I’ll summarise what I’m perhaps understanding:
1. At present the new HepC drugs are not listed at all, so they are not S100 medications. Therefore, right now, any medical practitioner can legally prescribe them.
2. If the drugs are listed in November, they will be S100 medications, and thus prescribing of them will be greatly restricted.
3. Therefore, if you want to get a prescription for the drugs now to use for the Buyers Club, it’s best to do it before the end of November, because any (kind and brave) doctor can do it now, but that might not be the case in December.Is all of this correct?
How about side effect profiles Ledipasvir vs Daclatasvir? Which one is most likely to have minimum effects so that I can work through the treatment?
I live in Queensland. Currently trying to find a doctor here who will prescribe. Thinking about waiting to see what happens with the PBS in November. If PBS won’t fund me then, I’ll want to go with buyer’s club. I need to arrange 3 months long service leave with work very soon, and I’m wondering exactly when to start the leave.
If I have a script by the end of November, will I be able to get the drugs in time to start my leave and treatment at the beginning of January? Or is that leaving it a bit tight? Should I go for mid-January or February?
If I allow myself to inhabit the part of me that doesn’t want to wait… I feel stronger. I feel in charge of my destiny. Not a victim of the villainy of pharma and a government that values patent over patient. I am actively claiming a new life now.
I have low fibrosis – after probably 38 years with this disease my liver is apparently almost normal. But am I “well”? Hard to say. What is “well”, as I’ve never had an adult life free of this disease. I’ve had years on a disability pension due to overwhelming fatigue. I overcame most of that with diet, meditation and Cathay Herbal’s CH100, and I’ve been working again continuously since 2006. But I’ve had to drop back to part time the last few years. After 3 days work I’m knackered. For decades I’ve needed to go to bed by 9.30pm or I’m tired the next day. My diet and stress levels have to be absolutely right or I crash. I’ve had a very stressful work situation for the last 2 years and I’ve been doing a lot of crashing. It hasn’t felt like “well” for a long time.
Forgive me, I know I’m talking to myself here just to hear how it sounds, and feel how it feels, but it’s helping.
I want to have energy. I don’t want to wait another year. The precious, potentially active months and years of my late middle age are ticking away as the interminable negotiations drag on.
Yes, maybe PBS approval will come by April. But who’s to say it won’t be triaged, with the supposedly “well” like me left out to prioritise the heavily fibrotic and cirrhotic? Which exact medications will be approved? Will I have the choice of say, Daclatasvir, or will only the better researched drugs get approval?
And when, eventually, it is approved, it will almost certainly not be completely free. I paid over $400 for the PBS approved Interferon + Ribavirin + Boceprevir a couple of years ago (70 something dollars per script, once per month for 6 months). Will the newer drugs have a larger gap even when PBS approved? Perhaps the financial difference with the buyers club isn’t as great as might be assumed.
Anyway, all of this is from the part of me that doesn’t want to wait. There are other parts…
I think we should take seriously the possibility that fixhepc.com and/or the associated Buyers Club may be shut down by a pharma legal attack.
I am downloading all the key info from this site that would enable me to do it on my own if this site is shut down.
I relapsed after Boceprevir + Ribavirin + interferon a couple of years ago. I am G1. My problem was white & red blood cells dropping dangerously low resulted in lowering of dose. I’ve been worried about what resistance might have developed ever since, so I’ll be closely following this topic. Here’s something I just found that’s rather hopeful:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961994/ This study includes the following paragraph [Note DCV = Daclatasvir]:
“A combination of DCV and a nucleotide analogue inhibitor of HCV RNA-dependent RNA polymerase, sofosbuvir, with or without ribavirin for 24 wk achieved SVR in 100% of untreated HCV genotype 1a and 1b patients (n = 44) as well as in HCV genotype 1a and 1b patients (n = 41) who failed to respond to prior treatment with telaprevir or boceprevir, peginterferon and ribavirin. SVR was achieved in 93% of patients infected with HCV genotypes 2 and 3 (n = 44)[89,90].”
41 patients who failed telaprevir and boceprevir must surely have included people with resistant varieties. Interesting that the excellent result was achieved both with and without Ribavirin.
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