Yes, my pharmacy told me 6 hours but it's close enough.

As the insert say's, if you miss a dose and it's within 18 hours then take it, then take your regular dose. That would be two pills within 6 hours but they don't consider it a double dose if taken then.

It's true at $1000 a pill care should be taken however I was told should that happen, the pharmacy would courier me another pill that they would have Gilead pay for. I still don't understand how the specialty pharmacies can have conflicting information since it should all be the same from Gilead. One of life's unsolved mysteries I suppose.

Have a great weekend everyone.

SF

Interesting. I remember seeing that now. There seems to be a lot of differing opinions out there. The people I have spoken with are against that second dose in 24 hours. Less than an hour then maybe. If the pill comes up whole, then there's no question. 

As always, before doing anything, it's good to run it by the doctor and the specialty pharmacist if possible. There isn't much mentioned about the reaction to a Harvoni OD. I guess there probably isn't too much info on human excesses with $1000 dollar pills. 

While we are on the subject, I just found the insert from Harvoni that was actually provided to me from this forum. They speak about vomiting in section 3. I cannot cut and paste it but have attached the pdf.

SF

singsong wrote:

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My thought is that answer matters more in first 8 weeks of Harvoni than 11-12 weeks along.

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 First 3 actually. Once UND it simply stays that way throughout treatment.

JimmyK

My thought is that answer matters more in first 8 weeks of Harvoni than 11-12 weeks along.

Pablo,

So, round we go with this, full circle to arrive back at where we started!

Tell me, did your friend ever end up getting an extra "replacement" pill from his doc, thus extending his treatment course by one day? Just curious ... and/or what did his doc end up saying about the upchucking event and all?

Is your friend still worried, or is he OK with it now?

Maybe he is well past his porcelain kiss scare.  C.

I just spoke with a pharmacist friend about this and he called his HCV Specialty pharmacist associate. The specialty pharmacist said the dose following ingestion will be absorbed in 2-4 hours in most patients. The pill will be past the stomach generally within an hour. So vomiting beyond that hour will have no impact. He also said under no circumstances do they recommend 2 doses in a 24 hour period. As Jimmy mentioned, if you can spot the pill in the gastric contents post vomiting, I suppose retaking it is an option. I might consider a new pill and write off the regurgitated sample, jmho. If you can get it replaced, that might be a better decision. My opinion only friends, ask your doctor if you're unsure.

My daughter said her pharmacy is charged $30,000+ USD for a one month supply of Harvoni.  I might be washing off a pill. Incredible costs make people do some incredible things!

Shadowfax wrote:

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I was specifically told by my specialty pharmacy that is the is the main one that sends out Harvoni, if you vomit less than 6 hours after you have taken it, then take another and call them and they will send out another.

Greetings SF.

Personally, I would have to question the "less than 6 hours" statement based on the available data regarding absorption.

" Following oral administration of HARVONI, ledipasvir median peak concentrations were observed 4 to 4.5 hours post-dose. Sofosbuvir was absorbed quickly and the peak median plasma concentration was observed ~0.8 to 1 hour post-dose."

http://www.rxlist.com/harvoni-drug/clinical-pharmacology.htm

The four hour window Tig is referring to with antacids ties into not interrupting the peak window of concentration in the plasma for the ledipasvir at 4 to 4.5 hours after administration.

Personally my belief is if you barf after taking a dose of Harvoni, a rather large and clearly identifiable pill, if you don't see it in the barf, do not take a second dose.

Also when you consider the the peak plasma concentration of Sofosburvir is observed at 0.8 to 1 hour after administration it should be considered how quickly the pill is gone and already present in plasma. Anything greater than 30 minutes after swallowing the pill the likelihood of identifying it in a pool of vomit is disgustingly slim. ;)

JimmyK

SF,

I believe the 4 hour reference pertained to the use of antacids. Gilead advises against their use 4 hours before or after Harvoni administration. Medication will typically pass through the stomach within an hour, minimizing or eliminating loss from vomiting beyond that. 

If you can get a link to that 6 hour reference from your pharmacist, please send it to me. That would be good to have.  I would be concerned about taking another dose if vomiting occurred after that first hour. It would be nice if they would specifically address these questions. There seems to be some differences of opinion.

I remember my first day of treatment so well. Same thing happened to me. Took the injection, popped 600 mgs of Ribavirin and within an hour >>>HURL<<<. These drugs can really throw our stomachs into fits. I had to take medication to prevent nausea throughout treatment. Whatever it takes... 

Well my response is a bit late and we actually covered this before in another thread many many months ago.

I was specifically told by my specialty pharmacy that is the is the main one that sends out Harvoni, if you vomit less than 6 hours after you have taken it, then take another and call them and they will send out another. When we discussed this here, I believe, this is not carved in stone that Tig had researched what Gilead's program had said and that was 4 hours.

Why the difference when any pharmacy could only get the information from the manufacturer, who knows. That being said, you were so close to the end, I would not sweat it and there is little to be done now. This is one pill that takes a long time to dissolve in your stomach, hence the long times instructed by the pharmacy.

Cheers

SF

Not taking the second dose was the right call. Taking two doses in a 24 hour period is considered an overdose. I think he received a good portion of that first dose. Since he is already undetected and continues to be compliant, one dose won't matter at the end of treatment. Let the doctor know and stay away from bad curry!

Extra dose is unwise.

"If you miss a dose of HARVONI, take the missed dose as soon as you
remember the same day. Do not take more than 1 tablet of HARVONI in a
day. Take your next dose of HARVONI at your regular time the next day"

If it were me I would let it go. He will not become UN-compliant with that short a pause if he did lose the whole enchilada. 

As always a call to the pharmacy for proper direction is best.

JimmyK

Hmm, good guess I'd say. You would think ... dissolving/initial gastric breakdown (ready for absorption) would have been very much in progress/done in 45 mins. But who knows? You and he had no other means to ask his doc/or any other person that night, so ... just based on good guessing by you two, that's probably where i would have ended up too. My other questions tho, is WHY he was vomiting in the first place! I worry about that (just on principal) whether he absorbed the dose or not. Then again, back to absorption, some people have very (naturally) slow Gi systems, for various reasons - some people are well on their way to breaking down stomach contents, ready for the absorption process, quite quickly. Alcohol/sugars for example are quickly taken up even right at the stomache stage. Most of what we consume requires time to traverse through the bowel for absorption for the needed components to be absorbed into the bloodstream. I still lean to the likelihood he got a dose. I would doubt he did not get at least some of the dose. But what do I know! Had his gut come to a complete shutdown/standstill, rebelling, because of flu, bowel obstruction (or for whatever the reason he was vomiting) and the dose was still just sitting there, high up, nowhere but in the stomache in liq. form for 45 minutes, then maybe, within 45 minutes, when he vomited the content of his stomache, it could have included most of the dose. Possible, but you would not think it likely. If he knew his vomitus was comprized of contents that had been consumed an hour (or hours) earlier - in that case then, depending on how old the contents was that he was up-chucking, that might lead you to believe more, that his gut had come to a standstill before his stomache decided to simply turf  the contents out in self-defence. Even so, I would still think he more likely dissolved/absorbed the dose, or at least most of it. He didn't see a pill in it, right? No "taste" of the pill in the vomitus? Might be hard to discern. Was the contents of what he vomited, consumed over an hour prior (or hours prior)? He did this at 11 weeks of a 12 week regime? I guess his doc will settle it.

Prolly, won't matter. But nice, you were there for him.  C.

Hi all

I have a friend who is in week 11 or 12 of Harvoni who called me tonight in a panic saying he threw up about 45 minutes after taking his dose of Harvoni.   He's obviously concerned that he will have emitted the medication from his system.

My advice to him was to not worry too much about it as a) quite a bit of the medication will have been absorbed into the blood within 45 mins and b) he's near the end of treatment (being UND at week 4); and that he should tell his gastro in the morning.

Is this solid advice?  He was thinking of taking his tomorrow's dose early and asking the gastro for an extra but I thought this risky.  I looked up the absorption rate of sofosbuvir and it said that peak plasma levels occur at 30mins post dose to 2 hours.

Thanks

Pablo