Hi again Nancy,

Well, I too am so glad you are feeling better than you were! Is it still going OK now?

Sorry, it took me a while to get back to you, but I had been wondering how you made out, and how you were doing - it has been hard for me to communicate lately without having internet up and running until late last night - so, I am relieved to get internet service back on again now!

I am glad it seems the worse of what you were experiencing is over, whatever that was!

I can just imagine how you must have felt, dreadful those things, i just don't know why these things have to happen right when they do! Just to undermine your confident new start on epclusa and just when you have others depending on you - a horrid helpless feeling, on top of being sick as a dog. Really not fair, totally bad timing. Let us hope it was just one of those unlucky, one-off, poorly timed bouts of stomache bug something, which sounds like it should clear quickly. What a terrible rough start for you.

From your good description of the dosages of what PPI you were on prior, and your docs pre-treatment advice in the slow morphing over to the H2 blocker (famotidine), and your current dosages of the H2 blocker while on epclusa, I can see your doc seems to take into account the best acid reducer and dosing he could orchestrate for you. Your H2 blocker dosing regime does seem to follow what is recommended in the epclusa insert (if I interpret the insert correctly) that Tig posted prior:

     H2-receptor antagonistsc (e.g., famotidine) - H2-receptor antagonists may be administered simultaneously with or 12 hours apart from

     EPCLUSA at a dose that does not exceed doses comparable to famotidine 40 mg twice daily.

Mind you, there ARE different formulas of famotidine - some can have different contents, including the OTC ones - Pepcid "Complete" has more in it than just famotidine - so, just be sure with your doc that you ARE on the correct famotidine/"Pepcid", the ones with added stuff "perhaps/might possibly" have to be taken a little differently again.

ANY acid reducer affecting the ph of your stomache (prescription or OTC) - PPI's, H2 blockers, or ordinary antacid tablets and similar formulas, can all decrease the amount of velpa that can be absorbed (somewhat, and to varying degrees), thus, the small cautions Gilead provides when taking them. 

You and your doc are probably waaaay ahead of me on this, and are already doing exactly what needs to be done.

Sorry to hear of your prior experience with your riba-based treatment, but, you have the best now with epclusa, and will be rid of this virus once and for all!

Please do keep us informed on if you are still feeling improved now. I hope so. Maybe a 20 hour nap WAS very needed and just the thing that helped a lot! If you are able to now - drinks tons of water! Ample, AMPLE hydration is SO important on these DAA's.  C.

Hi Nancy,

When there are several replies, we usually address everyone at the same time. Makes it easier. People are just happy to hear from you! 

It's nice to know you're feeling better. When you described your symptoms, I thought about the flu right away. Hopefully the worst is over. 

Epclusa is a co-formulation of Sovaldi and Velpatasvir. It seems the drug Velpatasvir, shows poorer absorption when PPI's are taken. If it isn't avoidable, the administration time can be adjusted to maximize Velpatasvir absorption. The website Drugs.com has a good interaction checker. Following is a brief snip of an entry there dealing with PPI administration. 

MANAGEMENT: Concomitant use of sofosbuvir-velpatasvir with proton-pump inhibitors should generally be avoided. If coadministration is required, sofosbuvir-velpatasvir should be administered with food and taken 4 hours before the proton-pump inhibitor at a maximum daily dose equivalent to omeprazole 20 mg. Use with other proton-pump inhibitors has not been studied.

Not quite sure how to reply to each of you on this forum.  I was taking Prevacid 30 mgs. per day for about ten years.  Then right before starting treatment alternated daily with Famotidine 40 mg twice daily, until I made it 7 days without Prevacid.  Which I did.  I was told that I could NOT take a PPI or Epclusa would not work.  I take the Pepcid one with Epclusa and one 12 hours later.  I have a call into my doctor.  I feel better today!  I don't think I have ever been as sick as I was yesterday.  And I found out that I may have been exposed to a flu, but not sure.  Once I could sleep, I slept for 20 hours.  Just glad I got my pill down today and kept it down.  Am drinking water today too without feeling like I have to throw up.  Thank you all for your information, I read it all.  I really am hoping it was the flu because I don't want that to happen again.  I am 62 years old.  I was diagnosed about 6 years ago with no symptoms.  I took the old treatment with the shot to the stomach (Ribavirin and something else, cannot remember)  That did not work.  When Epclusa was approved my doctor got my on it.  I still did not have any HEP C symptoms, but felt thankful to get on the new medication.  I am not taking Ribavirin now.  They figure I had HCV for about 30 years or so.  Thanks again for all the responses, I will keep you informed...I will fill in my statistics as soon as I can.  oops, appears I posted two times, err

-- Edited by Nancy on Monday 10th of July 2017 03:10:30 PM

Greetings,

When being considered for a trial, I was asked to go from a PPI Omeprozol to one similar to what you recently switched to.

I had the EXACT same side effects and that was while not on a DAA.

Fact is that switch simply was not going to work for me.

You may need to get back on a PPI and take it within the prescribed manner as set forth in the guidelines Tig posted.

By the way this is a topic that my Doctor was really concerned with yet both my wife and myself treated successfully while staying on the PPI. I believe it to be a matter of absolute consistency with dosing guidelines.

Best of luck and welcome!

JimmyK

Oh dear, poor Nancy!

Agree with you and Tig - must consult with doc on this one, ideal to see/speak with your own doc, but any port in a storm if necessary, you cannot be having continuing vomiting and diarrhea/barfing acid and having no fluid intake. So, go see anyone if your doc is not available.

Tig is right, you must find a way to remain hydrated in the meantime - whatever drinks you can think of (such as gatorade or maybe even "pediolyte" (for babies with diarrhea) or the like, that will work to keep fluids/electrolytes in you and up. Gingerale, water, clear fluids, (full fluids - milky - if it does not make things worse). Find something you can sip on constantly, knowing water and electrolytes are ideal.

Maybe you do have a gastric flu, or, maybe you are just experiencing just a "perfect storm of everything" all at once, your body may be having an "initial" reaction to the epclusa (in part), and, in parcel, with other things and other conditions as well.

You mention long-standing "acid problems" for which you were normally on PPI "Prevacid", and then the (recent?) change to Famotidine (Pepcid) one of those H2 blockers - this is also standing out to me! How long ago did you start the new Pepcid and how much?

No dosages mentioned for either of these acid drugs. How many mg. of Pepcid do you take at once, how many times a day, and what time of day - your known acid stomache problem and prior known need for acid reducers, and a new Pepcid could be part of the problem - so, the need to discuss all with a doc (including dosages) and how much you used to take (of the PPI's), and the dosages you are taking now of the Pepsid H2 blocker as well, to see what may be contributing to the grief.

Sorry, not nice, you must be feeling dreadful.

If we are lucky, you will just turn the corner all by yourself by tomorrow, I hope so, but still, do communicate fully with a doc.  C.

Hi Nancy,

Welcome to the forum, but I'm sorry you're feeling so lousy. I hope this passes soon and lets you keep something down. By all means, call your doctor and share how you're feeling. Is it possible that you picked up a bug, like the flu? It's unusual for Epclusa to make you sick, but it's possible. Are you taking anything else, like Ribavirin? Try hard to get water down, as much as you can tolerate. With the diarrhea and vomiting, you're dehydrated and Epclusa demands water! Do your best, it's very important. The side effects will increase without 3-4 liters of water daily. Most common side effects are fatigue, headache and muscle ache when water needs aren't met.

Regarding the antacids, here's Gilead's recommendations:  Section 7.3 Table 2  

Epclusa Monograph

Be sure to ask for something to help the nausea if it continues. Try and get down some ginger ale, and if you can tolerate some Gatorade, do it. You're losing a lot of electrolytes right now. Replace them!

When you feel up to it, please tell us more about yourself. Some history, like genotype, blood tests, fibrosis level,  previous treatment, etc., helps to know when replying. Add it to your signature and you won't have to repeat it. You can see what most of us have provided. There are directions in red in mine if needed.

Good luck and check in when you can. Take a sip of water now! You'll be better for it. 

Hey Nancy.. I am so sorry that epclusa is giving you those horrible side effects.  I am taking epclusa as well. I am about a week and a half into treatment. I had a similar thing happen to me after a couple days of taking it, although I wasn't vomiting. I was in the bathroom for 3 hours that night. Luckily it did not last long, only a day did I have those horrific side effects, then it went back to the usual, (feeling tired, loss of appetite, an all around unwell feeling). I hope you feel better soon. This message board is awesome, there are so many wonderful people here to give support!

Here is a demonstration of our body's fighting Hep!  (We are the blue guy)

Hi Nancy, I'm kind of a newbie too and just began Harvoni treatment. I just wanted to say I hope you find the reasons for the way you're feeling and will pray that you begin feeling much better. You aren't alone--great support system here.

I am on my 4th day of Epclusa - I felt alright until the middle of the  night last night.  Terrible diarrhea, major heartburn, stomach pain.  I have always had stomach acid problems, but it was under control with Prevacid.  Cannot take Prevacid with Epclusa, so was switched to Famotidine.  Last night I vomited several times and it was so acidy it burned my mouth.  The thought of drinking water sounds awful right now.  My body must be confused because it wants everything out of me.  Managed not to vomit for two hours after taking my pill this morning.  I will call my doc tomorrow as it is Sunday.  I feel like crap.  Have read a lot about the treatment and side effects and hope it just gets better.  My husband is disabled and I am his caregiver, so it is rather a bummer I don't have anyone to help me.  But, it is what it is.  I feel like giving up but I won't.  Just pay it gets better.