Hi bowlingb,
It?s good to hear your liver function tests (LFTs) are within
normal limits and your viral load is fairly low. As you probably know,
the viral load is the preferred test for measuring your progress, and
is a much better indicator than LFTs alone.
I?m not a doctor, and I?d like to direct your attention to the
disclaimer at the bottom of the page. Having said that, I?m a little
perplexed at the two medications you are taking. You take the Provigil
to stay awake, while the Carisoprodol causes drowsiness. The two drugs
are antagonistic? they work against each other. The half life of
Provigil is about 15 hours in a healthy person, possibly longer in
someone with impaired liver function. Half life means that half of the
dose is cleared from the body in a number of hours. With Provigil,
half of the dose is excreted in the urine after 15 hours.
(metabolites, which are a sort of by-product of the drug, can have a
half life of up to 40 hours) When you take 100mg of Provigil at 5am,
that dose is half gone at 8pm. But if you take 100mg more at noon
(which is still a safe dose), you are extending the half life time.
Half of the noon dose is still in your system at 3am! Provigil is
trying to keep you awake, while the is trying to make you sleep!
Carisoprodol?s half life is 8 hours, meaning if you took this drug at
home, in the evening, half will be gone when you get up in the
morning.
If your doctor recommends this regimen, s/he has a good reason, and
that?s one thing. But if you decided to take your medications in this
manner, I would think twice and discuss this with your doctor. It
makes sense to take the complete 200mg dose if that is how it was
originally prescribed.
Your doctor obviously feels your liver can handle both of the drugs
you asked about. (I?m assuming the doctor who prescribed both drugs is
aware of your hepatitis C (HCV). If not, you must make him/her aware
of this.) In researching this answer, I did find that both drugs are
metabolized by the liver, but both are relatively safe. It is highly
recommended, and you are apparently doing so, that you have your viral
load and LFTs performed on a regular basis while taking these
medicines. It?s also a good idea not to drink alcohol or smoke while
on this drug regimen.
Carisoprodol is intended for short term use, so there is less risk
that you would sustain liver damage from this drug if you use it as
intended. It is best taken at bedtime. (Which is why taking the
Provigil at noon may not be a good idea. Some of your muscle pain may
itself be triggered by the HCV, and some is probably attributed to you
degenerative disk/osteoarthritis). (I address this further down in the
answer) As you recuperate, you may no longer need muscle relaxants.
Perhaps your doctor can prescribe an anti-inflammatory for you rather
than Carisoprodol, although taking Tylenol and other non-steroidal
anti-inflammatory (NSAIDs) drugs is usually contraindicated for HCV
patients.
?HCV infection typically progresses to chronic infection in more than
60% of patients, and may lead to cirrhosis in as many as 20% over a 20
year time period. Serum aminotransferase levels reflecting
hepatocellular injury may fluctuate, as does the viral load.?
http://www.clevelandclinicmeded.com/diseasemanagement/gastro/hepatitis_c/hepatitis_c.htm
Provigil (Generically known as modafinil)
==========================================
?The major route of elimination (~90%) is metabolism, primarily by the
liver, with subsequent renal elimination of the metabolites.?
Significant accumulation of modafinil sulfone has been observed after
multiple doses due to its long elimination half-life of 40 hours.
Hepatic Impairment: The dose of PROVIGIL should be reduced in patients with severe
hepatic impairment
In patients with severe hepatic impairment, with or without cirrhosis,
PROVIGIL should be administered at a reduced dose as the clearance of
modafinil was decreased compared to that in normal subjects.
Concomitant Medication
Patients should be advised to inform their physician if they are
taking, or plan to take, any prescription or over-the-counter drugs,
because of the potential for interactions between PROVIGIL and other drugs.
Alcohol
Patients should be advised that the use of PROVIGIL in combination
with alcohol has not been studied. Patients should be advised that it
is prudent to avoid alcohol while taking PROVIGIL.
Allergic Reactions
Patients should be advised to notify their physician if they develop a
rash, hives, or a related allergic phenomenon.
Laboratory Changes
Clinical chemistry, hematology, and urinalysis parameters were
monitored in Phase 1, 2, and 3 studies. In these studies, mean plasma
levels of gamma glutamyltransferase (GGT) and alkaline phosphatase
(AP) were found to be higher following administration of PROVIGIL, but
not placebo. Few subjects, however, had GGT or AP elevations outside
of the normal range. Shifts to higher, but not clinically
significantly abnormal, GGT and AP values appeared to increase with
time in the population treated with PROVIGIL in the Phase 3 clinical
trials. No differences were apparent in alanine aminotransferase,
aspartate minotransferase,
total protein, albumin, or total bilirubin.
Before starting PROVIGIL tell your doctor
? about all your medical conditions, including if you:
? are pregnant, are planning to become pregnant, or are breastfeeding.
It is not known if PROVIGIL may harm your unborn baby, or if PROVIGIL
passes into your milk and if it can harm your baby.
? have high blood pressure or heart problems.
? have liver or kidney problems.
? have abused medicines called ?stimulants? or street drugs.
? have or had a mental problem called psychosis.
? about all the medicines you take, including prescription and
non-prescription medicines, vitamins, and herbal supplements.
PROVIGIL and many other medicines can interact with each other causing
side effects. PROVIGIL may affect the way other medicines work, and
other medicines may affect how PROVIGIL works. Keep a list of all the
medicines you take. Your doctor or pharmacist will tell you if it is
safe to take PROVIGIL and other medicines together. Do not take other
medicines with PROVIGIL unless your doctor has told you it is okay.
PROVIGIL can affect hormonal birth control methods (contraceptives).
Women who use hormonal contraceptives such as birth control pills,
shots, implants, intrauterine devices (IUDs), or patches, may have a
higher chance for getting pregnant while taking PROVIGIL, and for one
month after stopping PROVIGIL. Talk to your doctor about birth control
methods that are right for you while using PROVIGIL.
How should I take PROVIGIL?
? Take PROVIGIL exactly as prescribed by your doctor. Your doctor will
prescribe the dose of PROVIGIL that is right for you. Do not change
your dose of PROVIGIL without talking to your doctor. Do not take more
PROVIGIL than prescribed.
? Your doctor will tell you the right time of day to take PROVIGIL.
Patients with narcolepsy or OSAHS usually take one dose of PROVIGIL
every day in the morning. PROVIGIL may help you stay awake during the
day but it should not affect nighttime
sleep. Patients with SWSD usually take PROVIGIL about 1 hour before
their work shift. Do not change the time of day you take PROVIGIL
unless you have talked to your doctor.
? You can take PROVIGIL with or without food.
? If you take more than your prescribed dose, or take PROVIGIL too
late in your waking day, you may find it harder to go to sleep. Call
your doctor if you have any concerns.
What should I avoid while taking PROVIGIL?
? People with sleep disorders should always be careful about doing
things that could be dangerous, including driving a car. Discuss your
level of sleepiness with your doctor at each visit. Do not change your
daily habits until your doctor tells you it
is okay.
? Do not take other medicines including prescription and
non-prescription medicines, vitamins or herbal supplements unless your
doctor has told you it is okay.
? You should avoid drinking alcohol.
What are the possible side effects of PROVIGIL?
The most common side effects of PROVIGIL are headache, nausea,
nervousness, stuffy nose, diarrhea, back pain, anxiety, trouble
sleeping, dizziness, and upset stomach.
PROVIGIL may cause the following infrequent serious side effects. Call
your doctor or get emergency help if you have any of these or any
other serious side effects while taking PROVIGIL:
? chest pain.
? mental problems.
? allergic reactions, such as a rash, hives or other allergic reaction.
Some effects of PROVIGIL on the brain are similar to other medications
called ?stimulants?. If you have a history of drug and/or
stimulant use or abuse you should discuss this with your doctor before
starting PROVIGIL.
Tell your doctor if you get any side effects while taking PROVIGIL.
These are not all the side effects of PROVIGIL. For more information,
ask your doctor or pharmacist.
In patients with severe hepatic impairment, the dose of PROVIGIL
should be reduced to one-half of that recommended for patients with
normal hepatic function
PROVIGIL® (modafinil) Tablets
100 mg Each capsule-shaped, white, uncoated tablet is debossed with
?PROVIGIL? on one side and ?100 MG? on the other.
NDC 63459-101-01 ? Bottles of 100 200 mg Each capsule-shaped, white,
scored, uncoated tablet is debossed with ?PROVIGIL? on one side and
?200 MG? on
the other.
http://www.provigil.com/physician/home.aspx
?Provigil etc. (Modafinil) is a unique wake-promoting agent that is
chemically distinct from traditional stimulants. Officially an
Alpha1-adrenergic agonist medication (also known as an "eugeroic"
drug), Modafinil is similar in chemical make-up and therapeutic action
to Adrafinil (Olmifon).
Alpha1-adrenergic agonists are believed to by increase the
receptiveness of brain's alpha-1 receptors to the neurotransmitter
noradrenaline, thereby boosting alertness, memory and energy.
Modafinil was approved in 1998 (U.S. FDA) for the treatment of
excessive daytime sleepiness associated with narcolepsy. A small
number of clinical trials have also suggested that Modafinil also has
memory-improving and mood-brightening effects.
For these reasons it is now being used to augment treatment in
depression patients who have had only a partial response to
antidepressant therapy. Similarly, Modafinil has also found a number
of other potential uses like reducing fatigue and cognitive problems
commonly found in health conditions like Multiple Sclerosis, Chronic
Fatigue Syndrome etc.?
http://remedyfind.com/rm-3061-Provigil.asp
PROVIGIL
"Provigil is a wake-promoting medication for treatment of excessive
daytime sleepiness. Unlike other stimulant medications, Provigil has a
mild and more targeted effect on the central nervous system. In
addition, it is the only wakefulness medication that does not require
a triplicate prescription. Provigil may be prescribed alone or in
combination with other stimulants. Provigil can reduce the dosage of
other stimulants needed to achieve wakefulness.?
http://www.charityadvantage.com/narcolepsynetwork/Medications.asp
?Years of experience with modafinil have led to no particular safety concerns.?
http://trots.blogspot.com/2005/01/attenace-upcoming-treatment-option-for.html
Carisoprodol (Also known as Soma)
==================================
?There is no justification for long-term use of carisoprodol.
Prescribers should evaluate patients for discontinuation of
carisoprodol. If relief of pain or associated symptoms is indicated,
an alternative agent such as an anti-inflammatory drug or long-acting
opioid, may be introduced while carisoprodol therapy is tapered. This
allows carisoprodol to be discontinued without causing any unnecessary
discomfort to the patient. Many patients with chronic pain may not be
getting pain relief from the drug but may still be reluctant to
discontinue it because of its effects on associated problems such as
depression, anxiety and sleeping difficulties. These problems should
be evaluated and addressed with appropriate therapies.?
http://pharmacy.oregonstate.edu/drug_policy/news/4_8/4_8.html
Dosage for adults: 350 mg 2-3 times a day. (take last dose at bedtime).
?Does not directly relax skeletal muscles. Sedative effects may be
responsible for muscle relaxation. Onset: 30 min. Duration: 4?6 hr.
Peak serum levels: 4?7 mcg/mL. t1/2: 8 hr. Metabolized in the liver
and excreted in urine.
USES
As an adjunct to rest, PT,(Physical Therapy) and other measures to
treat skeletal muscle disorders including bursitis, low back
disorders, contusions, fibrositis, spondylitis, sprains, muscle
strains, and cerebral palsy.?
http://www.nursespdr.com/pdf/bnmn11.pdf
?Carisoprodol distributes widely in the body; it crosses the placenta
and is distributed into breast milk. Carisoprodol is hepatically
metabolized to several metabolites, including meprobamate. Plasma
half-life of carisoprodol is about 8 hours. Excretion is mainly via
the urine as metabolites.?
http://www.chwframe.staywellsolutionsonline.com/modules/goldstandard/monograph.asp?cpnum=883&name=Aspirin,%20ASA;%20Carisoprodol
?Carisoprodol, the active ingredient in Carisoprodol, is metabolized
in the liver and excreted by the kidney ; to avoid its excess
accumulation, caution should be exercised in administration to
patients with compromised liver or kidney function.?
http://pharma-help.com/carisoprodol
?Athough side effects from carisoprodol are not common, they can
occur. Tell your doctor if any of these symptoms are severe or do not
go away:
· drowsiness
· dizziness
· clumsiness
· headache
· fast heart rate
· upset stomach
· vomiting
· skin rash
If you experience any of the following symptoms, call your doctor immediately:
· difficulty breathing
· fever
· weakness
· burning in the eyes
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682578.html
?Do not take carisoprodol if you have acute intermittent porphyria
Before taking carisoprodol, tell your doctor if you have kidney or
liver disease. The maximum amount of carisoprodol you should take in
one day is 1,400 mg (4 tablets). You may need a lower dose or special
monitoring during your therapy.
Soma etc. (Carisoprodol) is a centrally acting, skeletal muscle
relaxant medication used to relieve the pain of muscle injuries,
spasms, sprains, and strains. Skeletal muscle relaxants act in the
central nervous system (CNS) and block nerve impulses originating from
the spinal cord. Skeletal muscle relaxants are similar in chemical
structure to antianxiety agents. Whether skeletal muscle relaxants
relieve pain due to their muscle relaxant or sedative effects is
unknown.?
http://remedyfind.com/rm-2684-Soma.asp
?Disease Interactions
Caution is advised when taking carisoprodol. Consult your doctor if
you have a history of any of the following: allergies, drug abuse or
dependence, kidney disease, liver disease, porphyria, epilepsy, or any
other seizure disorder.?
?Stopping the Drug
This medication should be taken as prescribed for the full treatment
period. Do not stop taking carisoprodol abruptly.
Prolonged Use
Therapy with carisoprodol ranges from several days to weeks. Prolonged
use may be associated with an increased risk of side effects.
Over 60
Adverse reactions to medications such as carisoprodol may be more
likely and more severe in older patients.
Driving and Hazardous Work
Carisoprodol may impair your ability to drive or perform hazardous work.?
http://www.wholehealthmd.com/refshelf/drugs_view/1,1524,89,00.html#Disease_Interactions
?People with Hepatitis C may suffer joint pain and inflammation caused
by cryglobulins. Ctyoglobulins are antibodies that most folks with
Hepatitis C have.
Rheumatology associated with hepatitis C presents with symptoms such
as arthralgia (joint pain), myalgia (muscle pain) are frequently seen
in patients with hepatitis C that may effect a few or many
joints/muscles. In some, muscle and joint pain can be severe and quite
disabling.
There is a blood test to specifically identify cryoglobulinemia. The
blood test must be done under special conditions and therefore the
blood drawing can usually only be done at a lab. Treatment usually
consists of treating the underlying disease (hepatitis C),
immunosuppressive measures, and plasmapheresis ( blood is taken from
the body, processed and returned to the body). People with
cryoglobulinemia should be evaluated for lymphoma.?
http://www.hcvadvocate.org/news/reports/zevin.html
Viral Load Chart
http://hepatitis-central.com/hcv/hepatitis/loadchart.html
Read more on the Reticular System (Sleep system)
http://www.mona.uwi.edu/fpas/courses/physiology/neurophysiology/ReticularSystem&Sleep.htm
Lastly visit this page for a list of hepatitis C remedies
(prescription only). If you?re not using any of these, one or more may
be indicated for you. Ask your doctor!
http://browse.drugs.com/cond-chronic_hepatitis_c.html
If you experience any of the side effects mentioned above, call your
doctor. Please continue your lab tests and check with your doctor on a
regular basis. S/he knows your medical history and can make the best
decisions for you.
I wish you the best! If any part of my answer is unclear, please
request an Answer Clarification, before rating. This will allow me to
assist you further, if possible.
Regards, Crabcakes
Search Terms
=============
Drugs contraindicated + hepatitis C
Soma + hepatitis C
Provigil + hepatitis C
Modafinil sulfone
Carisoprodol
Carisoprodol metabolism
Provigil metabolism
soma + liver damage
Provigil + liver damage |
