New Member
Posted 02 September 2011 - 06:58 PM
Never mind, reread your original post. Didn't realize you already had 3 months of pills on hand. I suppose you could try cutting them in 4 x 100 mg pieces, but I think that would be awfully hard to cut correctly, especially since you wouldn't have it already "pre-grooved".
Traci
New Member
Posted 02 September 2011 - 11:46 PM
I love your comment about being sick and tired all the time! I feel so much better since taking 2 small 100s after lunch and 2 more after dinner......for me, the smaller pills are much easier on my stomach and the fatigue is less. I finally feel like I might get a bit of my old life back. I am thinking of dropping to 3 small pills a day......give it a try.....Lala
Advanced Member
Posted 03 September 2011 - 08:55 AM
Phil,
It is mainly CYP3A4 inhibition that is the issue, since CYP3A4 is found in the liver and regulates drug clearance from the body. Inhibiting CYP3A4 slows down drug removal from the blood, which is what grapefruit juice does. You mentioned CYP450 in the intestine, which can also be inhibited by grapefruit juice, but that only affects items that have a low bioavailability (hard for the body to uptake from the intestines unless they are first metobolised). Drugs like the TKI ones have a very high bioavailability, so their uptake is very fast (most uptake occurs through the stomach and duodenum before ever getting into the main part of the small intestine). So a very good input, but grapefruit juice will overall result in higher levels of TKI drug in the blood. But people who also take other drugs should check with their doc about those (esp heart medications, anti-depressants, etc).
Drug Interactions with Grapefruit Juice: An Evidence-Based Overview
New Member
Posted 03 September 2011 - 09:27 PM
Show this article to your doctor:
Can grapefruit juice decrease the cost of imatinib for the treatment of chronic myelogenous leukemia? (http://www.lrjournal.com/article/S0145-2126(10)00462-5/fulltext)
Advanced Member
Posted 05 September 2011 - 05:03 AM
So based on the Japanese study (admittedly very small), Grapefruit juice has no significant interaction with G. Bad news for anyone wanting to use it to leverage their G dosage. Great news for anyone who really likes grapefruit. I feel a cocktail coming on!
Advanced Member
Posted 05 September 2011 - 10:31 AM
So out of 4 people, 2 had a higher maximum Gleevec plasma concentration and 2 had lower. Some interesting info, even though inconclusive. I think the grapefruit juice may require a few days to build up in the liver. They took the Gleevec with a glass of juice and quit after only 3 days. But I think the intestinal uptake issue seems to be more important, which could explain why plasma levels of less bioavailable drugs can be significantly boosted by drinking grapefruit juice, but highly bioavailable drugs like TKIs are not significantly boosted (or maybe not at all) by grapefruit juice. Very interesting. I'll drink (a grapefruit cocktail) to that.
New Member
Posted 18 January 2012 - 02:41 PM
Friends,
I wanted to update everyone from my original post sent in August:
I opted not to pay the $5K deductible twice, and made my 3 months supply of Gleevec last for 4 months. As recommended here, I did not go without Gleevec for the entire month, but instead rationed with smaller dosages and supplemented with grapefruit juice. Today I visited my doctor and my PCR test came back with no signs of the BCR-ABL transcript. <sigh of relief>. I am back on my regular schedule of Gleevec.
Thanks to all who added advice and opinions.
RJF
Member
Posted 18 January 2012 - 04:37 PM
Wow, that's great news! Glad it worked out for you.
Advanced Member
Posted 18 January 2012 - 09:08 PM
Wow, that's great. How much grapefruit juice did you drink daily, and did you drink it with your dose? Do you think it made a difference? I can't help but wonder .....
Dan - Atlanta, GA
CML CP Diagnosed March 2011
Gleevec 400mg
Advanced Member
Posted 19 January 2012 - 12:09 AM
Hey RJF, It's unfortunate that you had to do this experiment, but such great news that it worked out for you
Diagnosed 9 June 2011, Glivec 400mg June 2011-July 2017, Tasigna 600mg July 2017-present (switched due to intolerable side effects, and desire for future cessation attempt).
Commenced monthly testing when MR4.0 lost during 2012.
2017: <0.01, <0.01, 0.005 (200mg Glivec, Adelaide) <0.01, 0.001 (new test sensitivity)
2016: <0.01, <0.01, PCRU, 0.002 (Adelaide)
2015: <0.01, <0.01, <0.01, 0.013
2014: PCRU, <0.01, <0.01, <0.01, <0.01
2013: 0.01, 0.014, 0.016, 0.026, 0.041, <0.01, <0.01
2012: <0.01, <0.01, 0.013, 0.032, 0.021
2011: 38.00, 12.00, 0.14
New Member
Posted 19 January 2012 - 09:31 AM
Thank you. As you can imagine, I am glad I didn't have to report negative news.
Dan - I only drank grapefruit juice on days I did not take the full dosage. I would take a half pill with about 10 oz of grapefruit juice. I would avoid the juice on days I would take full dosage. I have no idea if this helped, and would not endorse others trying this.
RJF
Advanced Member
Posted 19 January 2012 - 04:32 PM
Hi RJF,
Great news on your successful experiment. Did you notice any difference in side effects on the day you took the half pill/grapefruit juice V the full dose.
J
Dx Dec 2010 @37
2x IVF egg collection
Glivec 600 & 800mg
PCRU March 2012
Unsuccessful pregnancy attempt - relapsed, 3 months interferon (intron A), bad side effects from interferon
Nilotinib 600mg Oct 2012
PCRU April 2013, 2 years MR4.5 mostly PCRU with a few blips
April 2015 stopped again for pregnancy attempt (donor egg), pregnant first transfer, 0.110 at 10wks, 2.1 at 14wks, 4.2 at 16wks, started interferon, slow dose increase to 25MIU per wk, at full dose PCR< 1 for remainder of pregnancy
Healthy baby girl Jan 2016, breastfed one month
Nilotinib 600mg Feb 2016
MMR May 2016
PCRU Feb 2017
New Member
Posted 19 January 2012 - 04:39 PM
Hi JJG,
I really didn't notice a difference between days.
RJF
New Member
Posted 20 January 2012 - 11:36 AM
I am on gleevec I had a gist tumor the doc put me on 400mg I was so swollen from it I took my self off 400 and now take 200 and I feel much better. I'm sure my doc will be mad but I couldn't function on all that med you have to feel good or it's not worth jit to just exist. I hope you are feeling well. Jeanie
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