POZ Community Forums
Meds, Mind, Body & Benefits => Questions About Treatment & Side Effects => Topic started by: WillyWump on April 13, 2011, 07:43:00 pm
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Here we go again.
I'm in my second week of Epzicom, going on my 3rd week.
I am aware that I have to be on the lookout for a rash. But over the last couple of days Ive developed a distinct redness on my neck and upper chest, almost like a sunburn, but not as red. If I put my hand on it and pull away it leaves a distinct white outline in the redness. I've always thought a Rash meant bumps and itchiness, which is not what I have as it's just red. It seems to be a bit worse today. Am also feeling a bit "off", like very slight tingliness.
Normally this wouldnt worry me but the Ezpicom website states "Patients taking EPZICOM may have a serious allergic reaction (hypersensitivity reaction) that can cause death". uhhh.
Would this be considered a "hypersensitivity reaction"? and If so why would it pop up a;most 3 weeks into the dosing? Also I tested negative for that HLA thingy
Is this something to worry about? Should I not take the Epzicom tonight and call doctor tomorrow? Or is it Ok to go ahead and take my normal does tonight. I know that If I call the after hours number for my doc I will get someone who has never seen me and they will automatically tell me to stop taking it, which If I do According to the Epzicom website, I cannot start it back up again. Ever. And I'm not relishing the thought of having to start another regimin if I stop taking the Epzicom tonight.
I would really like to talk to my Personal doc tomorrow instead of some random doc tonight, but If taking my normal dose tonight will kill me ::) then obviously I dont want to do that.
What are your thoughts?
btw, the only other thing I started since the Epzicom is Nexium
-Will
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Will,
When I started on Abacavir, I had some slight redness, around the neck and upper torso, but the doctor didn't seem to be too concerned about it, as I wasn't experiencing anything else from the other groups of possible reactions.
Just curious,.. Did you have the Abacavir hypersensitivity blood test done?
Ray
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The wallet card they give you with Epzicom is pretty forbidding. I was pretty nervous those first few weeks.
Here's a link to the epzicom page on hypersensititvity. http://www.epzicom.com/hcp/screening/screening_for_hypersensitivity.html
It says that passsing the HLA test doesn't rule out hypersensitivity, it only makes it a lot less likely.
As far as whether or not to stop if the doc on the phone suspects a reaction:
-- if it is a hypersensitivity reaction, then stopping would be a good idea.
-- if it isn't a hypersensitivity reaction then shouldn't you be able to restart tomorrow after you see your doc? It only says you shouldn't restart if you had a hypersensitivity reaction -- if it wasn't one shouldn't you be fine to start up after a single missed dose (no different from missing a day)?
Good luck; hope this helps. Let us know what you hear.
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Info on what the hypersensitivity rash looks like
The rash is described in the prescribing info :
"Physical findings associated with hypersensitivity to abacavir in some subjects include lymphadenopathy, mucous membrane lesions (conjunctivitis and mouth ulcerations), and rash. The rash usually appears maculopapular or urticarial, but may be variable in appearance. There have been reports of erythema multiforme. Hypersensitivity reactions have occurred without rash." http://www.drugs.com/pro/epzicom.html
"A maculopapular rash is a type of rash characterized by a flat, red area on the skin that is covered with small confluent bumps. The term "maculopapular" is a compound: macules are small, flat discolored spots on the surface of the skin; and papules are small, raised bumps. It is also described as erythematous, or red.
This type of rash is common in several diseases and medical conditions, including scarlet fever, measles, secondary syphilis, erythrovirus (parvovirus B19), and heat rash. It is also a common manifestation of a skin reaction to the antibiotic amoxicillin or chemotherapy drugs.[1] .
This type of rash can be as a result of large doses of niacin or no-flush niacin (2000 – 2500 mg),[citation needed] used for the management of low HDL cholesterol.[3]"
http://en.wikipedia.org/wiki/Maculopapular_rash
Urticaria = hives
http://en.wikipedia.org/wiki/Urticaria
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What are the symptoms of hypersensitivity?
Hypersensitivity to abacavir is clinically defined as a multi-organ syndrome usually characterized by a sign or symptom in 2 or more of the following groups:
Group 1: Fever
Group 2: Rash
Group 3: Gastrointestinal (including nausea, vomiting, diarrhea, or abdominal pain)
Group 4: Constitutional (including generalized malaise, fatigue, or aches)
Group 5: Respiratory (including dyspnea, cough, or pharyngitis)
If your patient experiences a hypersensitivity reaction, stop treatment with EPZICOM immediately. Symptoms should resolve in a few days. Following a hypersensitivity reaction to abacavir, NEVER restart EPZICOM or any other abacavir-containing product because more severe symptoms can occur within hours and may include life-threatening hypotension and death.
As I mentioned earlier, I wasn't experiencing anything , from the other groups. I only had the slight redness. It lasted a couple days and went away on it's on.
It worth talking to your doctor about.
Ray
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The wallet card they give you with Epzicom is pretty forbidding. I was pretty nervous those first few weeks.
-- It only says you shouldn't restart if you had a hypersensitivity reaction -- if it wasn't one shouldn't you be fine to start up after a single missed dose (no different from missing a day)?
Ahh, ok, that is what I was unclear on. Perhaps I didnt read it closely enough, I took it as "if you stop Epzicom, you cannot restart it ever".period. due to increased risk of fatal reaction once you restart.
Based on you and JRE's response, I think I will not take my dose tonight and call my Doc in the morning.
-Will
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The warning iinfo about stopping and restarting is written pretty harshly, but it really boils down to talking to your doctor before you restart... and you'll be doing that. There's the one day aspect too -- if people couldn't restart without problems if they miss a single daily dose it is hard to see how they could get a license to sell it on the market. Even the (harsh) warning talks about stopping for "a few days"
"If you stop EPZICOM for any other reason, even for a few days, and you are not allergic to EPZICOM, talk with your healthcare provider before taking it again. Taking EPZICOM again can cause a serious allergic or life-threatening reaction, even if you never had an allergic reaction before. If your healthcare provider tells you that you can take EPZICOM again, start taking it when you are around medical help or people who can call a healthcare provider if you need one."
Good luck tomorrow
A
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"If you stop EPZICOM for any other reason, even for a few days, and you are not allergic to EPZICOM, talk with your healthcare provider before taking it again. Taking EPZICOM again can cause a serious allergic or life-threatening reaction, even if you never had an allergic reaction before. If your healthcare provider tells you that you can take EPZICOM again, start taking it when you are around medical help or people who can call a healthcare provider if you need one."
And this is why I already hate Epzicom, too much to worry about. >:(
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Hi,
It requires expertize to distinguish being and adverse effect that require medication interruption and some superficial effect that may fade out. Like JRE, I had a bit of strange skin reactions that was alarming but it went off.
The proper answer is to be given by you doctor. I would seek his/her advise before skipping a dose or suspending treatment.
I am sure you have taken all necessary measures in this initiation period (avoid sun, drink lots of water, etc)
The HLA test does not rule out the hypersensitivity reaction, but, now that the screening is very effective since in the relevant study, only 1 % had adverse hypersensitivity reaction, (on top of my mind 4 of 500 hundred participants, 2 of which had other liver conditions...) So if you are otherwise carefull and healthy, the odds are more around 0.5 %. This is too low to make a decision without seeing your doc.
I think my doc mentioned that the rash appears preferentially on the chest, but I do not recall if he was mentioning the viramune rash or the ABC rash (I take both).
I understand the feeling about Kivexa... But, please bear in mind that if you succeed the initiation period it is a pretty well tolarated drug. It is currently your 'best' option from what I understand (although I am not commenting that your other options would not be at least as good...). So do not rush to conclusions without medical advise. On the other hand I would rush to get that medical advice without any delay.
Best I can tell and share with you based on my personal experience and research (I take it, so I know about the risks...)
Cheer up my friend ! Whatever pans out, we are here for you.
Eric
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Apparently I am a guinea pig now.
Went to see doc today. She wants me to stay on the Epzicom and "see what happens" over the next couple of doses. :o
The reason she says this is because I am really not showing any of the clear indicators for ABC hypersensitivity. She said my Rash was not really a rash but more of a flushing, and the slight tingling sensation is due to the flushing itself. She said a flushing can occur anytime a new med is introduced, even otc meds.
However, the timing of the flushing is consistent with the timing of the onset of hypersensitivity, wich is usually in the 2nd week, and could still potentially develop into a rash. She said If I did in fact have an allergy to ABC that the symptoms would get markedly worse each time I dosed. So over the next couple of days I am supposed to be on the lookout for anything out of the ordinary such as flu-like symptoms or a worsening of the "flushing". She said the hypersensitivity would show itself in the next few days if it was there.
Also, just because you test negative for the HLA-B alele, doesnt necessarily preclude you from getting the hypersensitivity. It's just a tool they use to weed out "most" of the susceptible people.
She said I was not going to die in my sleep ;D that the fatal reactions happen when people ignore the indicators for some time. Which she said, was the reason why the warning label was written so harsh, so people wouldnt ignore the indicators and would call their doc. (uhh, it worked).
I told her I still didn't like Epzicom, but she said the weird feeling should go away after my body gets used to the drug and she wants me to stay with it. She reminded me that when I started Truvada I vomitted for a week and that that turned out ok.
So, whatevs.
-Will
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Hey Wumpster, it sounds like your doctor thinks you're just a redneck. ;)
Make sure you do get back in contact with her if you start feeling worse, especially if you start getting a fever. From everything I've read, the fever seems to be one of the most common symptoms of ABC sensitivity. Good luck, I hope you're just going through an adjustment period. It does sound like that's the most likely explanation.
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Will,,
I think your going to do just fine with the Epzicom
Ray
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Hi,
relieved to hear you could get in contact with your doctor.
When I had some strange skin effects it was the middle of summer and my doc was on vacation...
I hated that...
Bear in mind a few things that 'may' help:
- no stress, no overwork
- drink lots of water
- eventhough Epzicom is once daily and can be taken along with your other medication, I had in fact let 2 hours between my other drug (viramune) and Epzicom for about 2-3 months, so that they do not go through the liver all at once. May be an overkill, but, at least harmless...
Cheers
Eric
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Dear Wumpette: your doctor called you a hypochondriac
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Hah -- I was writing a post about what a caring and careful doctor she seemed to be while Miss P was posting. ::)
Hope things go well.
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Dear Wumpette: your doctor called you a hypochondriac
Yes. Yes, I suppose she did. But she loves the Wumpy, although I didn't get a sucker this time.
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Yes. Yes, I suppose she did. But she loves the Wumpy, although I didn't get a sucker this time.
Just the standard check of your testicles eh?
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Just the standard check of your testicles eh?
She refuses to look at them anymore. She says they are "normal", but I know my balls, and I KNOW they have shrunk.
As a side note, she rescheduled my "Swallow Test" (for my throat issues). I told her a swallow test was not necessary as I have a lonnnng list of names that can vouch for my swallowing abilities. But you know how the doctors are, everything has to be in a "controlled, clinical setting"
btw, thanks anyways to Phild for offering to be a willing participant in any Swallow Tests I have to undertake.
-WIll
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btw, thanks anyways to Phild for offering to be a willing participant in any Swallow Tests I have to undertake.
-WIll
I've always passed all my swallow tests with flying colors --- although most did not occur in a medical setting.
The difference between like and love ---- a spit and a swallow.