The starting and maximum doses of ribavirin and the impact of therapy on hemoglobin levels have been shown previously. The dose of ribavirin was able to be increased in four patients; however, only three patients (23%) received doses of ribavirin greater than 1000 mg/day. Seven patients (54%) received greater than 10.6 mg/kg of ribavirin, although the dose was further reduced in four of these patients. Eleven of the 12 patients receiving ribavirin in combination with PEG-IFN had a drop in their hemoglobin, with a mean decrease of 34.4 g/L (range 5 g/L to 63 g/L). Erythropoietin was used only in patient 8 and although this increased his hemoglobin level and improved his symptoms, he ultimately did not achieve a SVR.
Most patients experienced subjective side effects while on treatment. Neuropsychiatric complaints including depression (patient 5), hallucinations (patient 6) and irritability (patient 7) led to discontinuation of medication in three patients. In patient 5, PEG-IFN and ribavirin treatment was terminated after 38 weeks because of symptoms of depression and lack of virological response. However, his ALT level flared to 636 U/L two months after therapy was discontinued and low doses of pegylated-interferon alpha 2a (90 pg of Pegasys [Hoffman-La Roche, Canada] weekly) were introduced as suppressive therapy. You finally have a choice and can find yourself a perfectly reliable pharmacy to shop with for best medications available: buy ampicillin antibiotics and see how quick and easy it could be to spend less money.