Thanks Peg, my problem was that the onc I had at the time, decided to put me back on Gleevec and Gleevec has quit working for me before. Here I was taking all these meds and my platelets and WBC were still too high. The doctor was giving me prilosec twice a day due to my complaining about the pain in my side. I never had heartburn. If I had, I could have understood why they were giving it to me. Hang in there with Tasi; it could be the one for you. Jeanie<3 In a message dated 12/2/2013 11:07:12 A.M. Eastern Standard Time, [email protected] writes:
Hi Jeanie, You are right about the proton pump inhibitors...they are designed to work over a 24 hour period, meaning that there is no good time to take them around TKI's. All the TKI's carry a warning about this, because if the stomach acid is reduced too much the TKI will never reach full absorbtion. However, having said this, on Sprycel, I did have to take prilosec for the first week or so until I adjusted to taking Sprycel. The heartburn would have killed me. However, it was only for about a week or so. I have also had to do the same thing for a few days with Tasigna. It is a trade off, as the TKI may be impaired by it. However, I did find that once I adjusted to taking the TKI I no longer required prilosec except on the rare occasion. Good for you for standing your ground. Most docs never check the interaction checker far enough to see that things like proton pump inhibitors can affect absorption or other drugs that are liver enzyme inducers can affect metabolism of the TKI's. It pays for us to be patient active! Fight on, Peg On Tuesday, November 26, 2013 1:58:38 PM UTC-8, Jeanie wrote: Hi all and just wanted to say a few words about Prilosec. The Sprycel leaflet does say specifically do not take proton pump inhibitors. I had to fight with my doctors while in the hospital as they were giving me this twice a day and the meds I was on for CML were not working. I finally told the nurse when she brought them in that I would not be taking them anymore and showed her the leaflet. And I had no indigestion or anything just the pain in my right side that I always had. We are all different so maybe some people can take them without any side effects. Happy Thanksgiving Everyone, Jeanie<3 In a message dated 11/25/2013 3:58:03 P.M. Eastern Standard Time, [email protected]_ (javascript:) writes: Hi Peg and thank you. As for the Prilosec, all of my doctors and I have discussed it and feel that the benefits of me continuing to take it outweigh the risk. I don't take the prilosec with the TKIs, there's at least a couple of hours in between. Given my health history, it's an unfortunate necessity. I agree with you and have been battling my doctors since March regarding the whole "minimal effective dosing" issue. I see no need to take the maximum dose if the minimum is doing what it needs to be doing. At this point of my life, it's quality over quantity and if I can't actually live and enjoy my life, I really don't see much point. Being sick and living in the shadows isn't really my way. Suzanne On Monday, November 25, 2013 2:31:42 PM UTC-5, peg wrote: Hi Suzanne, Like you I have been on Gleevec (8 mos), Sprycel (3 yrs) and have just recently switched to a low dose Tasigna (200mg once daily). When on Sprycel I had esophageal spasms, where what I swallowed would not go down. This may be similar to what you are experiencing. I do use liquid Donnatal for this and other stomach problems, but I use it sparingly as it can inhibit the metabolism of Tasigna! There is not much point in taking a TKI, and suffering the side effects, if you take another drug for the side effects that renders the TKI useless! Which brings up a concern...your Prilosec. While I will use that only very occasionally, acid inhibitors like prilosec are contraindicated with TKI drugs as they impair the absorbtion. There is mounting evidence that too little stomach acid will result in too little absorbtion of the TKI's. As far as your oncologist wanting to increase your dose to the standard recommended dose, there is also growing evidence that dosage can be tailored to the actual need for each patient, but because CML is absolutely fatal without treatment and too low a dose can sometime lead to resistance, many oncologists are afraid to reduce the dose below the standard in the absence of absolute medical necessity. However, were medical necessity has prevailed many patients are being maintained fine on lower than standard dosing, myself included. Since you are already on a low dose, you might want to ask your oncologist to wait through at least 2 or 3 PCR's to see what your numbers are doing. They recommend at least 2 PCR's before making any changes as PCR's can fluctuate, so you would not ever want to make a change based on any one, but rather a trend of two or three, and they must be from the same lab!!! You cannot compare a PCR from one lab to that of another. It is like apples and oranges. However, if your numbers are good, there may be no need to put you on a higher dose. Just one school of thought...you may find others who disagree. I have just had such extreme side effects on TKI's that I have to hope and pray that low dosing will work. I PCR every month to monitor this. Like you I also have a complicated diagnosis, and balancing drugs and side effects is at the least challenging and sometimes depressing. I have had Multiple Sclerosis for 25 years, was diagnosed with CML and Melanoma at almost exactly the same time, almost four years ago, and this year have been diagnosed with an unrelated abdominal tumor and possible lung tumors. Through all the years of my MS I barely took any medication, but now pop handfuls of pills several times a day...very disheartening. I encourage you to find the lowest dose of everything that works for you and try to find a way to make it all work for your life. Some times for me this has taken a bit of life modification. I know first hand how tired and worn out you are...I get there too. Try to take one day at a time...and when that doesn't work, one hour at a time. Know that you are not in this alone. 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