Besremi and Zyrtec

[nyelynndesigns]

Hi.........I'm going through the process of getting approved for Besremi. My not specialist hem is worried about me taking Zyrtec, She told me that I need to stop taking once I start Besremi. I take it for bad allergies and my PV JAk2+. Anyone been told this or are there folks still taking Zyrtec?

[hunter5582]

Your doc is heads up on this issue. It turns out there is a drug interaction issue.

Avoid/Use Alternative

ropeginterferon alfa-2b + cetirizine

use alternative: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

online.epocrates.com/intera...

I also have allergies and take Claritin for them. I am also likely to be taking Claritin permanently while on Besremi as I have had some issues with itching due to Besremi (histamine response). The Claritin does an excellent job controlling this adverse effect. I get no side effects form Claritin and it does not show with a dug interaction with Besremi.

Hopefully you will find an viable alternative to the Zyrtec

[nyelynndesigns in reply to hunter5582]

Thanks Hunter5582.............How is Besremi treating you?

[hunter5582 in reply to nyelynndesigns]

I have done well on the IFNs. First Pegasys and now Besremi. As my iron levels have restored I feel much better; however, my HCT is starting to creep up. I just increased the dose to 150mcg, which is still relatively low.

I have had some adverse effects. Mild lymphopenia and borderline neutropenia. I have also had some itching (histamine response). I am taking Clairin which controls the itching. i recently had a couple of bouts with arthralgia which are like Besremi adverse effects. On the whole, I am very pleased with the Besremi. It is proving effective and the adverse effects are manageable. I had previously tried hydroxyurea and phlebotomy-only. These treatments were much more difficult to tolerate and did not work nearly as well.

I would suggest Besremi as a first choice to anyone needing to treat PV with cytoreductive therapy. Hope you find it suitable.

[nyelynndesigns in reply to hunter5582]

Thanks for the feedback.....How long have you been on Besremi? I had a bad experience on Pegasus even though it made my numbers normal, so I'm a bit anxious about starting Bes. I'm hoping the side effects will be manageable for me as they have been for you

[hunter5582 in reply to nyelynndesigns]

I started on the Besremi Feb 2, 2022. Started on 100mcg. Have now upped the dose to 150mcg., I was on Pegasys prior to that, which I started on May 19, 2021. I was on 45mcg of PEG. Was about to up the dose when I switched to Besremi.

Besremi is supposed to be easier to tolerate than Pegasys due to its mono-pegylated formulation. I expect that this will be true for some people but not all. Hopefully you will find it easier to tolerate.

All the best.

[nyelynndesigns in reply to hunter5582]

Thanks!

[EPguy]

I don't have an actual answer, but I can find there is some connection to MPN issue with the drug

<<Cetirizine ... stimulated the production of ... cytokines IL-10 and TGF-β>>

jacionline.org/article/S009...

--

This report suggests more TGF-β (maybe from Zyrtec?) along with PEG could be useful for some cancer types:

link.springer.com/article/1...

<<We show here that costimulation with IFN-α and...TGF-β potentiates antiproliferative activity in a ... human melanoma cell line.>>

Above is just speculative and not any sort of advice. But it might point to a positive connection to adding Zyrtec. Does your Dr have a reason for the concern?

There should be members with real world experience to get a more practical answer.

[nyelynndesigns]

Yeah, my doc that's not my specialist says there's an interaction with Besremi. I've taken zyrtec for years for my PV and allergies. The Pharm wouldn't actually fill the script unless she cleared it.

[EPguy in reply to nyelynndesigns]

Between that and Hunter's very specific info (which I missed) it seems a clear answer. Always good to have that. So even if the combo were useful somehow it's not worth these real risks.

I'm also on Bes and find it generally improvement over HU so far. I get a minor pruritis after shower that started only after I started Bes. But not bad so far. But the dose selection has been hard for me as you can see in my recent posts.

[jon1972]

I had no idea there was interaction issues with Zyrtec and Bes. I had been taken them both for several weeks and was experiencing severe brain fog, fatigue, and feeling generally awful. I thought maybe they were depression symptoms. My specialist had told me to take allergy medicine for my severe throat pain I've been having since starting Bes. He said it was probably just post nasal drip and that an allergy medicine would help. He did not tell me to avoid Zyrtec though 😡

[nyelynndesigns in reply to jon1972]

Hi Jon1972…I’m still waiting to hear from my specialist about Zyrtec. My regular onc hasn’t dealt with Besremi. There’s a lot of folks that I’ve encountered that still take the z. My specialist has a lot of patients on Besremi, so I’ll be interested to see what he says.