Starting tec, but I don't eat breakfast

[football-mom]

So my tec came yesterday and I plan to start it on Thursday after Christmas. I'm off next week, so will be able to start the 240mg while I'm off from work. My dilemma is, I don't eat breakfast, I haven't in about thirty years. I just have always had a hard time trying to make myself eat so early in the morning and the attempt actually makes me a bit queasy by itself.

I can eat later morning, around 10-11, just not around 7 when I take my other meds. Do you think I will be alright just taking maybe a zantac and aspirin and skipping food, or take the tec later around brunch or lunch? I won't have any problem taking an evening dose around 10 pm or so because I go to bed late anyway.

[Toomnyhats]

I think that taking it with food (protein/fat/carbs) & as close to 12 hrs apart is more important than specifically "morning" and "evening".

I will say that, for me, toast with peanut butter in the morning is enough food for me to not get sick with my morning dose. An option to keep in mind if you find your tummy needs a little food.

[MSer102]

The prescribing information for Tecfidera says that it can be taken with our without food. For effectiveness it doesn't matter. Some testing done, and apparently some real life experience, has shown that taking it with food containing fat can reduce how bad the flushing is afterward.

You may have to experiment to see what kind of side effects you get and how long they last and decide what time to take your Tecfidera so any side effects don't interfere with your daily activities.

Some people take their Tecfidera in the morning with breakfast not just because it's easier that way but also because the flushing and itching have worn off before they go to work.

If you want to take yours at lunch and you are at work, you might have to spend your lunch hour and maybe longer flushing and itching and maybe more. If you are trying to keep your personal medical information private it might be hard to do if you have to explain to your coworkers why you are flushing and itching after lunch every day.

So it might be that Tecfidera tells you when and how you should take it. You'll know more after you start it and get up to the higher dose. I hope everything goes well for you.

[Don2480]

I never ate breakfast before I started Tecfidera but from all that I read I started. The prescribing info stats that it may be taken with or without food but I think that the adjustment period requires food. At least that is what people are saying and I have been problem free.

I have been making and freezing breakfast sandwiches for a quick breakfast.

[Marco]

Your initial dose and first 240 mg dose are apt to be the hardest on you. When the medication first came out we weren't really taking it with food. After several months, it became a suggestion, but certainly isn't mandatory.

• I take my tecfidera with just a small handful of nuts and have no real problems. I don't notice a difference between a few nuts and eating an entire meal.
  
• I also try to take the doses no closer than 10 hours apart. Based on what you said, I would just take the Tecfidera around brunch and again before bed.

Please keep us informed.

[nosrepmodnar]

Trial and error

I worried myself sick on the first dose.
Don't do it, take it and you will either get ill or you won't.
I started with meals and after not seeing any side effects I now take it without food, both morning and night, probably 1 hour before eating in the morning and 2 or 3 hours after eating dinner.

Everyone is different so you will have to wait and see.

Good Luck!

[football-mom]

I worried myself sick on the first dose.
Don't do it, take it and you will either get ill or you won't.
I started with meals and after not seeing any side effects I now take it without food, both morning and night, probably 1 hour before eating in the morning and 2 or 3 hours after eating dinner.

Everyone is different so you will have to wait and see.

Good Luck!

Thank you very much! That is totally my attitude about things usually, the "why worry, it will happen or it won't". I just popped my first dose, so we will see how it goes. I haven't had anything to eat but a few Whoppers Santa put in my stocking. I'll let everyone know how it goes.

The only downside is I did end up coming to work today because the only legal assistant scheduled for today is down with the flu, so I got called in (the other one is out of the country).

[football-mom]

Okay, so four hours after my first dose and I'm not too bad. I have some burning in my ears and scalp with some mild redness and tingling in my face, but I'm black so its not very noticeable. There is some mild tingling across my shoulders and the back of my neck, but its not quite itching yet, just tingling. What is concerning is the nausea. I did not barf, but I've gagged a couple of times, so I called my doctor about recommendations for nausea and I will wait to hear what he says. But overall, its much better than starting Rebif, plus no shot of flipping acid to go with it, so I'm pretty happy.

I am disappointed with Biogen's service though. It takes way too long to reach a nurse, and I shouldn't have to go through two people to reach the third, the nurse. And then the nurse wouldn't give me any recommendation other than call your doctor. I resent being asked so many questions and then not getting any information in return. I've learned more here from all of you. What are the nurses there for if they won't help you?

[OrangeMetal]

Hi Football Mom,
I had the same dilemma as you. I do eat breakfast but because of my work and commuting schedule and both morning and evening work schedules on some days it was not really going to be possible for me to be exactly 12 hours apart.

I did call the nurse line and explained my entire scenario (I seemed to always get through to them ok during normal business hours) the nurse told me that as long as the dose was 8-12 hours apart I'd be "covered". I repeated my self to really make sure I got that and I said 8 hours apart was ok? And she said yes. So that's what I've been doing more or less as I don't wake up early and I don't eat late at night either.

[MSer102]

What are the nurses there for if they won't help you?

The nurses are basically triage nurses. They can say whether something sounds like an expected side effect for their company's drug. A lot of people never read the prescribing information that comes with the medicine so the nurses are there to tell them what it says about side effects. Based on the situation they can tell if something is seriously wrong and the person should go to the ER or if calling their doctor for medical advice will do.

The nurses can also provide information about the proper way to take the medicine.

The nurses are not there to provide medical help. Because the nurses are representatives of the drug company, the FDA forbids them to say anything that isn't in the official, approved, published prescribing information. There is rarely any medical information in the prescribing information for a drug, so there's not much the nurses can say.

They can't tell a person to do anything their doctor hasn't told them to do or go against any doctor's recommendations. And the nurses absolutely can't pass on any of the unapproved tips and tricks people share unofficially on message boards.

The nurses are there so a person has an option of having somebody to call rather than having nobody to call. They're probably the best source for information about how a medicine should be taken and what the side effects are. The drug's helpline is probably a much better place to call than, say, an medical group's or insurance company's triage nurse who isn't familiar with the medicine and has no idea what the person is talking about.

The nurses are not there to provide medical help or any information that the FDA hasn't approved.

[football-mom]

I wasn't asking for medical advice, just what do they know of that can improve your experience taking their drug. The Rebif nurses were very good at telling you home remedies to help you out, like extra water, ice and massage, tylenol, etc.

So as far as I am concerned, the Biogen nurses are worthless. I felt like all they were doing was interrogating me to improve their database and weren't there to help at all.

[Cindybridgeman]

Hi, I just took my first dose of Tec with food so we will see how it goes. This is my first MS DMD as I just was diagnosed late November. I liked the idea of a pill rather than injections especially since I travel a lot for work.

Good luck football mom....and wish me the same

[football-mom]

So I started eating with each dose and now feel perfectly fine. I'm still a touch queasy in the morning from eating, but have zero problems in the evenings. The flushing stopped too and I don't take the aspirin, just some food in my stomach.

[Cindybridgeman]

Great football mom! I'm still doing well...just some flushing and no GI problems..

[football-mom]

I started the 240 mg dose today. I ate a substantial breakfast with plenty of fat at the same time I took it and my stomach isnt feeling so great. I took a zantac about an hour later, which helped that burning feeling, but my stomach still feels bad with the sensation of needing to burp and/or vomit. My arms feel a bit weak as well, though my legs are okay right now. Mild tingling in the face too.

I'm pretty determined that tecfidera is going to work for me though, and if this is as bad as its going to get then I can tough it out.