Diving while on Interferon-B (aka Rebif)?

[AggieDiver]

I was diagnosed with multiple sclerosis in 2006. I have been on three dive trips since my original symptoms in 2004 and have been on one trip since I was dxed and started taking Copaxone. I had no problems on any of the trips, do not currently suffer any disability due to my MS, and I exercise regularly and recently completed a 150 mile MS fundraising bike ride over a 2 day period.

With that said, in january, I switched from Copaxone to Rebif (interferon-B), as an MRI showed I was still accumulating additional lesions despite my lack of symptoms. Are there any diving contraindications to taking Rebif? Thanks in advance for any assistance!

 

[DocVikingo]

Hi AggieDiver,

Reportedly no symptoms have developed to date, but only CNS lesions consistent with multiple sclerosis. As such, this discussion will leave aside the issue of diving with symptomatic MS.

Rebif (interferon-beta-1a) is a powerful medication and has an entirely different mode of activity than Copaxone (glatiramer acetate injection). Possible side effects of concern to SCUBA include fatigue, flu-like symptoms, increased susceptibility to infection, easy bruising or bleeding, headache, and anxiety and depression.

The user of interferon-beta-1a should take the drug for an adequate period topside to assess for potentially worrisome side effects. If none develop, then it likely is safe to dive while on the medication.

Of course the treating physician should clear the diver for SCUBA.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such. Consult with your physician before diving.

 

[AggieDiver]

Thanks Doc! I will definitely be talking to my docs before our trip in August and make sure they have no objections. I have been taking it for several months now and periodically wake up feeling like crap the morning after a shot, but otherwise haven't had any really significant side effects since the initial dosage ladder. I take ibuprofen to reduce the flu-like symptoms on nights when I do the shot. Any indications of elevated seizure risk to Rebif that you are aware of that would suggest caution towards the use of nitrox?

 

[DocVikingo]

Hi AggieDiver,

Good the issue of seizures has been raised. About 4-5% of those taking Refib within the recommended dosage range report convulsions. However, bear in mind that most persons taking this drug have active/symptomatic MS, not just CNS lesions consistent with the disease, and seizures are considerably more prevalent in this group than in the non-affected general population. Plus, it is likely that some subset of these patients had a pre-existing seizure disorder or predisposition to seizures not related to MS. Thus, in this situation increased risk of convulsions from Refib seems quite small, although not non-existent.

Given a several month trial with no adverse reaction other than "periodically waking up feeling like crap the morning after a shot," the picture for return to diving appears promising. Still, the diver on Rebif will want to continue monitoring for worrisome side effects, particularly those of a psychiatric nature.

As for EAN used appropriately, there is no way of knowing what additional risk it may contribute to the diver on Refib having a seizure. It would appear very small, but not absent.

The diver in the situation described would be prudent to dive as conservatively as possible and to take all reasonable steps to avoid problems from this medication.

Again, the treating physician should be asked for clearance to dive.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such. Consult with your physician before diving.

 

[AggieDiver]

Thanks again Doc!

The diver in the situation described would be prudent to dive as conservatively as possible and to take all reasonable steps to avoid problems from this medication.

Ask my wife..."diving conservatively" is my middle name. I have appts with my neurologist and PCP scheduled between now and August, so I will definitely ask for their clearance.

 

[DocVikingo]

Cool.

Please let this forum know what your neurologist and PCP have to say.

Thanks,

DocV