Question About The Absorption of Meds

[RobbyR]

I have a question about absorption of meds..I know some meds require taking on an empty stomach, which I did with Atripla for two years, and others like Complera which I am trying now (due to hopefully less side effects) require that you take it with solid food and 400 calories. I am a ritualistic type of person, and I was so used to taking my nightly Atripla that it's going to take some getting used to to taking Complera with a full meal. But if the side effects are less, I guess it's worth it.

My question is, does taking a medicine with food affect it's effectiveness? Speaking as a layperson, it would seem that taking a pill with a full stomach might lessen it's effects? But clearly Complera must work better with food or they wouldn't have the strict requirements. So taking a medicine on a full stomach won't in fact negate some of it's effects? It just seems like to me the medicine would be absorbed better and more effectively in the bloodstream on an empty stomach than on a full one..But I guess Complera is the opposite.. I guess I am feeling some anxiety about changing my regimen, while the insomnia I had (which I can't prove was caused by Atripla, but I suspect), was irritating, Atripla always kept me undetectble and healthy. So I'd hate to see my next labs show an increase in viral load. I am just going to see how I do on Complera for a couple weeks and if it's going well, I may continue it, but I am hoping that it keeps my viral load as wonderfully undetectable as Atripla did. I'm going to continue Complera on a trial basis and try and get in the habit of taking it in the daytime with a meal, which still seems SO strange to me, since I took my atripla so long at night on empty stomach! But I guess it's worth a try!

[mikeyb39]

I've just heard that some medicines are sensitive to the gastric acids in the stomach, therefore eating pill with food causes you stomach to move it thru to the small intestine where it is absorbed better.

I'm not a doctor, so this is just word of mouth.

[vaguesbleues]

Some medications require you to eat with the food to help with absorption (if you eat it on an empty stomach, the body doesn't take it up as well).  I'm pretty sure that's what the reason is for why you must take Complera or Stribild with a meal.  If you don't take it with a meal, the body won't take it up and absorb it as well.  It might just not be water soluble enough and so you need that extra "fatty" (i.e. greasy) stuffy in there with it to help your body take it up. 

I'm not a doctor, but I am a chemist   So just speculating here...

[RobbyR]

Thanks for the input ya'll! (Yes I'm from the South, & we say ya'll here  ). I guess the absorbtion just varies based on its solubility. I am just feeling some anxiety about switching meds and hoping the complera will keep me as healthy and undetectable as atripla did. I will give it a while and see how I feel on it, if not, I will want to switch back to the atripla, since it's kind of like an old friend to me lol. And the sleeplessness I had while on it I do not know for a fact was due to the atripla or other factors..So If my sleep issues persist while on complera, I will want to return to atripla because I just have a gut feeling that it is an overall more effective medication as far as keeping the hiv in check..Not sure if that's an accurate assumption...Just speculating, because the atripla has 600mg of sustiva where as complera has only 25 mg of viread. Otherwise the two have the same composition. I guess time will tell for me, but I am sort of missing my atripla because it was like an old friend lol..The deciding factor for me will be if my sleep issues improve on complera or don't improve.

[WindySkies]

Over my first 30 days on Complera I went from a VL of 57,000 down to 80, and my CD4 went from 730 to 929.  All with no side effects, weird dreams, mood swings, inability to sleep, or any other brain altering issues.

[Solo_LTSurvivor]

Over my first 30 days on Complera I went from a VL of 57,000 down to 80, and my CD4 went from 730 to 929.  All with no side effects, weird dreams, mood swings, inability to sleep, or any other brain altering issues.

Can we please stop the atripla bashing?  It has been acknowledged that some people cannot tolerate efavirenz and subsequently have specific side-effects that they just cannot tolerate.  That does not mean that 99.9% of the population will take this drug and suffer as a few people do.

I definitely would love to see you post some stats regarding the percentage of people who suffer from the symptoms/side-effects that you avoided by not taking a drug you have no experience with, and could've possibly been one of the few who didn't even have to deal with:

side effects, weird dreams, mood swings, inability to sleep, or any other brain altering issues.

Any drug you take runs the risk of causing situations which people cannot adjust to.  Why else do you hear these thirty minute disclaimers whenever you see an ad on TV for a drug, or read an insert in the prescription -- yet you don't see people shouting from the rooftops don't take Claritin because it will make you jump out of your skin from being so amped up 

[wolfter]

Can we please stop quoting only portions of other peoples' post to change what was actually said? 

Windyskies clearly states that he didn't experience any of the side effects and is achieving great results with Atripla.

Wolfie

[newt]

This is an interesting question and as has been said it depends on the med.

Atripla will work if taken with food. It's  recommended taken on an empty stomach because for many people food, especially fat, increases side effects of the efavirenz it contains.

Some meds need food to be absorbed effectively, for example Reyataz requires an acid stomach environment to be absorbed properly, and the rilpivirine in Complera requires food to be absorbed at an effective concentration.

The mg dose of different drugs depends on the size of the chemical molecule.

For example tenofovir (Viread) comes as a pill containing 300mg of tenofovir disoproxil fumarate which your body turns into tenofovir proper (this is the same for Complera by the way). It's 300mg because the molecule is big.

By contrast the new drug dolutegravir is being tested at a 25mg dose, because the molecule is small.

- matt