Atripla and food

[J220]

So I'm on my second week on Atripla, and everything is going fantastic. I just have a question about food (by the way I will see my doc in two weeks, but wanted to get opinions here as well).

I am taking the med on schedule every night, the only thing is that my eating habits are not too structured. I always take the pill on an empty stomach as directed, or at least 2 hrs after eating, but the problem is that sometimes my stomach is really really empty, as in dinner at 6pm, then atripla at 11 pm. All this has to do with my work and all that, kind of hard to control.

So, question, how long after I take the pill can I eat? I try to go to bed right after I take it but sometimes I am just so hungry, dizziness and all, that it takes almost all my willpower to not go and raid the fridge a few hours after taking it. Does anyone know how long I should wait, and if this somehow minimizes the beneficial effect of the medicine? And while I am at it, why does this med have to be taken on an empty stomach? Is is because of effectiveness or maybe because it can cause a stomach ache or something? Just curious. J.

[ndrew]

Hi,

I share the same food issues.

Someone will correct me, but I think it is do not eat 3 hours before you take it.  You can eat 1 hour after you take it??

Drew

[Peter6836]

Hi I have heard the same recomendations that Drew has given
Peter

[J220]

The drug fact sheet accompanying the prescription says to take , "at least 1 hour before, or 2 hours after eating". I guess that answers my question about when to eat after taking it- hadn't read this properly, but I was erring on the side of caution, waiting several hours to eat before or after taking it. But it is clear that you can take it 2 hours after eating, and eat after one hour.

So this is good news for me then, that means that I can eat 1 hour after taking it, although I would probably wait an hour and a half to be sure. I am still not clear why it has to be taken on an empty stomach, but hey, I will follow the indications! J.

[milker]

Hi,

the pharmacokinetics for Atripla has been tested on fasting people. The documentation says:

Effects of Food on Oral Absorption
ATRIPLA has not been evaluated in the presence of food. Administration of efavirenz tablets with a high fat meal increased the mean AUC and Cmax of efavirenz by 28% and
79%, respectively, compared to administration in the fasted state. Compared to fasted administration, dosing of tenofovir DF and emtricitabine in combination with either a
high fat meal or a light meal increased the mean AUC and Cmax of tenofovir by 35% and 15%, respectively, without affecting emtricitabine exposures

AUC is how long the drug stays in the body, or its average concentration time curve. So for example, efavirenz with high fat meal increased the time the drugs stayed in the body by 28%. But Cmax is the absorbtion rate (or peak plasma concentration), and here it took 79% more time to absorb the tablet.

The interesting facts are also, when fasting:

Efavirenz peak concentration: about 3-5 hours
Emtricitabine: 1-2 hours
Tenofovir disoproxil fumarate: 1 hour

Then, you have to add the interaction with other drugs you may be taking ! There is a table that shows the AUC/Cmax changes when Atripla is taken with other drugs:

http://www.atripla.com/images/7_2006_GS_21_937_001_ATRIPLA_US_PI.pdf

So basically, it seems that it is better to take Atripla when fasting, that is at least 3 hours after eating, and at least 1 hour before eating.

Bio people, correct me if I'm wrong !

Milker.

[milker]

The drug fact sheet accompanying the prescription says to take , "at least 1 hour before, or 2 hours after eating".

lol you were typing that when I was tying at least 1 hour before eating, or 3 hours after eating.

So we agree, except that I added 1 more hour after eating to ensure fasting. I guess it might depend on how fast is your metabolism.

Milker.

/* edited to fix the order of the sentence so it's less confusing.*/

[J220]

Thanks for that info Milker. I guess it all has to do with the absorption rates. Interesting about the peak concentration times. I know that it is about 2 hours after taking Atripla that I feel the effects are strongest (dizziness, etc.) Still, I thank science every time I pop down an Atripla, I am grateful to live in this time when this is available// Cheers, J.

[budndallastx]

It also seems that the Sustiva is absorbed faster with a high fat meal.   The fat content seems to magnify the absorbtion of the drug into your system.  I can eat a fairly decent salad (little fat) and pop Sustiva with now effects.  On the other hand, I can eat a slice of pizza (bad Tom) and then take Sustiva two hours later and really feel the effects of the drug an hour later. 

I think the timing is going to based upon how each person individually handles the drug.  Some people are taking it in the morning with no effect while others must take it at night.  It doesn't hurt to experiment to find the best time interval between dinner and taking the pill.  For me, it's an hour later and no effects whatsoever unless it's a high fight meal which is very very rately.

[RichieRich]

I've been taking Atripla for a year now, and right from the start my doctor put on the label to take it at bedtime.  I try to do the 3 hours of no food before bed, but there have been times that it's like 2 and no problems.
The only problem I have is the Vivid Dreams that to this day have still not gone away.  Some nights are better than others but counts are really good.

[chm02]

my pharmacist said that the reason you want to take Atripla on an empty stomache is to minimize the incidence or severity of any negative side effects you may experience- by maximizing its rate of metabolism in your body. There is no problem from an efficacy point of view. So, if you don't have any bad side effects with it, then you can take it with food or not.

[wiser]

I am a little confused about the Atripla thing. I see now you can take it one hour after food. I have been using it for a year now and kept to taking it at night before bed (3 to 4 hrs after a meal). Lately I have been having trouble sleeping. I wake up about 2 hrs after falling asleep, feel a little groggy and agitated, and can have a lot of trouble falling back to sleep. I am becoming anxious at this time also and getting feelings of depression. It may be Sustiva related (the waking up, anxiety, depression cycle). I am considering taking the Atripla when I get home from work (like 4pm) and eating 6pm or 7pm to see if that keeps side effects away from sleeping. I guess what I might expect with this is a period of grogginess for a period of time after taking the Atripla (like maybe two hours after) and it lasting maybe a couple of hours. Curious to any reactions to trying a plan like this. My goal is just to try to get a good nite's sleep.

Of course the sleep probelm and anxiety depression could all be related to life stress, relationship problems I am having now and so on.

[bradmeistr]

Wiser - I was taking the sustiva and truvada, the same two drugs in atripla and tried to take the sustiva part at 6:00pm right after work.  It almost drove me crazy that night - literally (I only did that for one night) so be careful.  That night I decided the sustiva might not be the drug for me.  I took sustiva for 15 months with the hopes that the side effects would go away, but they did not.  The dreams seemed to be less of an issue over time, but the fogginess, anxiety, forgetfulness, and inability to concentrate (I now call it the zombie feeling) never went away.  I switched to viramune and am very thankful I did.

Brad

[wiser]

Thanks Brad. I have an appointment with a psychologist on Tuesday to talk through the emotional issues that might be contributing to the sleeping problem. I am keeping a sleep log as of Friday night also to track the timing and so on.

Monday I am calling my HIV doc to set up an appointment with him to get his opinion. I am thinking now from your post that the more cautious way to go would be to see if there is some sleep aid the HIV doc can recommend that will not interact negatively with the Sustiva. The next step if that and the counseling don't work or the situation worsens would be maybe trying an anti-anxiety or anti-depressant.

I would hate to give up on the Atripla because of ease of dosing and the fact I haven't had any problems of note with it up to this point. I'll let you know how it goes.

[bradmeistr]

I hear ya on the ease of dosing, after switching the 6pm dosing on the weekends is sometimes hard to remember.   Do keep us posted on what the docs say.

Brad

[bostonguy]

Hi, Folks!
This is my first post --- it is great to see so many people with positive attitude about HIV and meds.
I was diagnosed about 2 years ago, and just started treatment 12 nites ago.  I'm not having so good a time, as I have some nasty side effects [mostly major fatigue throughout the day, nausea, headache, stomach cramps, some mild diarhea, etc].   My doc wants me to stick it out for another few weeks, which I def want to do.  But looking for some advice on:
1.  Nausea remedies?
2.  Fatigue remedies?
3.  Doc told me that the pharma recently eliminated any requirements that Atripla be taken on an empty stomach and I could try taking it immediately after eating.   He is a very  and knowledgeable HIV specialist, so I trust hit...  YET, I cannot find any info online that also states this.

Thanks much!