change of intake time

[rolf1]

i am a little bit confused since my last doctor visit. i am since one month on tablets, 1x Lamivir (Lamivudine) 150mg and 1x Viread (300 mg) in the morning (9 am), 1x Lamivir (150 mg) at 6pm and 1x Stocrin (600 mg) at 9 pm before bedtime.
Now after my latest visit my doc says i should take now 2x Lamivir (each 150 mg) and 1x Viread (300 mg) at 9 am and only at 9pm the Stocrin (600 mg).
what is the reason to change the intake time? i am still on the old intake time as i wanted to consult you guys first. as i know the adherent to the normal intake time is very important for the success of the regimen.
my doc states that it is good...yeah i know, it seems i have to change the doc - but that was his explanation.
thankful for any ideas or suggestions regarding this issue.

[newt]

The daily dose of Lamvir is 300mg a day.

Usually to start with this is prescribed as 1 150mg tab twice a day, but you can take both of them in one go if you like,.Many docs recommend this after people gets settled on treatment.

Indeed, you could take all your meds in one go if that is more convenient.

- matt

[rolf1]

thanks for the quick reply. so there is no difference between taking 2x 150mg over the day yhan 1x 300mg?? it seems too simple?? isn't it true that, if i take 1x 300mg in the morning, the level of the meds isn't so high 20-23 hours later than when i take 1x 150mg in the morning and another 150mg one in the evening?? isn't it better 'dispensed' like this?

[vokz]

isn't it true that, if i take 1x 300mg in the morning, the level of the meds isn't so high 20-23 hours later than when i take 1x 150mg in the morning and another 150mg one in the evening?? isn't it better 'dispensed' like this?

Not quite, Rolf.

For between 14 and 16 hours of the day, the one 300mg dose will give you higher levels of the Lamvir in your blood than the two 150mg doses will.

For the remaining 8 to 10 hours, one 300mg dose will give you much the same levels of Lamvir as the two 150mg doses do.

You get the same amount of Lamvir over 24 hours; but the 300mg once a day dosing schedule will give you:

• a much higher peak level of Lamvir
• a higher average level of Lamvir over 24 hours
• roughly the same minimum levels of Lamvir

The 2 X 150mg option minimises the chances / severity of side effects whilst you accustom yourself to the Lamvir; but the 300mg option is more potent overall (and - provided your adherence is good - allows fewer opportunities to develop resistance).   

[rolf1]

thanks for the info. ok, i understand so far. what about, if i show 'severe' side effects due higher potency with the 300 mg in the morning, could i swich back to the 2x 150 mg or is it than too late, as the virus is used to the higher level of lamivir?? are the 2x 150mg only the slower way for the same goal, only with less side effects??
still considering...

[vokz]

Lamvir / 3TC / Epivir side effects are most likely to occur during the early weeks of treatment. If you are tollerating it well after a month, you are unlikely to experience anything bothersome from increasing your dose to 300mg .. but if you do, switching back to the 2 x 150 regimen shouldn’t be a problem.

Personally, if I was you, I would be looking very seriously at Matt’s suggestion about taking all your drugs together in the evening.

[rolf1]

ok, i understand the thing with taking the 300mg Lamivir once per day, but you stated, i should think about to take all tablets at once?? even the stocrin?? all together in the morning? what is the advantage about it as they are different (stocrin / viread) and there can't be a higher level of them in the blood. please advice. thanks.

[rolf1]

sorry, but just one more thing. i just read the post "Changing Atripla to AM....Question" and there came a good question up. how to change intake time of the meds? do i skip the evening lamivir (150mg) and take two lamivir (300mg) in the morning or take the one in the evening and take the next morning 2 tabs. seems the less riskier sollution as i asume higher med levels are better than too less. even i read that loshan did it successfully, it would be nice to hear some comments of resistence chance during some hours of the low med levels. any more advice outthere?

[vokz]

Taking all your meds at once doesn't directly affect the potency of your treatment; but most people seem to think that organising your day around one single set of meds will tend to make adherence easier.

Given that you have only been taking your meds for a month - and assuming that you are still getting accustomed to Stocrin - I would personally make that once a day in the evening for now. If, in a few months time, you still find that Stocrin is causing sleep disturbances, then perhaps you can look to switching to taking all your drugs in the morning.

When I made the switch from evenings to mornings, I took an extra dose of all my meds (i.e. a full dose before going to bed and then another full dose on an empty stomach the next morning) .. but that was after allowing myself many months to get used to Sustiva (Stocrin).

Whether Sustiva (Stocrin) will work best for you in the morning is a 50/50 thing. Half the people who try it seem to think that taking it in the morning makes them feel too dizzy, 'drunk' or unable to concentrate properly during the day. The other half cope well with morning dosing and say it makes them sleep better, have fewer strange dreams and find it much easier to remember to take the pills in the morning. Personally, I found that taking it in the morning eliminated all my obvious medication side effects in an instant.

[rolf1]

ok, another one,
is it a difference, beside experiencing side effects, if you take meds in the morning or evening. as far as i know, sleep for itsself and using sleeping tablets in the night slows down the metabolism. doesn't that mean it would be better to take them in the morning, even if one experience stronger side effects, as the meds are better distributed during the day (not sleep) than during the night (sleep)??

[vokz]

I am sorry Rolf, but you are way overcomplicating this with incomplete science.

Think that one through for a bit longer. If the drugs are metabolized more slowly, then they are also active for longer.

Anyway, this is getting into territory that I am just not going to get into - so I will leave it someone else, or your Doctor, to explain.

[rolf1]

sorry for overcomplicating. just new - just asking.

[vokz]

I understand that Rolf. I am not criticising you and I am certainly not expecting you to apologise

Any of the options that have been discussed will provide you with potent therapy.

From there on, forget about the science for a while and worry about taking the drugs exactly as prescribed and finding the best way to work your life around the drugs .. with as few side effects as possible.

Personally, I think it is good to understand the science; but try not to let that desire for understanding complicate your decisions.