sustiva+kivexa: how forgiving with timings?

[lost_boy]

Hi guys,

Just a quick one! I recently moved treatment, from Atripla to a two pill combo of Sustiva+Kivexa to see if it would help get my numbers up. My question is, I know Atripla is quite forgiving with the timing window for when you take it (couple of hours either side). Does anybody know if the current combo I am on will be similarly forgiving? I am about to go abroad with work for a while and jumping a few time zones, so it is highly likely I will be "out" of the usual time I take my pills on a couple of occasions. Should I be alright, or is it a cause for concern?

Cheers!

[Ann]

LB, you should be just fine. Just make sure you're taking it every day and don't sweat the time difference. It would probably be easiest if you take it at the time you're accustomed to, even if that time (on the clock) is a couple hours ahead or behind your home time-zone.

Remember to get some R&R in while you're away.

[lost_boy]

Cheers Ann, I figure should be okay, just wanted a second opinion. Unfortunately no RnR for me, 6 weeks working on the trot! ... and then I go lie on a beach somewhere 

[Ann]

... and then I go lie on a beach somewhere 

I'm all jealous now!

[elf]

Sustiva+Kivexa is of less forgiving timing than my old regimen (Kaletra+Kivexa).
With KK, I could take pills, one day at 9 pm, the next day at 00 am...
With S+K, I try to limit myself to one hour difference.
Lately's been like this: 01 am, 02 am, 03 am, 02 am, 01 am
  at 03 am one day, and 00 am the next day is less dangerous
that at 00 am one day, and at 03 am the next day.

[eric48]

Hi,

I do not really understand where patients get a rationale for backing their opinion on whether a given drug is more forgiving than another.

I have never being able to get my doctor to spit out a time window.

the only trustable data is measured concentration (intracellular, I suppose).

In Atripla, I kind of remember that it is the EFV (aka sustiva) component that has significantly longer time span. I do not recall that there is any difference between Truvada (the other - co formulated - part of atripla) and Kivexa in that respect

In a conservative understanding, it should be the less 'forgiving' component of a tri-therapy that should retained as the deciding value.

One should not forget that the efficient time span for a drug depends not only on the drug but on the patient as well (this has been clearly identified in the case of NVP, where efficient time span depends on the patients BMI)

Same amount of active component (in mg) is given to people whose weight range from 50kg (100 lbs) to 3 times more

Personally I take my Kivexa right on the hour (with a minus 30 min. allowance, not even a plus /minus), not so much because of the Kivexa part of my combo, but because I take Viramune 2x200mg off label, once daily, and do not want to take more risk until Viramune XR is available here.

When I travel overseas, and need to adjust for time difference, I would rather take pills ahead than allowing more than a 24h time span. On a round trip this will result in taking one more dose (obviously).

On one occasion where I had to take Kivexa 6 hours ahead of schedule, it resulted in a much softer stool (you might call it a very very lite diarrhea) which was not of any inconvenience at all. other occasions did not raise any problem.

I think it has become easier (for me) to stick to a very strict schedule since I became able to take the pills in the morning vs the evening (I could not stand the morning dosing until one year or so into treatment)

hope this helps

Eric

       

[lost_boy]

Eric, I guess you are right that the less 'forgiving' component should be the guide. But as you say, I've never had an exact figure from the doctor... he's always seemed quite relaxed about the timing, in that I can get away with about an hour either side of my usual timings. I think he's just keen that a) you take it roughly the same time each day, and b) that you actually take the damn pills! Not had any problems there though, viral load supressed so that's all good. Any my numbers were up a little last test, so that's encouraging (still low 200's though  )

Seeing as I'm asking questions, I have noticed on this combo my guts are a lot more 'noisy': sounds like I have a rumbly tummy a lot of the time, mostly when I wake up and just after taking pills! No other noticeable effects, no other discomfort. But is this something I should flag up?