Kivexa swap from Truvada

[palerider]

Hi, I recently had to swap to Kivexa from Truvada, because of bad renal levels, I'm one of the people who had a bad reaction to truvada building up in my kidneys.
The side effects of Kivexa are really horrible, compared with Truvada.
I don't have the Hypersensitivity gene, so it's not a severe reaction, but pretty grim nontheless.
The question is..does this pass, do the side effects get easier to cope with over time,?
I have sweating, cramps, nausea, joint pain, headaches, sore eyes, fatigue.
I really don't want to have this for ever.
I'm really not prepared to put up with this stuff all my life.
Does anyone have experience with this, and can give some accounts of it.?
I take reyataz and Norvir as well.

[Miss Philicia]

I've found that I get headaches easily the first few weeks that I switch around meds, almost from any class but especially NRTI ones. Also some nausea and fatigue too, but less so -- but everyone is different.  Aspirin always tamed the headaches (somewhat) and my nausea always passes quickly, but I've heard people on this board swearing by getting lemons, cutting them and sniffing them to lessen nausea so try that.

[palerider]

Wow, lemons, really.?
Okay, I'll try it. I also heard that peanut butter, the healthy kind, not the oily stuff, on white bread can settle the tummy and not make me get the motion sickness.
I seriously considering having a drug holiday, it's really annoying me.

[Inchlingblue]

I seriously considering having a drug holiday, it's really annoying me.

I have a good friend who is on the same combo (Reyataz/Norvir/Kivexa (Epzicom) and he is not feeling any side effects at all. He's doing very well with very good numbers.  

There have been several studies showing that drug holidays are damaging, they do more harm than good.

[Assurbanipal]

Hi

I'm on Kivexa too (well, the US version -- Epzicom) and it doesn't give me problems so far.  I'm more concerned about the other drugs.

But, I think you are assuming that you can't have a problem with the drug just because you passed the genetic test.  That is not true.  Passing the genetic test doesn't mean you are immune from a hypersensitivity reaction -- just that it is less likely.  Here's what the prescribing info says:

HLA-B*5701-negative patients may develop a hypersensitivity reaction to abacavir; however, this occurs significantly less frequently than in HLA-B*5701-positive patients. Regardless of HLA-B*5701 status, permanently discontinue ZIAGEN if hypersensitivity cannot be ruled out, even when other diagnoses are possible.
Important information on signs and symptoms of hypersensitivity, as well as clinical management, is presented below.
Signs and Symptoms of Hypersensitivity: Hypersensitivity to abacavir is a multi-organ clinical syndrome usually characterized by a sign or symptom in 2 or more of the following groups.
Group 1: Fever
Group 2: Rash
Group 3: Gastrointestinal (including nausea, vomiting, diarrhea, or abdominal pain)
Group 4: Constitutional (including generalized malaise, fatigue, or achiness)
Group 5: Respiratory (including dyspnea, cough, or pharyngitis).
Hypersensitivity to abacavir following the presentation of a single sign or symptom has been reported infrequently.

http://us.gsk.com/products/assets/us_ziagen.pdf

Even though I passed the genetic test they still send me a wallet card to carry that lists the above 5 classes of symptoms. 

In your shoes, I would call the doctor and describe your symptoms.  You may need a different set of drugs.

Best wishes (oh, and welcome to the forums)
Assurbanipal

[palerider]

yeah, thanks guys for the replies, and the welcome
I tried to call my doc on the weekend, but he didn't ring back. I'm living in  a small town and he's about 580km away. I've decided to stop the Kivexa , until I see him on Wednesday.
The side effects are just appalling, and, as much as I hate to stop taking the bloody things, I just can't stand the sides at the moment, and it's only 1 week.!!
I don't even have a doctor in my town who can write scripts for my drugs, let alone anyone with any knowledge.
I figure three days won't kill me, and we can work something out.

[Inchlingblue]

If you still have Truvada left it would make more sense to go back on it for a few days, I doubt that in a few days it would severely damage your kidneys.

Stopping Kivexa could lead to resistance to some meds, which could limit your future treatment options. It can be a slippery slope to salvage therapy if you're not careful.

[palerider]

Yeah I know. It wasn't an easy decision, but there's no more truvada left, so I'll just have to wait.
I rang Glaxo/Smith/Kline, and they said they will look into the meds as a combo, and tell my doctor if they find any info on the effects of using them altogether.
Hmmm, not a lot of help.
Everyone trying to cover their AS*, so as not to get into trouble.
Meanwhile, we can't get any info.
Grrr.

[newt]

You may be able to take less Truvada (well, less tenofovir) if your kidneys are affected by it. The dose adjustment is in the package insert.

http://www.gilead.com/pdf/viread_pi.pdf (PDF - look under DOSAGE AND ADMINISTRATION

- matt

[Inchlingblue]

You may be able to take less Truvada (well, less tenofovir) if your kidneys are affected by it. The dose adjustment is in the package insert.

http://www.gilead.com/pdf/viread_pi.pdf (PDF - look under DOSAGE AND ADMINISTRATION

- matt

This is interesting.

Do you think that even without renal impairment it could work to take less Truvada, say every other day?

[newt]

1. If anything, it's less tenofovir, which is half of Truvada only.

2. Tenofovir is primarily excreted by the kidneys, hence less kidney function = lower rate of excretion = safe drug levels with less frequent dosing.

Without renal impairment, the pharmokinetics do not seem quite favourable enough for, say, every other day dosing...plus it's difficult to remember. "Less is enough" is a nice idea tho.

- matt.