POZ Community Forums
Meds, Mind, Body & Benefits => Questions About Treatment & Side Effects => Topic started by: chris on December 31, 2006, 03:16:06 pm
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Hi,
I'm 53 (a gay man) and was only diagnosed this year (April/2006). After a case of bacterial pneumonia I told my doctor that I was ready to start meds. He put me on the Truvada/Kaletra regimen in June/2006. My CD4 count had been good, over 500, though my viral load had gone up to 500,000 when I had pneumonia. In June it was about 200,000. I think the Truvada/Kaletra combo worked great. After six months my viral load had gone down to 118 (and CD4 at 675), but still not undetectable. My main problem was the gastrointestinal effects from the protease inhibitor, that being just about constant diarrhea. So on 12/13/06, I asked my doctor if I could switch to Atripla and he agreed.
Substituting the Sustiva/NNRTI component for the Kaletra has definitely helped with the diarrhea. There was a very slight rash on my arms, legs and chest that went away quickly and looked no worse than an overdose of sun. Dreams have become a bit more vivid (before I couldn't even remember my dreams). There have been no other discernable side effects other than insomnia.
I started out taking the Atripla at 8:00pm. Now, of course, I had to deal with taking my HIV med on an empty stomach (and going from five pills a day to one was a shock to my routine -- had I forgotten somehting?). I usually eat dinner late in the evening so I thought great, I'll make 6pm-9pm my fasting slot. Well, right away I ran into a conflict with a group I was going to that started at 7pm and served food. So, thinking I was smart, I shifted the pill to 8:00am. I did this by taking a 2pm dose the day after my last 8pm pill and then an 8am dose the next day (which placed those three doses 18 hours apart -- pharmacist recommended). At 8am each day my alarm goes off and I take the pill and then either stay up or go back to sleep. Either way I don't eat anything until 9am at the earliest.
I can't be sure that the insomnia at night and now the morning/afternoon lethargy is due to the efavirenz, but I need to try another time slot I think. I was not able to get to sleep until maybe 3am/4am/5am. And then I would sleep for a couple of hours, wake, sleep again... something like that. So now I got my doctor to give me something to help me go to sleep at night. He gave me a script for both Trazodone and Restoril to try (not at the same time of course). I tried the Trazodone once and that was the night I was up until 5:30am. Enough of that. I knew that benzodiazepines had worked for me before so I got the Restoril/temazepam filled. For the last three nights I've taken three 15mg capsules and they worked great. I slept.
However, now I get tired, practically lethargic in the mornings and afternoons. Is it due to the after effects of the temazepam? I read that efavirenz can cause either insomnia or the opposite so I'm not sure what effects are coming from what right now. I have the feeling that if I don't feel sleepy after taking Atripla then I'm in the minority. Another concern is that I will become addicted to temazepam. I've been on Klonopin before so I know how one can easily get used to that (and I've been an addict before -- another story).
Anyway, I figure I should switch back to an evening timeslot for my Atripla dose. This time I'm thinking of aiming for midnight which would mean no food from 10pm-1am. When I say late dinner I mean late, sometimes around 10pm or later. I'm sure that's not healthy for me (though I'm 180 lbs with a body fat percentage of less than 12%). I guess some adjustments as far as my eating schedule are in order. Dinner has to be finished before 10pm and I can't have that nightime snack before going to bed.
So to get back to the subject, I was wondering what time of day other people were taking once-a-day meds such as Sustiva or Atripla or anything else that required fasting and what effect this has had on their routine.
-chris
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HEY CHRIS....
I HAVE BEEN GOING THROUGH THE SAME ISSUES. I WAS ON SUSTIVA/TRUVADA FOR 6 MONTHS WITH MINIMAL INSOMNIA ISSUES. I SWITCHED TO ATRIPLA FOR A MONTH (TAKEN AT 10PM) BUT COULD NOT DEAL WITH DRY MOUTH ISSUES AND INCREASED INSOMNIA. SO I WENT BACK TO TRUVADA IN THE AM AND SUSTIVA AT NIGHT BUT THE INSOMNIA CONTINUED. I SWITCHED THE SUSTIVA TO THE MORNING AND THAT WAS A WILD ROLLER COASTER! THE HIGH (AND ASSOCIATED PARANOIA) INTERFERED WITH MY ABILITY TO WORK....HOWEVER MY SLEEP IMPROVED! A FULL 600mg DOSE DURING THE DAY IS ALMOST IMPOSSIBLE WHEN YOU HAVE TO DEAL WITH THE FOOD ISSUES. ANY FATTY FOODS WILL ENHANCE THE "HIGH". THANKS TO THE ANGELS ON THIS SITE I HAVE LEARNED THAT THE SUSTIVA IS AVAILABLE IN 200mg CAPSULES SO I WILL EXPERIMENT WITH THOSE...2 AT NIGHT AND 1 IN THE AM? OR 1 AT NIGHT AND 2 IN THE AM? MOST LIKELY THE LATTER SINCE THE INSOMNIA IS MY MAJOR ISSUE AND I DON'T EAT A FATTY BREAKFAST (PROTEIN SHAKE) SO HOPEFULLY THAT WILL WORK. THE ONCE-DAILY REGIMEN OF ATRIPLA SOUNDS GREAT....AND WORKS FOR MANY....BUT IT MAY NOT BE THE ANSWER FOR ALL OF US. THANK GOD FOR OPTIONS! I HAVE LEARNED THAT THE SUSTIVA IS FAT-SOLUABLE SO IT TAKES LONGER TO LEAVE YOUR BODY THAN A WATER-SOLUABLE MED. THIS IS GOOD NEWS SINCE IT GIVES US A LITTLE MORE FLEXIBILITY IN TERMS OF DOSAGE TIMING AND AMOUNTS, ETC.
TWO GOOD SITES TO CHECK OUT:
HTTP://WWW.THEBODY.COM
http://qa.hopkins-aids.org/forum/categories.html?section_id=61
GOOD LUCK IN 2007...
BE WELL...
CRAIG
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Chris I took Atripla before going to bed. You will get over the insomnia in a few weeks.
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It sounds like your taking alot of different meds, my feeling is that you should take it before you go to bed, make it a nightstand drug, if you eat anything, try and wait at least 1 to 3 hours before you go to bed.
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Hey Chris - I have been on Atripla for about six weeks and take it before bed. Started by making sure I had waited at least two hours, then as I found I was lucky enough not to have any side effects so far, I started reducing the time after having a snack or something to as little as half an hour and still no side effects.
So for me it's around bedtime with is usually around 11 or so but can vary by a couple hours either way.
Hope you're able to find the right timing that works best for you.
Kevin
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Like the others have said, I take my meds just before hitting the sack. I got sick of walking around like a drunk, so have found it best to take them just before my head hits the pillow.
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Chris, I'm 16 days into taking Atripla (the only thing i'm taking) and I know what you're talking about. It takes about 1.5 hours before the dizziness hits me and i make sure that I don't eat anything 2 hours prior to taking it. The first week was really tough, but the past couple of nights, i've been ok. Have been sleeping well with the exception of going though sweating (that has been constant for atripla and me...i sleep on a towel). All other side effects have diminished.
Hope your experience gets better...
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I take it before bed with an ativan and sleep through the side effects. Even getting up to go to the bathroom is not a problem.
Rob