More issues about Atripla and adherance

[pozoz]

Hi everyone, I'm hoping someone can help.
Starting Atripla June 10th, about a year after testing positive. CD4 514, no OI's or any issues yet, but have decided to start for a few reasons.

I'm still fairly new to all this and still learning and researching as much information as I can.

The issue I'm having is that I work 1 week of day shift, 1 week of night shift, then have a week off. The shifts are 12.5 hrs, 6 to 630.

After reading about the need to take Atripla on an empty stomach and also at the same time each day, I can't find a easy solution due to my work schedule.

If on my last day shift I take it at bedtime, I'd like to know if Atripla is forgiving enough to allow me to delay the next nights dose untill the following morning when I'll be going to bed in the morning.

So basically a delay of 12 hours from the normal time.

Then when coming off nights and back to "normal" hours I'd have to do the same thing. This would mean a delay of 12 hours on the shift change days, about 2 to 3 times a month.

After reading some of the posts on here I'm even wondering if Atripla is the best option for a first time treatment. Maybe that can be another post lol

Any input would be greatly appreciated!! Thanks everyone, all the best 

pozoz

[mecch]

Did you put your schedule on paper and show it to a doctor who prescribed it?  I'm betting there is a comfort zone a doctor would give his OK to.

For what its worth, when I was on sustiva-truvada (sames drugs as ATripla) after just two months my doctor said timing wasnt really important - just to get it into me every day.  These drugs have a long presence in the body.  

I can't tell you the solution but I bet a doctor could. Its seems in fact that a doctor MUST find a solution for you.

As you seem to know, it is very important to feel comfortable that you can be adherent so please do get a professionals advice to put your mind at ease about those 12 hours timing shifts.

[averagejoe1977]

I think you should speak with your doctor about this. For what it is worth, when I was on Atripla my consultant told me that it has a long half-life when compared to some of the other anti-retrovirals. Unfortunately, I had to stop taking it due to side-effects though. I'm currently taking Truvada, Norvir, and Darunavir. No major side-effects and no empty stomach requirements!

[metekrop]

.. my consultant told me that it has a long half-life when compared to some of the other anti-retrovirals. Unfortunately, 

What does it mean?  Don't understand.

[kevykev110]

My doctor told me if i want a night life atripla is not the best drug for that. What if u get a doctor's note? would they change ur shift? Thats a tight spot ure in. I think a 12 hr difference may be a lil 2much. I party alot and my doctor told me try not to take it more than 4hrs late-- 12hrs is 3x more than he recommends. If im in your position i would try to consult with 2 doctors to ensure im on the safe side.
Well, i am yet to see how it will for for me since i will start 2nite

Kevykev

[averagejoe1977]

Sorry, I should have clarified!

Re. half life. In short, Atripla stays at high levels in the body for a long time after taking one pill. But like I said, check with your doctor first.

I agree with Kevykev's point that 12 hour difference may be too much.

[pozoz]

Thanks for the replies everyone

I will follow this up with my Dr on "Day 4" and see what he thinks.
I'm thinking if I can get away with it, I'll stay on Atripla.
Otherwise another drug option may have to be explored.

kevykev, unfortunetely I can't change my shift (I wish!) It's part of the deal. lol Look forward to hearing how you're travellin after you start--- good luck..

 averagejoe1977, Thanks, I heard it has a long half life also, but will definetely double check when I see my Doc on June 14th . I'm hoping he'll say the delay is fine as it will make my life alot easier.

mecch, thanks I'll get more info and definetely post how it all turns out, I'd have to say having this forum is awesome and seeing others going through some challenges definetely helps, hopefully I'll be able to help someone else in the future, to me that's important.

Thanks again for the input and advice,

 

[mecch]

Oh and PS - my ID said "atripla" was a good match for unpredictable times going to bed, and thus my nightlife, the contrary advice of kevykev's doc.  Just goes to show you - there is wiggle room it depends on your doctor's way of practicing.

[keegancassidy83]

im confused, r u saying i dont have to take atripla EXACTLY the same time every nightand if i hapened to be out i dont have to rush home??

[Matty the Damned]

im confused, r u saying i dont have to take atripla EXACTLY the same time every nightand if i hapened to be out i dont have to rush home??

I'm pretty sure there's a 6 hour window of grace or thereabouts.

MtD

[mecch]

im confused, r u saying i dont have to take atripla EXACTLY the same time every nightand if i hapened to be out i dont have to rush home??

Who told you it had to be so exact? Your doctor? What country, please.

[keegancassidy83]

actually my pharmacist, and USA....but i guess not

[Hellraiser]

actually my pharmacist, and USA....but i guess not

Atripla is a very strong drug and it takes a while to build in your system.  The same happens when you stop taking it, it takes a while to completely come out of your system.  For the first couple of months I would try to be very exact with the dosing (at least until you become undetectable), but I'm to the point now where I just take it before I go to bed which is generally within a 6 hour window.


Once you have reached undetectable there has been a study where some people do 5 days on, and 2 days off the drug and after 48 weeks they had neither developed resistance to it, nor permanently regained a measurable viral load.   This study is still controversial to some degree however and not recommended for anyone who is not undetectable for a while beforehand.

[kevykev110]

Oh and PS - my ID said "atripla" was a good match for unpredictable times going to bed, and thus my nightlife, the contrary advice of kevykev's doc.  Just goes to show you - there is wiggle room it depends on your doctor's way of practicing.


I guess different experts think differently. So do u think its okay not to take it for 12hrs?. If it reaches 12hrs it would be considered missing a dose. Example, if you normally take the pill  at 10pm on a nitely basis  and u go 12 hrs without it that runs u into 10am the following day. So basically that's a missed dose. Eventually, it will ketchup with you. Maximum i would say is 4hrs worse case scenario 6hrs. Anything after 6hrs i would consider a missed dose.

[ElZorro]

This study is still controversial to some degree however and not recommended for anyone who is not undetectable for a while beforehand.

I mentioned that FOTO study to my ID and she more or less freaked and told me not to even think about it. She also indicated that she was surprised that "they" were running those types of trials again    Would be nice if "they" could come to an understanding at some point though. I'd love to have a couple of "normal" days every week.

On an aside, I spent a week in New Orleans and was taking my Atripla every night on time but then continued to stay up and explore the city for a couple hours after (instead of just heading to bed). I got some of the best sleep I've had in a looooong time. I actually woke up refreshed and ready to go with less than 8 hours of sleep. I'm not sure if it's because I had a couple of beers in me afterwards or just because I was up and active/walking around while I digested it. Either way, I'd be interested if anyone else has found that taking it earlier in the day helps them get better sleep.

[justus35]

my id doctor said not only NO but HELL NO  and for me not to even think about it ...EVER as long as he  is practicing NO patient of his will be takining Atripla in that matter ...I said OK!

[YaKaMein]

Pozoz,
Considering that HAART is anti-viral .... I missed reading whether you had a detectable VL ... this is relevant since the purpose of the treatment is to reduce viral load and should be central in your decision to begin hard.

Secondly, if your commitment to HAART might be compromised by your current work schedule, then serious consideration is in order.

If this is your choice, then consider beginning treatment on your week off to allow for adjustments to any adverse effects.

IMHO, For others, any physician who does not engage in decision making with patients but uses coercive rhetoric does a patient a disservice in his/her care.