Atripla Newbie/Effexor veteran

[Broch]

New here!

Wondered if anyone has had experience with Atripla and Effexor. I have been on Effexor for depression and anxiety for a REALLY long time... about 14 years now. Though I have not had any struggles with depression/anxiety in many years, the withdrawal from Effexor always seemed too daunting to mess with, so I continued to take it @ 75mg per day.

I was diagnosed positive in September 08. Soon after my doc increased my Effexor to 150 and I switched to XR.

My numbers are "okay" -- high three hundreds /98k VL.

I am on day 13 of Atripla and it is quite a ride. I take it at bed time on an empty stomach, it puts me down for the count, usually about 10-12 hours, and I am groggy all day. I have not yet returned to work (luckily I have the time off) and it's fairly difficult to concentrate when I am awake. The best way to describe it I guess is.... it's like having a sleeping pill hangover... only more intense, and all the time.
Worst of all is a general feeling of malaise and disconnection which is a lot like depression to me.

I am a person who prides himself on having my wits about me, and I use those wits in my profession. In fact, they are pretty essential to my job. Friends say they think I am like myself, but slower.
I am wondering if I ought to be thinking about switching... or if I should wait it out? I am seeing the doc tomorrow but I wanted to get some feedback here first...
Thanks!

[Peter Staley]

You might want to wait another week or two, then decide.  You could still be in the Atripla adjustment period window.

Did all the symptoms you describe happen after starting Atripla, or were some associated with the Effexor dose increase?

[richva]

Definitely share your concerns with your doctor.  In your case, there's an argument for sticking with Atripla (i.e., for many "newbies," side effects lessen and/or resolve within 4-6 weeks; you're now 2 weeks into treatment) and for switching (i.e., your history of depression and anxiety, which can be exacerbated by the efavirenz.)  Not a very helpful answer, I know, so let me add this: I waited about 8 months before switching my meds, trying to deal with a host of unpleasant side effects (insomnia and depression, primarily, with a variety of sleeping aids and a short stint with Celexa).  I told myself that Atripla was "working" against the virus, so suck it up.  What I was slow to realize is that it was also working against me.  Talk with your doc.  It may be worth waiting to see what happens... but don't wait too long.  It's just not necessary given the number of available alternatives.

Just my two cents.

Good luck!

[Broch]

Hey thanks for the responses... saw the doc on Friday.

Plan is to take it week-by-week, since i have the time off of work, at least for the time being. If there is gradual improvement, stick with it; if there are two weeks that are pretty much the same, I can define that as "new norm" and then evaluate then.
Commence week three.
Still feeling loopy/fatigued/ have difficulty concentrating, and pretty much nothing I do changes that.When I try to wake up artificially with coffee I get really shaky and anxious.

Doc gave me the names of my other options and I am looking them up now. One was the one you are on now Rich. Any SE's I should know about there? Since it seems the Atripla affected u in much the same way it does me.

I am a little disappointed that Atripla may not work for me... I feel like a failure as stupid as that sounds. But it seems like everything brings me down lately. And that's the point I guess. Even if this "passes" if there is a long term risk of depression and anxiety, no thanks!

[leatherman]

I am a little disappointed that Atripla may not work for me... I feel like a failure as stupid as that sounds.

first off, without any new tests, you don't know if Atripla is "working" or not.  (if it gets your VL heading towards undetectable it's probably working ) I took Sustiva (a component of Atripla) for nearly 9 months and had good numbers, so it was working. Only problem was that for those 9 months, I was whacked out (side effect of loopy, doopey, drunk feeling) most of the time. That was back a decade ago when Sustiva was brand new, and there was no other med for me to switch to - that's why I stayed on it so long with those effects. As Rich mentioned, you may have to "endure" these issues for 4-6 to know if they'll resolve or not.

But if these issues don't change (even if it turns out Atripla IS working and your counts are better but you still have this strong of an effect), there are other meds out there to use. You should never feel like a failure when one med doesn't work. Aspirin doesn't work for everyone either. The only way for YOU to be a failure is to fail to take your meds

[Broch]

You're right, Atripla's "effectiveness" is still unknown in my case. Seems in conversations with doc and others, it's almost a forgone conclusion that it will do what I'm taking it for 

[richva]

Hey -

A week-by-week approach sounds smart for now.  Really, you may in another week or two be feeling completely different (i.e., better) than you are right now.  It's worth hanging in for a bit if you can.  But, if you decide to switch things up...

... a treatment may "fail" for us, but (as Leatherman points out) if we take as directed (i.e., adhere to treatment and play by the rules), WE don't fail.  The drug fails.  Efavirenz failed me - and may do so for roughly 5% of those who try it.  Sucks, but beyond our control. Sure, it's okay to be disappointed.  I certainly was.  I mean, one pill, once a day, one co-payment....  Pretty tight selling points.  Oh, well.

CONVERSELY, there're 3 drugs in Atripla - and 2 of 'em play nicely with me (and rough with my virus.)  So, really, switching to another combo only meant telling efavirenz to beat it and rolling out a welcome mat for Reyataz (boosted with a bit of Norvir.)  When you look at it that way, it just isn't that bad a deal, eh?  3 co-payments, true... but still once a day - and really, really easy to take.  (For example, I take mine with breakfast everyday and don't have to worry about it being too fatty or too this or too that.  I actually consider that a BIG advantage over my old one-pill-a-day combo.)

Lastly, you can read up on the (possible!) SEs in the lessons - but don't stress over any of 'em.  From my standpoint, this combo has been a piece of cake.

Keep us posted!

Rich

[BriGuy]

Hi! I am also an Effexor XR veteran. I take 225mg/day and have been on it for about 12-13 yrs. It works great for me and I am in no hurry to change meds due to the side affects. I tried once (not my idea, a crazy ARNP ,lol) and went back to my Dr. and he  put me back on Effexor. I started Atripla last night. It's my first med ever. I was just wondering how you are doing now that it has been several weeks? Are you getting 'over' the side affects? Also, what did you feel your first week or so? I appreciate the info, and good luck!

[maddalfred]

Definitely share your concerns with your doctor.  In your case, there's an argument for sticking with Atripla (i.e., for many "newbies," side effects lessen and/or resolve within 4-6 weeks; you're now 2 weeks into treatment) and for switching (i.e., your history of depression and anxiety, which can be exacerbated by the efavirenz.)  Not a very helpful answer, I know, so let me add this: I waited about 8 months before switching my meds, trying to deal with a host of unpleasant side effects (insomnia and depression, primarily, with a variety of sleeping aids and a short stint with Celexa).  I told myself that Atripla was "working" against the virus, so suck it up.  What I was slow to realize is that it was also working against me.  Talk with your doc.  It may be worth waiting to see what happens... but don't wait too long.  It's just not necessary given the number of available alternatives.

Just MY observations and opinions please take with a grain of salt:

I have been taking Atripla from the start, back in June of last year. I feel foolish having stuck it out this long without insisting on switching to ANYTHING that might also be good for my numbers but without the side effects that have NOT ceased. I see my ID doc today for my 3 month checkup and results of most recent bloodwork and I definitly plan to give her an ear full.

I completely stopped taking the Citilopram (anti-depressant) on my own 18 days ago, shortly after my last GP visit. Instead of helping with the depression, I had gotten to a state of crying every day after having increased the dosage twice over a period of time. She refused to increase the dosage citing concerns about the effects on my liver (Hep C) offered no alternatives and lectured me like a child about how she had no plans on prescribing any additional pain meds or a different pain meds to help me deal with that issue. I left her office that day and decided to never go back. I have had ONE crying spell since I quite the anti depressant. I still have no energy and the muscle/joint pain are just as bad. Neuropathy like symptoms persist as well as assorted skin issues.

It is my belief that anyone's ID doc should set some kind of time line for their patients taking Atripla regardless of its effectiveness on "the numbers" and weight the downside against the good with their patients at more regular intervals. Mine has not and I am up to here with it. She will know all about my feelings later this a.m.

To the OP, if your side effects remain troublesome as have mine for more than four to six weeks, I believe you SHOULD bring it up with your ID doc as a serious consideration. Do not be put off or poo-pooed or made to feel like you should just "suck it up". Stand your ground, they don't live your life and have no idea of the struggle some of us experience.

Rex