Raltegravir 200 mg bid ,or,400mg Q.D ? A pharmacokinetics expert MD reply.

[avi]

hello

This question is directed to a specialist in pharmacokinetics,
specifically in MK-0518.

I would very much like to shift from Truvada +Raltegravir 400mg bid ,
to, Truvada +Raltegravir 200 mg bid ,or,400mg Q.D.

I am a 50 y.O Israeli male.
diagnosed 5-07.on a.r.v.`s  since 6-07.
No drug resistance!

starting with Efavirenz+Truvada for 1\2  a year,changed to ,
SAQ500mg[HALF THE DOSE*], plus one 100mg Norvir+ Truvada,
Q.D [my decision backed by my physician] *Q.D!*for another 1\2 a year,and for the last year on trail with 400mg mk-0518 bis +Truvada.

ALL Drug shifting above due  to Adverse  affects :
stocrin causing narcolepsy and spatial disorintaion-
SAQ elevating triglycerides above 350 .
mk 0518 significantly improved every day to day  living but lately I am  feeling exhaustion and having myalgia [n.p.f] bursts occasionally.[recently discovered amp medical findings binding mk-0518 to myalgia from many patients].

Cd4 > 600-620
Viral load-undetected from second month on ARV`S up to now.
All Blood and Chem results are in norm ,hdl=40-43~ and TRIG significantly drooped  to bellow 200.
Healthy,engaged in sports: WO.gym,close combat ,Yoga,Thai- chi,swimming.
self employed.

I read some of the clinical data related to the furst 48 weeks trail with mk-o518 and how well even same results for 200mg b.i.s in terms of Viral load  and cd4.
I also read Dr. Markowitz :Markowitz M et al. Sustained antiretroviral efficacy of raltegravir as part of combination ART ...Seventeenth International AIDS Conference, Mexico City, abstract TUAB0102, 2008.quoting:
"  The 200 mg bid exposure is probably similar to that of a q.d (once-daily) 800 mg, so that is a possibility on the menu for further development."
since i respond very well to Arv`s ,non resistant to any strain,GENERALY in good health,adherent with treatment,i would appreciate your scholastic  mad opinion of chopping mk-0518 to the dose mentioned above.

I used to consult D"r Hirsch, the deceased chairman of The Israeli committee
for pwHIV\AIDS   who was outstandingly  innovative & non conformist about drug administering yet in the same time ,equivalently and strong-minded,who ,always gave a wonderful therapeutic relevant reply.
since he sadly perished away  there  is no one else  I can ask for a second
 unbiased wise opinion of on of us.
I hope you can assist me  upon that.
thank you
OSHA

[newt]

The table (first link) and report (2nd) summarise the virological efficacy but the question of once-daily versus twice-daily dosing has yet to be settled. It is the subject of a study which will report soon (3rd link).

http://www.i-base.info/htb/v8/htb8-8-9/images/Raltegravirlg.gif

http://www.i-base.info/htb/v8/htb8-8-9/Week.html

http://clinicaltrials.gov/ct2/show/NCT00745823

- matt

[Inchlingblue]

 It is the subject of a study which will report soon (3rd link).

 

Newt: Any way to find out when or approximately when they will report this? Thanks

[newt]

i expect preliminary 48 week results to be trailed towards the end of the year, and reported fully at Retrovirus next February. Clearly, if the results seem poor at this point the study may be stopped and the question considered settled. Otherwise full results will appear a year later. It's a 96 week study.

- matt