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Author Topic: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune  (Read 4818 times)

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Offline Robert

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I've had great results with the Reyataz/Norvir/Truvada combo but I need to switch (it's a long story but I'm tired of driving 136 miles one way to pick up my Norvir....pharmacy refuses to mail it because it ' must be refrigerated.')

My Dr has sugested either Lexiva/Truvada or Viramune. 

Any thoughts or suggestions?

thanks....

robt
..........

Offline newt

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #1 on: May 16, 2009, 05:09:25 AM »
Hmm

That is a switch to a twice daily combo, certainly for the Lexiva if you use it without Norvir.

The Norvir Summary of Product Characteristics says;

"Store [NORVIR] soft gelatin capsules in the refrigerator between 36-46°F (2-8°C) until dispensed. Refrigeration of NORVIR soft gelatin capsules by the patient is recommended, but not required if used within 30 days and stored below 77°F (25°C)."

So I recokon maybe your pharmacist should read the leaflet in the box, stick the bottle in a cold bag and post it to you. My clinic posts my Norvir to me no probs.

- matt
"The object is to be a well patient, not a good patient"

Offline aztecan

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #2 on: May 16, 2009, 09:00:19 AM »
Hey Robert, 

I take Lexiva and have had no problems with it. My numbers are good, etc.

I take mine with Norvir, though. The only problem I have had with Norvir, aside from elevated lipids, was that I have to be careful when I travel.

As Matt said, the packet says it can be left unrefrigerated for a month if it is kept at less than 77 degrees F. Unfortunately, I live in New Mexico, where the summer temps can range to the mid 90s most days.

I made the mistake of putting my suitcase containing my Norvir in the trunk of my car. The capsules melted.

But, as far as Lexiva goes, you shouldn't have a problem.

Here is what the lessons here said.

Quote
The FDA has approved three different dosages for Lexiva, which can be taken with or without food:
 
two 700mg tablets twice daily,
two 700mg tablets in combination with one or two100mg capsules of Norvir once daily, or
one 700mg tablet in combination with one 100mg capsule of Norvir twice daily.

I am on the last combo, one Lexiva plus one Norvir twice a day.

It works for me.

HUGS,

Mark

« Last Edit: May 16, 2009, 09:06:01 AM by aztecan »
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline Robert

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #3 on: May 16, 2009, 11:31:47 AM »
matt and mark.

thanks for the responses.  i'm talking to my Dr about this on Monday and want to feel informed.  She mentioned Lexiva 2 tablets twice a day with TRUVADA.  Does that sound right?

Also, Tim Horn wrote an article dated Feb. 7, 2008 that says "...Once-daily viramune is at least as effective as twice-daily dosing...."  Wouldn't that take care of the frequency problem?

Matt..I'm with an HUGE HBO called Kaiser.  Very bureaucratic.  I get headaches just trying to change the small stuff.  I've mentioned the labeling to them before but they just shrugged their shoulders.  According to their computers, the Norvir can't be mailed and there is nothing they can do about it.  (lazy, good-for-nothin' no counts)

thanks,
robt

by the way, Norvir supplements the Reyataz.  What's wrong with just taking 2 Reyataz with my Truvada?  Wouldn't that work?
..........

Offline Inchlingblue

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #4 on: May 16, 2009, 01:35:13 PM »
Have you considered Isentress/Truvada? Isentress is 2x a day for now, may be once a day at some point, it's being studied. Appears to be very tolerable and effective.

Offline Inchlingblue

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #5 on: May 16, 2009, 01:37:36 PM »
by the way, Norvir supplements the Reyataz.  What's wrong with just taking 2 Reyataz with my Truvada?  Wouldn't that work?

I think the reason this isn't done is there are more chances for bad side effects from higher Reyataz doses, as opposed to when it's Norvir-boosted.
« Last Edit: May 16, 2009, 04:36:24 PM by Inchlingblue »

Offline mecch

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #6 on: May 16, 2009, 02:31:00 PM »
If you are successfully on Reyataz Norvir, I can't see why risk the change. Isnt there some way that you can get this norvir sent to you, or collect it from somewhere locally? 
I'd put some pressure on someone to help find a solution for that. Doctor, talking to pharmacy, talking to post office etc.  Get people communicating and ask them to HELP you find a solution.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline aztecan

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  • 29 years positive, 57 years a pain in the butt
Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #7 on: May 17, 2009, 12:13:20 AM »
Hey Robert,

When the state pharmacy mails Norvir to someone here, they send it in a styrofoam container with those blue frozen cold packs.

They also include labels so the person can send the empty styrofoam contaner and cold packs back, via UPS.

My pharmacist was keeping my Norvir in the fridge when he received it, but he doesn't any more as long as its not too hot in the pharmacy.

Regarding taking two Reyataz rather than boosting it, here is what the lessons say:
Quote
What is already known about Reyataz?
For HIV-positive people who have not taken HIV drugs in the past—that is, people starting HIV drug treatment for the first time—the FDA-approved and recommended dose of Reyataz is one 300 mg capsule plus a single 100 mg Norvir (ritonavir) capsule, both taken once a day. For those starting HIV treatment for the first time and unable to tolerate Norvir, Reyataz 400 mg (two 200mg capsules) without Norvir is recommended.
 
For HIV-positive people who have taken HIV drugs in the past—for example, people who have experienced a rebound in viral load while taking other HIV medications (especially protease inhibitors)—the FDA-approved dose of Reyataz is one 300mg capsule plus a single 100mg Norvir capsule, both taken once a day.

I used to like Reyataz, but my stomach needed a PPI and I couldn't take it while taking Reyataz.

I hope you can get this worked out.

HUGS,

Mark


"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline BM

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #8 on: May 18, 2009, 07:07:47 AM »
Quick question about Norvir refrigeration: I like my milk VERY cold, what if Norvir is stored below 2°C?

To OP: isn't there an alternative formulation of Norvir in the pipeline that doesn't require refrigeration? If it's due to be released soon, it might be worth hanging on.
« Last Edit: May 18, 2009, 07:09:29 AM by BM »

Offline Miss Philicia

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #9 on: May 18, 2009, 10:39:35 AM »
Quick question about Norvir refrigeration: I like my milk VERY cold, what if Norvir is stored below 2°C?

Someone just posted "The Norvir Summary of Product Characteristics" -- if you read the thread you'll see that the answer is no.  It states that 2°C is the lowest temperature acceptable.  A refrigerator is not a freezer.  Anyway, you've been on Norvir now for 6 months.  Doesn't yours say on the label?
« Last Edit: May 18, 2009, 10:42:33 AM by Miss Philicia »
"I’ve slept with enough men to know that I’m not gay"

Offline newt

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #10 on: May 18, 2009, 10:41:37 AM »
Quote
what if Norvir is stored below 2°C

It freezes/solidifies and is therefore compromised
"The object is to be a well patient, not a good patient"

Offline BM

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #11 on: May 18, 2009, 11:48:53 AM »
Someone just posted "The Norvir Summary of Product Characteristics" -- if you read the thread you'll see that the answer is no.  It states that 2°C is the lowest temperature acceptable.  A refrigerator is not a freezer.  Anyway, you've been on Norvir now for 6 months.  Doesn't yours say on the label?
Thanks for your responses, Miss P and newt. Beyond being told to keep my ritonavir in the fridge, and a big sticker saying "KEEP REFRIGERATED" on the back of the generic dispensing bottle, there's no indication as to an optimal temperature. Indeed, I've never had a patient information leaflet with my ritonavir, unlike my other meds which come with encyclopedic amounts of info. I'll check things out with a thermometer. Thanks for alerting me to this, it's definitely something I'll mention to my doctor and pharmacist.

Offline mecch

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #12 on: May 18, 2009, 05:29:07 PM »
When I was on Norvir, my big shot swiss specialist said that there is a room temperature window of quite some time. Maybe even a few weeks.... Can you ask? You want me to ask him?
And yeah, I heard there is a booster coming soon that does not need refrigeration. Hey, if the combo works, why switch now?
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline BM

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Offline Robert

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #14 on: May 18, 2009, 10:52:48 PM »

To OP: isn't there an alternative formulation of Norvir in the pipeline that doesn't require refrigeration? If it's due to be released soon, it might be worth hanging on.

Hey BM...

Thanks for the heads-up.  I talked to my Dr on the phone this morning and we decided to stay with the regiman as is (Reyataz,Norvir,Truvada) at least for the time being.

And I'm going to send her that little bit of informatation. That's certainly good news.  It solves all my problems.  When my Dr and I meet again in July we'll discuss it.

Thanks to all of you for your kind and inspired wisdom.

robert
..........

Offline risred1

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Re: Dropping Reyataz/Norvir/Truvada for Lexixa/Truvada or Viramune
« Reply #15 on: May 23, 2009, 08:51:26 PM »
I'm retracting this statement..... Guidelines state I should be taking boosted Reyataz with Truvada.

I'm checking with my doctor.

---------


robert, you asked about unboosted Reyataz and Truvada....

I'm on the once a day 400mg (2x200) Reyataz and Truvada unboosted.

it actually is written in the guidelines that way. 400 mg unboosted, 300 with Norvir boost.

My doctor is defers to boosted, but agreed to let me try it without. The preference is simply because its a huge question as too efficacy of unboosted vs  boosted. And he's hoping for a study to shed more light on that aspect.

His view is maintain a higher consistent level in the blood intuitively seems to be a better choice, but there is enough information that shows efficacy without boosting. My doctor stress's adherence. (who doesn't). My expectation is that I will maintain excellent adherence.

It depends on your situation of course. I have the option of adding it in, if we feel that would improve performance. This is something you and your doctor should discuss and how to handle a transition to unboosted.... which is about monitoring closely your blood work.

This might help you out... but be careful to your unique needs and issues.

Good luck!
« Last Edit: May 23, 2009, 08:57:13 PM by risred1 »
risred1 - hiv +
02/07 CD4 404 - 27% - VL 15k
10/07 CD4 484 - 31% - VL 45k
05/08 CD4 414 - 26% - VL 70k
01/09 CD4 365 - 23% - VL 65k
05/09 CD4 291 - 23% - VL 115k - Started Meds - Reyataz/Truvada
06/09 CD4 394 - ?% - VL 1200 - Boosted Reyataz with Norvir and Truvada
07/09 CD4 441 - ?% - VL 118 - Boosted Reyataz with Norvir and Truvada
09/09 CD4 375 - ?% - VL Undetectable - Boosted Reyataz with Norvir and Truvada
12/09 CD4 595 - ?% - VL Undetectable - VIT D 34 - Reyataz/Truvada/Norvir

 


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