Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects

06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)

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Many thanks Ray ! for the multiple and documented answer !

psychologically, I have a hard time with the entire thing and I feel encouraged by your posts.

I wish I could edit my post and correct the mistakes. Thanks for pointing them out.

Now, I can only post answers/reports on Sundays and today is Sunday.

I have noticed that a number of people who say that this combo works for them have been staying with it for a long time. I think one needs to get past these 6 to 10 first weeks.
I have tried to create conditions that, hopefully, will be favourable:
- I have managed to get all the critical work done before taking the meds
- I have a weekly visit to my now-retired family doctor, who kindly spends some time with me (helps with the stress, the crying, the fainting, ...)
- I'll be working from home for the next 6-10 weeks, so medication is not so much a burden to my work and to others
- I am on 'house-arrest' : no going out, no sex, no alcohol

I take Kivexa (Epzicom) at 11:00 PM (moving daily by 15 min. in order to place it earlier in the day) and Viramune at 8:00 (the first 2 weeks, Viramune is only once a day)

I take Kivexa before bed because I was told it can be rough. Moving it forward 15 min. a day would place it at 8:00 PM when it is time for me to start taking Viramune twice a day (therefore 8:00 AM- 8:00 PM)

The first 3 nights/days have been absolutely perfect (no nothing). I was feeling great and relieved

Last night I felt bold enough and:
- had a bit of wine
- took the pill at 10:30 PM and went to bed at 0:30

At 2:00 AM I was awaken by stomach discomfort and noticed a slight pain on the liver
Putting the nausea on a scale of 10 where 10 is the urge to throw up, I d say it was 2-3
Putting the liver sensitivity where 10 is, say, pain, like you ate way too much chocolate cake the day before, I'd say 3
Enough to keep me awake until 5:00 AM
Took my Viramune at 8:00 AM
Have been feeling so-so all day. Lying in sofa most of the day. Tension has been low all day : 100/60

I'll be more careful tonight in hope for a better night. These are pretty strong medicine after all...

Back in the days, people must have been weighting pros and cons, before deciding for the meds and may have stayed a long time with the viremia

Nowadays, it seems that the recommended strategy is to start early, which also means for some people starting with relatively high CD4 counts.

As stated earlier, I am starting this regimen with a CD4 higher than the cut-off value of 400 (for men, 250 for women). Controversial or not, I would not know...

In my case, it also meant starting 10 weeks after diagnosis. No much time to recover from shock

It is comforting to see you could recover to safer levels. It is good news to hear you can take Kivexa (Epzicom) at daytime. If things go well I wish I can do the same...

I'll report later (next Sunday?) about this (mild) liver pain and on going progress.


Here is some info on Viramune:

You can make corrections on your posts within the first day (or two?) after posting by going to the post and clicking on "Modify." Of course if someone else has already mentioned the "mistake" in a subsequent post it's best to leave it as is so that it makes sense to others when reading the entire thread.

It sounds like you are approaching this very sanely; please keep us updated on your progress.

I was started on this combination and found it very easy to take, aside from an initial rash that passed without note. Unfortunately, I developed resistance to all three drugs quite quickly. Some doctors say you can take both tablets of Nevirapine at the same time, i.e. two tablets once a day. This is a non-standard dose and I suspect one of the factors that contributed to my developing quick resistance so I wouldn't recommend it if it is suggested to you (at least, not while your viral load is detectable). The year after my resistance developed, the British guidelines were updated to say that Nevirapine shouldn't be used if viral load is above 100,000 copies (my viral load was 1.1 million copies). Oh well!

Nevirapine passes the blood-brain barrier too.



--- Quote from: Inchlingblue link=topic=33062.msg407523#msg407523

It sounds like you are approaching this very sanely; please keep us updated on your progress.
[/quote ---

I also agree that you seem to be handling this well, considering your a relatively new to all this.  One step at a time, is what I say.

Keep us updated Eric, And don't hesitate to contact your doctor, if you feel things aren't going well.

Take care of yourself-------Ray

--- End quote ---

On Sunday, I was not feeling too well... My stomach a bit uncomfortable (although nothing serious)
I was a bit worried about taking Kivexa when something crossed my mind:
- my doctor in a previous visit had expressed concerns about my not drinking enough water (see my blood sugar issues)
- I had read one post mentioning that increasing water intake could help
- I had noticed that my weight had dropped overnight by 0.9 kG - 1.7 lb : that could be a bit of dehydratation

I theorised that ARVs are changing my metabolism and more water is needed.
I did take much more water (1.5 litre) in the few hours left before Kivexa time
I felt better about taking my Kivexa pill and went to bed full of hope. But then, suddenly, the alarm rang...

It was 8:00 AM. I had fallen sound asleep and had a very good night

I can not say for sure that the water did the trick, but I kept very careful the entire week about it.

I also think that Kivexa makes me wake up in the middle of the night or wake up early. I was feeling the lack of sleep.
Therefore on Friday night I took half a pill of Unisom (an over-the-counter sleeping pill that contains Doxylamine succinate) I very rarely use it (only when I have jet lag problems) and most likely a quarter of a pill would have been enough to ensure a good, undisturbed, night sleep.
As a result I slept until noon (took my pill on time at 8:00, though) and again till 4 :00 PM. This is more than I would expect from a 1/2 pill of unisom and indeed I must have had a tiredness that went unnoticed and is now behind me.

Physically, the entire week went OK. a bit constipated, nothing worth mentioning. No rash, no vomiting, etc. The Kivexa drug information mentions that side effects usually occurs from the second week of taking the meds.
I am now entering this 'dangerous' zone.

Since the diagnosis (therefore 10 weeks before starting the meds) I suffer from brain effects that scare the shit out of me.
When it occurs, I feel like my brain is compressed in a helmet and floating on springs. It does not go away with the usual pain killers
Most times it happens when I am stuck in my though because I have tumbled against the virus thing. (for example, writing these lines triggers it...). This was not happening before the diagnosis and had some occurrences before initiating the meds.
To me, this sounds like self-inflicted stress-induced, not drugs nor virus related, but it leaves me a deep despair.
I have fainted a lot (5 times in 10 weeks) and cried a lot too. I have less crying now, but (consequently?) more of the headache thing

I had expressed concerns about a potential weakness there to my doctor (obesity/diabetes/Alzheimer in my family)
When I asked him why he chose a regimen that is normally NOT recommended in my case (it is written in the US guidelines that it is NOT to be prescribed to men with cd4 over 400)
he said that he was interested in the potential protection for the brain and central nervous system.

This matter is still being debated and right or wrong I do not know if there is yet a final answer.

Nonetheless this link here below shows that ALL of my regimen compounds are crossing the Blood/brain barrier.

So not just Nevirapine and Abacavir (as discussed above) but also 3TC (to a lesser extend)

Whether this is a good thing or not I do not know, But I feel very happy (privileged?) that he had listened to my concerns and that we are doing something about it.

This is why I am so anxious to see me pass the 6 to 10 first initiation weeks.
I suffer from an immense sense of guilt and stupidity about my infection and a failure to carry on a combo that I came to like would only add to it.

After now 10 days in the meds, a bit of stomach/liver discomfort that has apparently and so far disappeared, I am more upbeat

Reading the forums has been very helpful and I have the feeling that this regimen, once successful, can be carried on for many years.

There has just been a new publication on pubmed that comforts this impression.

It concludes:
NVP demonstrates sustained efficacy and good safety and is very convenient to use as reflected by a high rate of persistency.

I must deeply thank those who are posting on this thread about their experience with this combo. There are so many posts about Atripla that I felt isolated
All advises are welcome. If things go fine, I hope it will make it easier for me to come to terms with my fears and guilt.

BM, Rey, Inchlingblue : Thanks for the advises and support

I intend to take Viramune with the twice a day dosage, as this dosage has now been proven better for treatment-naives.
On the long run, and if we ever get there, I will consider take Kivexa in the morning and then, I might consider Viramune as a once a day dosage along with the Kivexa.

Next week, Wed., I'll get my blood work and will start taking Viramune twice a day. Hopefully I should be able to post lab results soon. My current general feeling of well being makes me hopeful.

I'll keep my fingers crossed


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