Quantcast

Subscribe to:
POZ magazine
Newsletters
Join POZ: Facebook MySpace Twitter Pinterest
Tumblr Google+ Flickr Instagram
POZ Personals
Sign In / Join
Username:
Password:
Welcome, Guest. Please login or register.
November 25, 2014, 11:15:39 PM

Login with username, password and session length


Members
Stats
  • Total Posts: 647437
  • Total Topics: 49333
  • Online Today: 259
  • Online Ever: 585
  • (January 07, 2014, 02:31:47 PM)
Users Online

Welcome


Welcome to the POZ/AIDSmeds Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and others concerned about HIV/AIDS.  Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the conversation yourself by registering on the left side of this page.

Privacy Warning:  Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

  • The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own physician.

  • All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

  • Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators of these forums. Click here for “Am I Infected?” posting guidelines. Click here for posting guidelines pertaining to all other POZ/AIDSmeds community forums.

  • We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are true and correct to their knowledge.

  • Product advertisement—including links; banners; editorial content; and clinical trial, study or survey participation—is strictly prohibited by forums members unless permission has been secured from POZ.

To change forums navigation language settings, click here (members only), Register now

Para cambiar sus preferencias de los foros en español, haz clic aquí (sólo miembros), Regístrate ahora

Finished Reading This? You can collapse this or any other box on this page by clicking the symbol in each box.

Author Topic: Truvada+sustiva and general anesthesia  (Read 3471 times)

0 Members and 1 Guest are viewing this topic.

Offline mesu

  • Member
  • Posts: 55
Truvada+sustiva and general anesthesia
« on: September 19, 2010, 11:35:23 AM »
Hello,

I dont think there will be any problem if i m  on truvada+sustiva and have a general anesthesia for a foot surgery...did anyone have similar experience, or confirm it is ok?

thanks

m
Jan/Feb 07 - infected :(
Sept3: cd4 162; 13.5% VL 24,000
Oct5: cd4 68 13.6%
Nov6: cd4 205  14.64%
Dec10,07: cd4 188  15.67%  VL: 9900
FEB15,08: cd4 242 18.62%
Mar10/08: cd4 219 15.64%  VL: 7300
May26,08: start Truvada and Sustiva
July 18,08: cd4 255, 18.50%, VL undetectable (<75)
Nov 4,08: cd4 380, 27.14%,
Feb 6,09: cd4 296, 22.7%,
May 26: cd4 351, 27%,
Aug 28: cd4 310, 28%,
Dec 2009: cd4 321, 35.67%,
March 2010: cd4 325, 32%,
June 2010: cd4 385, 29.5%,
Sept 2010: cd4 368, 30.75%,
Feb 2011: cd4 431, 43.1%,
Jun 2011: cd4 433, 30.93%,
Sept 2011: cd4 435,  36 %,
Jan 2012, cd4 467, 33.36%
May 2012: cd4 421, 38.21%,
Sept 2012: cd4 393, 30.23%,
VL: undetectable since July 08

Offline Ann

  • Administrator
  • Member
  • Posts: 28,140
  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Truvada+sustiva and general anesthesia
« Reply #1 on: September 19, 2010, 12:21:00 PM »
You should speak to your hiv doctor about this as there are some drugs used in general anesthesia which are contraindicated for use with Sustiva.

I found some information here. It's a little out of date but you may be able to find more information by googling "general anesthesia" + efavirens, "general anesthesia" + tenofovir and "general anesthesia" + emtricitabine. I find it's usually better to search using the generic names of the drugs rather than the brand names. You get more scholarly information that way.

From the link above:

Midazolam (Versed) is a drug commonly used for general anesthesia in outpatient surgery and other routine medical procedures where the patient must be "knocked out." If you are taking any of the following anti-HIV drugs, be sure to remind your doctor, nurse, etc. These drugs have interactions with midazolam that can put you into a coma! The reason this happens is competition between the anti-HIV drugs and midazolam, causing the midazolam to build up in the body. The result is like getting an overdose of midazolam. Although your health care provider should always check for drug interactions, it never hurts to remind him or her. Another anesthetic agent can be substituted for the midazolam.

    * Amprenavir (Agenerase)

    * Delavirdine (Rescriptor)

    * Efavirenz (Sustiva)

    * Indinavir (Crixivan)

    * Lopinavir/ritonavir (Kaletra)

    * Nelfinavir (Viracept)

    * Ritonavir (Norvir)

    * Saquinavir (Fortovase or Invirase)


You should definitely talk to your hiv doc about this before your surgery. He/she should be able to tell you what meds are ok and maybe even get in touch with your surgeon for you. Good luck with the op!
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline komnaes

  • Member
  • Posts: 1,898
Re: Truvada+sustiva and general anesthesia
« Reply #2 on: September 19, 2010, 12:58:10 PM »
Oh Jez.. only now I found out about this interaction that could have put me in a coma!

You do know that I did a colonscopy couple of months ago and I was put under general anesthesia for the prob and I don't remember the doctor asking me what I am taking (most likely he didn't). And THEN I did a spinal tap that also needed local anesthesia. For the tap the hospital knew I am HIV+ and I can also assume that they knew what meds I am taking.

Definitely something to check with the clinic dear.

PS - you need a surgery? You need to tell me what's going on by email.
Aug 07 Diagnosed
Oct 07 CD4=446(19%) Feb 08 CD4=421(19%)
Jun 08 CD4=325(22%) Jul 08 CD4=301(18%)
Sep 08 CD4=257/VL=75,000 Oct 08 CD4=347(16%)
Dec 08 CD4=270(16%)
Jan 09 CD4=246(13%)/VL=10,000
Feb 09 CD4=233(15%)/VL=13,000
Started meds Sustiva/Epzicom
May 09 CD4=333(24%)/VL=650
Aug 09 CD4=346(24%)/VL=UD
Nov 09 CD4=437(26%)/VL=UD
Feb 10 CD4=471(31%)/VL=UD
June 10 CD4=517 (28%)/VL=UD
Sept 10 CD4=687 (31%)/VL=UD
Jan 11 CD4=557 (30%)/VL=UD
April 11 CD4=569 (32%)/VL=UD
Switched to Epizcom, Reyataz and Norvir
(Interrupted for 2 months with only Epizcom & Reyataz)
July 11 CD=520 (28%)/VL=UD
Oct 11 CD=771 (31%)/VL=UD(<30)
April 12 CD=609 (28%)/VL=UD(<20)
Aug 12 CD=657 (29%)/VL=UD(<20)
Dec 12 CD=532 (31%)/VL=UD(<20)
May 13 CD=567 (31%)/VL=UD(<20)
Jan 14 CD=521 (21%)/VL=UD(<50)

Offline Hellraiser

  • Member
  • Posts: 4,140
  • Semi-misanthropic
Re: Truvada+sustiva and general anesthesia
« Reply #3 on: September 19, 2010, 03:25:34 PM »
Any time I see any sort of medical professional they ask me what drugs I'm currently on.  Even my dentist.

Offline mesu

  • Member
  • Posts: 55
Re: Truvada+sustiva and general anesthesia
« Reply #4 on: September 19, 2010, 07:50:58 PM »
Thanks so much for the information. I will talk to the doctor and make sure anesthesiologist is aware of the situation.

Jan/Feb 07 - infected :(
Sept3: cd4 162; 13.5% VL 24,000
Oct5: cd4 68 13.6%
Nov6: cd4 205  14.64%
Dec10,07: cd4 188  15.67%  VL: 9900
FEB15,08: cd4 242 18.62%
Mar10/08: cd4 219 15.64%  VL: 7300
May26,08: start Truvada and Sustiva
July 18,08: cd4 255, 18.50%, VL undetectable (<75)
Nov 4,08: cd4 380, 27.14%,
Feb 6,09: cd4 296, 22.7%,
May 26: cd4 351, 27%,
Aug 28: cd4 310, 28%,
Dec 2009: cd4 321, 35.67%,
March 2010: cd4 325, 32%,
June 2010: cd4 385, 29.5%,
Sept 2010: cd4 368, 30.75%,
Feb 2011: cd4 431, 43.1%,
Jun 2011: cd4 433, 30.93%,
Sept 2011: cd4 435,  36 %,
Jan 2012, cd4 467, 33.36%
May 2012: cd4 421, 38.21%,
Sept 2012: cd4 393, 30.23%,
VL: undetectable since July 08

Granny60

  • Guest
Re: Truvada+sustiva and general anesthesia
« Reply #5 on: September 20, 2010, 09:52:11 PM »
I think you have some of the same components of Atripla.  Hubby carries a card that says nothing in the class  Benzodiazapines which includes Versed ( generic  Midazolam).  After  things going bad during his colonoscopy and another round from surgery 2 or 3 , the anesthesiologist got together with the pharmacist and he came back with this written out  from the atripla label.  It is best to have your anesthesiologist get together with pharmacy and check.  Too many anesthesiologists are not familiar with HIV meds.  He had general anesthesia  3 more times where different meds were used with no problems and one where they kept him awake  and did an alternate shortened version of the surgery to prevent having a problem.  One anesthesiologist gave him Midazolam  even after the warning and filled him full of  heart meds and steroids to counter the  reaction.  From the Sustiva Label:
Contraindicated Drugs

For some drugs, competition for CYP3A by efavirenz could result in inhibition of their metabolism and create the potential for serious and/or life-threatening adverse reactions (eg, cardiac arrhythmias, prolonged sedation, or respiratory depression). Drugs that are contraindicated with SUSTIVA are listed in Table 2.

Table 2: Drugs That Are Contraindicated or Not Recommended for Use With SUSTIVA

Drug Class: Drug Name    Clinical Comment
Antimigraine: ergot derivatives (dihydroergotamine, ergonovine, ergotamine, methylergonovine)    Potential for serious and/or life-threatening reactions such as acute ergot toxicity characterized by peripheral vasospasm and ischemia of the extremities and other tissues.
Benzodiazepines: midazolam, triazolam    Potential for serious and/or life-threatening reactions such as prolonged or increased sedation or respiratory depression.
Calcium channel blocker: bepridil    Potential for serious and/or life-threatening reactions such as cardiac arrhythmias.
GI motility agent: cisapride    Potential for serious and/or life-threatening reactions such as cardiac arrhythmias.
Neuroleptic: pimozide    Potential for serious and/or life-threatening reactions such as cardiac arrhythmias.
St. John's wort (Hypericum perforatum)    May lead to loss of virologic response and possible resistance to efavirenz or to the class of non-nucleoside reverse transcriptase inhibitors (NNRTI).

Offline mesu

  • Member
  • Posts: 55
Re: Truvada+sustiva and general anesthesia
« Reply #6 on: September 21, 2010, 11:43:25 AM »
Thanks. Granny60.. the information has been very useful. I called my HIV doctor in the clinic. He told the nurse that as long as the HIV meds are not taken together with the drugs for anesthesia. it should be fine.  I guess i have to tell the surgeon as well as the anesthesiologist about my meds and print out the table of drugs that are contraindicated with SUSTIVA .

I hope things are well with your hubby now.

thanks.
Jan/Feb 07 - infected :(
Sept3: cd4 162; 13.5% VL 24,000
Oct5: cd4 68 13.6%
Nov6: cd4 205  14.64%
Dec10,07: cd4 188  15.67%  VL: 9900
FEB15,08: cd4 242 18.62%
Mar10/08: cd4 219 15.64%  VL: 7300
May26,08: start Truvada and Sustiva
July 18,08: cd4 255, 18.50%, VL undetectable (<75)
Nov 4,08: cd4 380, 27.14%,
Feb 6,09: cd4 296, 22.7%,
May 26: cd4 351, 27%,
Aug 28: cd4 310, 28%,
Dec 2009: cd4 321, 35.67%,
March 2010: cd4 325, 32%,
June 2010: cd4 385, 29.5%,
Sept 2010: cd4 368, 30.75%,
Feb 2011: cd4 431, 43.1%,
Jun 2011: cd4 433, 30.93%,
Sept 2011: cd4 435,  36 %,
Jan 2012, cd4 467, 33.36%
May 2012: cd4 421, 38.21%,
Sept 2012: cd4 393, 30.23%,
VL: undetectable since July 08

Offline Ann

  • Administrator
  • Member
  • Posts: 28,140
  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Truvada+sustiva and general anesthesia
« Reply #7 on: September 21, 2010, 11:55:22 AM »
Every time I've ever had an op, I've had too meet with the anesthesiologist before hand. This is the person who will most likely take an active interest, because s/he's going to be the one administering the general anesthesia and isn't going to want to cause a reaction with your regular meds while you're his/her responsibility.

Feel free to quiz him/her about their knowledge of hiv meds. If their knowledge seems at all sketchy, insist they contact a pharmacist. This is an area of health care where it will pay to be pro-active, even if it feels like you're being a pain. Better safe than sorry.
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Truvada+sustiva and general anesthesia
« Reply #8 on: September 21, 2010, 12:03:45 PM »
I know I have paid the price for not asking questions about anesthesia before surgery. And I have been a little amazed at how hit-and-miss medical professionals can be when it comes to drug interactions and making sure instructions are clear.

Ech, my last surgical experience was not fun for me OR my best friend who got to hold the bucket while I puked in it. Better to be prepared than not when it comes to that sort of stuff.

JK

(who always seems to prefer the long way home)
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Granny60

  • Guest
Re: Truvada+sustiva and general anesthesia
« Reply #9 on: September 21, 2010, 12:35:17 PM »
Thanks mesu,   considering everything he has gone through with 7 surgeries in the last year he is doing well enough to get from day to day. It is clearly the call of the anesthesiologist and you should  discuss it with him/her prior to surgery.  The Efavirenz ( Sustiva) stays in your body a long time ( several days)  and every sedation he had  there was a no food /drink restriction for 12 hours prior which included all meds except for  BP meds,  but there was still enough efavirenz in his system to  cause BP crashes, etc. when they did give him constrained meds.  He did do well with propofol   which is commonly used but carries risks of it's own. Since so many anesthesiologists are unfamiliar with HIV meds I would recommend you  print a copy of the  product label to give them.  I just makes a better day for EVERYBODY  when you have no problems.  I helps to be proactive as nobody has a more vested interest in your health than YOU.  Good luck with the surgery!

 


Terms of Membership for these forums
 

© 2014 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.