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Author Topic: think im switching to rilpivine  (Read 5281 times)

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Offline surf18

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think im switching to rilpivine
« on: July 22, 2011, 08:24:46 AM »
wish me luck
any advice to those taking this pill?

Online BT65

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Re: think im switching to rilpivine
« Reply #1 on: July 22, 2011, 04:38:44 PM »
Hi Surf, I"m not on this personally, but I do have a client who just went on this.  The doctor stressed to take it with food. (This is Edurant, correct?)
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline surf18

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Re: think im switching to rilpivine
« Reply #2 on: July 22, 2011, 05:07:27 PM »
yep thats the one. thats the one thing holding me back.
i have to weighs the pro's and con's of both meds regimens im on.
what i was hoping to get away from was the night time selzentry pill having to worry about taking that betweent 4:30-8:30 and i thought the one pill deal would be great. but then now i have stress as taking it with bfast.so thats not like my normal time to take pills. i usually take pills/supps when i first get up and then do my morning stuff to get ready for work then 45 mins later i eat bfast. but i dont know what if its a weekend and i eat a little later.ughhhhh
and i cant take it at night because i dont always eat dinner between 4:30-8:30.
so you see how complicated i made this one a day pill become. hahha

Offline Tempeboy

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Re: think im switching to rilpivine
« Reply #3 on: July 22, 2011, 10:03:15 PM »
Hello,

You could ask your doc why it needs to be taken with food.  Some meds need to be taken with food for them to reach their therapeutic levels in blood, others to lower the risk of side effects.

If you can take it without food and not experience side effects and it will still work then it might be part of a great combo that works around your routine.

Do others have info as to why Rilpivirine needs to be taken with food?
Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

Dean Kiley

Offline surf18

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Re: think im switching to rilpivine
« Reply #4 on: July 22, 2011, 10:17:39 PM »
i believe it needs to be taken with food due to absorption.

Offline Tempeboy

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Re: think im switching to rilpivine
« Reply #5 on: July 23, 2011, 09:42:17 PM »
Hey Surf,

I checked with a friend who works in the field and your quite right, it is for absorption - and a glass of milk would probably do the trick.

There are rumours of new trials with a dose of 50mg instead of the currently prescribed 25mg. 

Have you looked at other once daily options?

TB
Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

Dean Kiley

Offline surf18

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Re: think im switching to rilpivine
« Reply #6 on: July 23, 2011, 09:57:27 PM »
Tempe-
I have checked on atripla at dx time. Being that I have loon qualities we thought that would not be good for me. Ha
My first meds was verimune
Terrible rash so the one a day verimune is out

Offline newt

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Re: think im switching to rilpivine
« Reply #7 on: July 23, 2011, 10:06:02 PM »
This drug needs food. It's a very small pill, which is good.

Good luck. Sometimes people don't get on with a class of drugs, in this case NNRTIs. But there you go, each med is different and it don't follow that cos 1 or 2 NNRTIS was crap the rest will be. In any case, there are plenty of viable non NNRTI-based combos so I wouldn't worry.

It's very new, interested to see how it goes.

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

Offline surf18

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Re: think im switching to rilpivine
« Reply #8 on: July 23, 2011, 10:42:36 PM »
newt-
what you saying?this class is risky for me?
im confused more now. ha

Offline Tempeboy

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Re: think im switching to rilpivine
« Reply #9 on: July 24, 2011, 02:34:25 AM »
I think what Newt meant (and please jump in Newt) is that the NNRTI class of drugs, including Efavirenz, Viramune, Rilpivirine and Intelence are more associated with skin rash as a side effect than other classes of drugs used to treat HIV.

Having said that, the newer drugs in this class, such as Rilpivirine, don't seem to cause rash to the extent that the older drugs in this class do, such as Viramune.

This drug looks very good on paper in terms of research, so chances are you should be fine.

Intelence can also be taken once daily and doesn't need to be taken with food.

Take care

TB
Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

Dean Kiley

Offline kellybryana

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Re: think im switching to rilpivine
« Reply #10 on: July 24, 2011, 03:03:15 AM »
Hey there. I'm actually on this med. I take it with truvada and I have had no side effects, which has been wonderful, but no blood tests since I started so I'm not sure how the virus in my body is responding to it. I take it anywhere from 7:45 to 10 at night, and I take it with a minimum of 300 calories. My doctor told me its important to take it with protein of some sort because that's how its absorbed. The pharmacist told me to take it with 600 calories or more, but I eat like a bird (a little bit, all day long), and I don't even think I take in 600 calories at one time...ever.

I lagged on starting medication because of the whole me not eating that much at one time thing. I went into the doctors office though after 3 weeks of being prescribed the meds but not taking them, and expressed my concern about me not being able to take the med with enough food, and he told me that I could take it with a couple pieces of toast. I was actually a little confused by that, having been told twice that I should take it with a substantial meal, but I started taking it anyways because my viral load tripled in 3 months. I go to the doc on the 18th of next month for blood work. I'll let you know how it goes!

Offline eric48

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Re: think im switching to rilpivine
« Reply #11 on: July 24, 2011, 04:54:30 PM »
Having said that, the newer drugs in this class, such as Rilpivirine, don't seem to cause rash to the extent that the older drugs in this class do, such as Viramune.

Which makes Surf18's report most interesting, because, if I remember correctly (may be, I am wrong...) I think one of the forum members did report a Viramune rash and on top of memory I think that is ... surf18...

(if the above is not correct, please be kind enough to forgive me...)

good luck

Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0

Offline surf18

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Re: think im switching to rilpivine
« Reply #12 on: July 24, 2011, 06:03:25 PM »
hey eric. good memory. yep im the rash boy. head to toe. after reading that they are the same class of drugs that is on my list to ask my dr tomorrow. will i get the same adverse reaction from two drugs of the same class? man you got a good memory!

Offline newt

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Re: think im switching to rilpivine
« Reply #13 on: July 25, 2011, 06:15:29 AM »
Surf

This is why I mention NNRTIs as a class. People who get rash on one are more likely to on another. From the initial studies, rilpivirine seems, say, 10 times less like to cause rash the efavirenz and therefore perhaps 30 times less like than nevirapine.

Also ask your doc about how much food rilpivirine needs (it does need a fair amount), and whether it is as good as other drugs if your viral load is over 100,000 (cos seems a little less robust in these circumstances).

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

Offline surf18

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Re: think im switching to rilpivine
« Reply #14 on: July 25, 2011, 07:24:03 AM »
thanks newt.
load is ud at this time.

Offline eric48

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Re: think im switching to rilpivine
« Reply #15 on: July 25, 2011, 11:58:54 AM »
Because millions of people currently use or have used nevirapine (the active component of viramune) there is a hunch in the scientific community that some genetic trait could be identified and would help screen people out before they are put on nevirapine.

This has been found true for Abacavir, where a simple test has reduced the hypersensitivity reaction (very adverse) from 6 % occurrence (before the test was introduced) to less than 1 %

A number of such genetic factors candidates for nevirapine rash have been identified, but they seem to be not just one and not as specific as for the case of Abacavir.

Research is still going on and I remember reading that the identified genes may help explain why the nevirapine rash is more commonly observed in Asians (on top of my mind, do not quote me on that)

If a patient has been removed from one med, for virological reasons, there are some meds of the same class that they can not even consider as they select the same variants.

If a patient has been removed from one med, for rash reasons, the patient should not be put on that same med (as the same cause will produce the same effects) this is even worse with abacavir as the adverse reaction might be lethal... But that does not prevent the use of other drugs in the same class.

Surf, you should be doing OK...

My question is: you are on Integrase inhibitor + Entry inhibitor. (am I corect ?)

Which one are you substituting to Rivilripine ?

Here, in our socialized health system, maraviroc is not allowed for treatment naives (neither is Raltegravir)  and seems to be very difficult to get. (something that pisses me off greatly)

Here, you would be considered as a privileged member of the happy fews

You obviously have easier access to the more modern meds than we do !

Please keep us posted.

Thanks

Eric
« Last Edit: July 25, 2011, 12:02:42 PM by eric48 »
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0

Offline newt

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Re: think im switching to rilpivine
« Reply #16 on: July 25, 2011, 12:05:00 PM »
Quote
load is ud at this time

No worries then. But perhaps an idea to have a plan B?

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

Offline surf18

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Re: think im switching to rilpivine
« Reply #17 on: July 25, 2011, 04:06:30 PM »
Eric-I'm on selzentry (marivoch)
And truvada

Newt- just looking for an easier dosing- a one a day option.

Offline austinguy

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Re: think im switching to rilpivine
« Reply #18 on: July 25, 2011, 11:42:51 PM »
Hi,

I am on 25mg of this med as well as Truvada. I take it once a day. If I forget to take it when I eat dinner I eat a couple of spoonfuls of peanut butter and down a glass of milk. I am almost into 24 weeks of taking this one a day combo and I am really liking the outcome. I was on Atripla before. On this new combo I don't have the dreams, I sleep well through the night and just feel more like myself all around again. I am not trying to tell anyone what to do. I know I will continue to take this med after the trial is over in late December. I've said this in a previous thread but the "fog" that was constantly around my head when I was on Atripla is gone now.

Good luck-

Offline Hellraiser

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Re: think im switching to rilpivine
« Reply #19 on: July 26, 2011, 05:06:28 AM »
Hi,

I am on 25mg of this med as well as Truvada. I take it once a day. If I forget to take it when I eat dinner I eat a couple of spoonfuls of peanut butter and down a glass of milk. I am almost into 24 weeks of taking this one a day combo and I am really liking the outcome. I was on Atripla before. On this new combo I don't have the dreams, I sleep well through the night and just feel more like myself all around again. I am not trying to tell anyone what to do. I know I will continue to take this med after the trial is over in late December. I've said this in a previous thread but the "fog" that was constantly around my head when I was on Atripla is gone now.

Good luck-

This is definitely something I'm going to look into doing at my next appointment.  I don't like the need to consume something with the pill, but the slight inconvenience of having to eat at dosing time is worth it if I can erase all the side effects (that I've now been bitching about for going on a year).

Offline eric48

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Re: think im switching to rilpivine
« Reply #20 on: July 26, 2011, 07:11:36 PM »
Hi,

In a similar fashion, I do not have intention to enter a discussion on which combo is better or what have you.

I am currently on Nevirapine (viramune, on which Surf had a rash on) and Kivexa (virologically quite close to Truvada)

Originally I was on twice a day dosing but at month 8 into treatment I was allowed to go once daily (off label).
At first it did not seem to matter to me, but in fact, I do understand now the ease of use of once daily.

Therefore, I , for one, do understand the practical advantage of once a day.

When I was under 'threat' to be switched to Raltegravir (which is now clearly not recommended as once a day), I was not too happy about that.

Yet, the only one med that I would have liked to take on whatever dosage there is (even three times a day) is Selzentry (maraviroc), which is why I was somehow a bit envious of Surf

the background for this is reminded here:

http://www.aidsmeds.com/articles/croi2011_thomas_campbell_2581_20025.shtml

If I understand properly  Selzentry (maraviroc) does not enter all the cell of you body, but remains outside (if my understanding is correct). Whichever of the other meds that are currently on the table have the ability to enter (almost) any type of cell and mess up with the internal processes of the virus replication , but, as a collateral damage, it does interfere with other internal processes within the cell (to a various extend, admittedly)

In that respect, If I had been given the opportunity (which I was not) I would have preferred (may be based on false sense of environmental precaution) a regimen that penetrates less into the cells.

While  I do understand that bi daily dosage can be a pain, I thing I would have preferred to endure that until once daily entry inhibitor come to the market, which if my memory is correct is expected sooner or later.

I even went as far as trying to enroll in a trial involving maraviroc (but was busted out) and my next opportunity is a trial where I do not yet meet one of the requirements (it is required that the patient be < 50 for 3 years, and I 'm <50 for only 6 months).   

So strong is my belief (I can be wrong...) that a medication that targets the outside of specific cells is conceptually a better way.

Not everyone can be virologically successfull on maraviroc; Surf is and I look at this with a bit of envy

If successfull on entry inhibitor once, may be a switch to an other class will not prevent a return to entry inhibitors when once-a-day are available, may be it will, I have not looked into this.

beside the virological aspect of the question, in our socialized health system, getting a double switch (to more expensive) meds is a luxury that I will not be entitled to. (eventhough my insurance premium far exceed the cost of medication ! )

For me getting a chance to access that medication (which I conceptually like) and on top of that qualify (tropism) and on top of that be successfull seems such a far out reach target that I was a bit surprised with the OP and the underlying reason for the switch.

Leaving in a conservative, socialist country sometimes makes me mad.

I guess it is just a neighbours lawn looks always greener effect

Just some thoughts

Eric





   
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0

Offline surf18

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Re: think im switching to rilpivine
« Reply #21 on: July 26, 2011, 10:33:52 PM »
somethingelse that does entice me about this drug is that it is only 25 mg of drug,where as say selzentry is 300mg a day.
doesn't it make a difference really on toxicity or not.

just seems wild that something that only is 25mg can pack the same punch as something that is 300 mg or more.

Offline eric48

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Re: think im switching to rilpivine
« Reply #22 on: July 26, 2011, 11:23:36 PM »
I am 2000 mg aspirin most of the time and 10 mg prazepam (anxiolytic)

this is the lowest dosage of the mildest anxiolytic and still knocks me down at times (I need to cut the pill...)

I would not pay too much attention to that weight difference, but a smaller pill may help psychologically.

the weight may also be related to the size of the molecule, so, it's hard to make this a decision factor.

Important is that you feel comfortable with the meds you take

Cheers!

Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0

Offline flip408

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Re: think im switching to rilpivine
« Reply #23 on: August 02, 2011, 02:41:47 AM »
trial nurse made it clear to me, had to be taken with food and not a snack, over 400 calories. Absorption chemistry?  They never said anything about protein, oh and no vitamins or supplements within 4 hrs. 
Start where you are, use what you have, do what you can.    A Ashe
05/14/11  501  <50  20%
4/14/11  483  <50  19%
2/10/11    523  <50 18% start Rilpivr/trvda
11/15/10  470  <50
1/6/10    430  <50  16%
7/13/09  345  <50  12%
1/26/09  347  <50  16%
7/22/08  306  <50  6%
11/26/07 238 <50  8%
6/11/07  253  <50  5%
11/9/06  122  <50 7%
9/05/06  <25 >100000  PCP

Offline newt

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Re: think im switching to rilpivine
« Reply #24 on: August 02, 2011, 02:17:41 PM »
Yer, well said. The whole "take with food" question is quite unclear on a per drug basis, there should be a table somewhere that tells you what this means in practice.

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

Offline simpleguy

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Re: think im switching to rilpivine
« Reply #25 on: August 02, 2011, 04:49:33 PM »
A guide to what food to eat, and how much, and its composition of fats, proteins etc., would probably need a lot of trails to figure out, because people are very different when it comes to how the drug is absorbed, and how the body handles the drug.

During the clinical trials, I imagine they'll try it out with different kinds of meals (e.g. kcal- and fat-wise). People have different metabolic rates, amount of blood protein (albumin) and what not - some might have problems with absorbing the drug in the small intestine. There's lots of different factors, that could have an effect on how the drug is distributed, metabolized and maybe even cause adverse side effects.

A one-size-fits-all pill. Think about how difficult it must be to make a pill that fits all (or most), even including liver problems, hep c, trouble with kidneys, gender, age, race and so on.

More on food and Edurant:
Look under section 12.3, page 12, in the prescribing information, Effects of Food on Oral Absorption

P.S.: I'm on 2 x 200mg Intelence w/food. I'm feeling alright, but I would like a more simple regimen.

2008 JUL: Sustiva OCT: Rayataz DEC: Kaletra 2009 Off meds 2011 Intelence 2012+ Complera

Offline newt

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Re: think im switching to rilpivine
« Reply #26 on: August 02, 2011, 06:58:14 PM »
The registration studies were done with a certain amount of food (Big Mac or equivalent it seems in some). This is the amount of food you need to get the PK (drug level) results seen in registration studies.

Since no-one in the phase 3 studies was ever monitored for food as a rule it's a moot point re: virological outcomes, but there are some drugs where I'd rather be safe than sorry, Edurant being one and individual digestive systems notwithstanding, so think it would be helpful to have a summary. Who wants to be in the 10-20% that don't get a good virological outcome from a combo for want of a sandwich (or bit more in some cases)?

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

Offline surf18

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Re: think im switching to rilpivine
« Reply #27 on: August 02, 2011, 07:54:37 PM »
i met with my dr yesterday in discussing my possible switch. i decided to stay with my current regime. i guess to me i was trading the inconvience of the night time pill ,the second selzentry pill for the inconvience of the food issue on the one a day rip pill.
it was just to much work to worry about taking with food,he said it had to be a high fat but not a high protein meal.well good luck with that! because most fat i eat in my diet is meat which is high in protien.
and the other factor was that i had the rash on verimune which as mentioned in this thread is of the same family as the rip pill. thanks to eric for bringing it up as it was on my list of things to ask him but he brought it up to me before i could even ask him.
so i for the moment am choosing to stay on the current meds. now if the tri/s go up again after todays blood work then i will re think this.

Offline austinguy

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Re: think im switching to rilpivine
« Reply #28 on: August 04, 2011, 04:32:51 PM »
After the initial meeting where I signed the contracts for the trial food has never been brought up again. If I take the pill within an hour of eating it seems to be fine for me.

 


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