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Author Topic: Stribild and empty/full stomach  (Read 2045 times)

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Offline Betelgeuse

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  • Posts: 163
Stribild and empty/full stomach
« on: November 05, 2013, 04:35:25 AM »
I've been taking Stribild now for a few months and I really appreciate the absence of side effects from taking this medication.

I'm just now finding out that Stribild is to be taken with food.  When I started this regimen, I set up my once-a-day dosage at a time that would be most convenient for me whether I am at home on on a weekend or at work (I work a 5 on, 5 off schedule).  This also means I have been taking this medication at a time of day when I am not hungry, and not likely to have had a meal +/- an hour of taking the medication.

Are there any long term issues I should be aware of taking this medication regularly on an empty stomach?  Is this something that will cause me to build a resistance to Stribild?

My doctor didn't mention this one caveat and so I'm thinking it's not a HUGE deal, but I just wanted to make sure.  I'm sorry in advance if this question has been answered previously on this forum.  I did do a rough search that did not yield any answers for me.

Thank you.
04/19/11 - Diagnosed positive
04/29/11 - CD4 188 @ 12.5% / VL 18k
05/03/11 - CD4 171 @ unk% / VL 7k
06/04/11 - Start Truvada/Isentress
07/11/11 - CD4 not tested / VL UD
09/07/11 - CD4 252 @ unk% / VL UD

Offline oksikoko

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  • Writing the congressman again
Re: Stribild and empty/full stomach
« Reply #1 on: November 05, 2013, 06:21:28 AM »
The basic gist: taking Stribild with a relatively fatty meal increases the bioavailability of the drugs. It has nothing to do with resistance. You really should take it with a meal, but not everyone does. It's likely best to follow the recommendations, though. Time will tell.

Copy/paste from: http://forums.poz.com/index.php?topic=47453.msg593549#msg593549

When Stribild was given with a light meal (approximately 373 kcal; 20% fat), bioavailability of elvitegravir and tenofovir increased by 34% and 24%, respectively, relative to fasting conditions. When administered with a high-fat meal (approximately 800 kcal; 50% fat), it increased by 87% and 23%, respectively, relative to fasting conditions. The changes to cobicistat and emtricitabine, the other two components of Stribild, were not clinically significant with either meal.
Code: [Select]
2014-11-14: CD4 Wars Episode II: Return of the Stribild (released in Europe as Stribild II: Werewolf Bitch)
2014-11-06:                ☣ VL (→) 12,627      ☣ CD4 (→) 639
2014-??-??: off treatment  ☣ VL (?)              ☣ CD4 (?)
2013-10-03:                ☣ VL (=) undetectable ☣ CD4 (+) 1105
2013-05-23:                ☣ VL (=) undetectable ☣ CD4 (-) 945
2013-02-25:                ☣ VL (-) undetectable ☣ CD4 (+) 1123
2012-12-16: Enter Stribild
2012-11-20: HIV+           ☣ VL (→) 132,683      ☣ CD4 (→) 920
2012-04-01: HIV-
Dates in this signature file conform to ISO 8601. ;-)

If no one complains, nothing will ever change.

Offline Schnauzer

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  • Posts: 38
Re: Stribild and empty/full stomach
« Reply #2 on: November 05, 2013, 01:51:11 PM »
I have a question that I never seem to get a straight answer to: Is the increased bioavailability necessary or just a added bonus to your fatty meal?
One good turn gets most of the blankets.

Offline Betelgeuse

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  • Posts: 163
Re: Stribild and empty/full stomach
« Reply #3 on: November 05, 2013, 02:43:45 PM »
Thank you for your kind responses.  I guess I should have reworded my question.

I know that you *SHOULD* take Stribild with a meal and *WHY*.  There's a lot of great discussion on this forum from which I got a lot of good information.

My question is simply:  What happens if you *DON"T* take Stribild with a meal consistently.  Are there any dangers associated with a person taking Stribild not on a full stomach?   I mention drug resistance because I didn't see this as much different from missing doses - if all of the drug is not available to the body when taken on an empty stomach.

A little clarification would be much appreciated.
04/19/11 - Diagnosed positive
04/29/11 - CD4 188 @ 12.5% / VL 18k
05/03/11 - CD4 171 @ unk% / VL 7k
06/04/11 - Start Truvada/Isentress
07/11/11 - CD4 not tested / VL UD
09/07/11 - CD4 252 @ unk% / VL UD

Offline Schnauzer

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  • Posts: 38
Re: Stribild and empty/full stomach
« Reply #4 on: November 13, 2013, 12:53:40 AM »
My question is simply:  What happens if you *DON"T* take Stribild with a meal consistently.  Are there any dangers associated with a person taking Stribild not on a full stomach?   I mention drug resistance because I didn't see this as much different from missing doses - if all of the drug is not available to the body when taken on an empty stomach.

A little clarification would be much appreciated.

My question is along the same line except that I keep asking if the additional bioavailability of taking Stribild with a fatty meal is really helpful or just an added and, possibily, unnecessary bonus.  First, I find it very odd that the an anti-retroviral for what is essentially meant for widespread use would gain world-wide approval if its performance varies so greatly depending on what one eats .  To me that seems pretty implausible given the vast economic spread among PLWHA. What happens to those people for whom food is scarce or for those for whom a 600 kcal/50% fat meal is culturally unusual? Yes, one can answer that there are other pharmaceutical options for those who don't access a high fat meal, but it doesn't make a lot of financial sense for Gilead to develop a once-a-day HIV drug only for those who have quick access to a Big Mac.  Secondly, Atripla, which is still the benchmark for effective HIV control, contains Tenofovir. Due to the side effects of Sustiva, we were told to take Atripla on an empty stomach.  That would lead one to conclude that increased bioavailability of Tenofovir was not so important.  Finally, there is increasing evidence that lower doses of Sustiva (400 mg) are just as effective as the current (600 mg) of Sustiva that is found in the formulation of Atripla.  This might lead one to wonder if, in some cases, we are being overmedicated.  Do we really need an additional 34% to 87% bioavailabilty to keep our virus levels undetectable?

I've asked this question several times to several doctors and on this forum.  I've yet to receive a satisfactory answer, which either means that I'm stubborn and not easily satisfied or a satisfactory answer doesn't exist (yet).  It's quite likely that it's both.

As for me, on Thursday I'm asking my ID doctor for a switch to dolutegravir/abacavir/lamivudine (Tivicay/Epzicom).
One good turn gets most of the blankets.

Offline oksikoko

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  • Posts: 681
  • Writing the congressman again
Re: Stribild and empty/full stomach
« Reply #5 on: November 13, 2013, 01:50:19 AM »
Do we really need an additional 34% to 87% bioavailabilty to keep our virus levels undetectable?

My gut feeling is 'no', but don't make decisions based on that. I'm consistently undetectable, and I never eat with it or near it. There are however, other metrics that we don't regularly check for. Is the fact that I don't eat with it affecting the size of my viral reservoir? Who knows? I pulled that example out of the air, but what we still don't know about HIV could fill oceans, so we may not even know what question to ask.

Everyone's body is different. Some people need more, some less, but for economic reasons, there's only one formulation of Stribild that has to accommodate us all. When they decide the dosages, I'm sure they err on the side of overmedication for some in order to get the dosage high enough to be effective for a large majority of people needing it.

Good luck with dolutegravir. I really want to switch too, on account of the cobicistat.

Edit:
"That would lead one to conclude that increased bioavailability of Tenofovir was not so important."

You can't really conclude this. There may be differences in how tenofovir works with elvitegravir and how it works with, say, lamivudine, and what matters in one combo may not matter in another, even with one drug in common. For instance, lamivudine and AZT are synergistic and work particularly well together. Or at least that's my understanding.
« Last Edit: November 13, 2013, 01:54:09 AM by oksikoko »
Code: [Select]
2014-11-14: CD4 Wars Episode II: Return of the Stribild (released in Europe as Stribild II: Werewolf Bitch)
2014-11-06:                ☣ VL (→) 12,627      ☣ CD4 (→) 639
2014-??-??: off treatment  ☣ VL (?)              ☣ CD4 (?)
2013-10-03:                ☣ VL (=) undetectable ☣ CD4 (+) 1105
2013-05-23:                ☣ VL (=) undetectable ☣ CD4 (-) 945
2013-02-25:                ☣ VL (-) undetectable ☣ CD4 (+) 1123
2012-12-16: Enter Stribild
2012-11-20: HIV+           ☣ VL (→) 132,683      ☣ CD4 (→) 920
2012-04-01: HIV-
Dates in this signature file conform to ISO 8601. ;-)

If no one complains, nothing will ever change.

Offline Ann

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  • Posts: 28,140
  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Stribild and empty/full stomach
« Reply #6 on: November 13, 2013, 07:00:55 AM »

Secondly, Atripla, which is still the benchmark for effective HIV control, contains Tenofovir. Due to the side effects of Sustiva, we were told to take Atripla on an empty stomach.  That would lead one to conclude that increased bioavailability of Tenofovir was not so important. 


It's the rilpivirine (brand-name Edurant) component of Stribild that you need to take with a high-fat meal, not the tenofovir component. Tenofovir can be taken effectively with or without a meal.

The third component of Stribild, emtricitabine, can also be taken effectively with or without a meal.

When a medication (any medication) is supposed to be take with a meal, it's usually for one or two of two possible reasons. Either you need digestive fluids present to break it down and make it available for the body, and/or you need to have something in your stomach to prevent nausea.

When you specifically need to eat a high fat meal, it's because you need digestive fluids present that specifically break down fat.
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"...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 aaware72

  • Member
  • Posts: 226
Re: Stribild and empty/full stomach
« Reply #7 on: November 13, 2013, 10:46:23 AM »
It's the rilpivirine (brand-name Edurant) component of Stribild that you need to take with a high-fat meal, not the tenofovir component. Tenofovir can be taken effectively with or without a meal.

The third component of Stribild, emtricitabine, can also be taken effectively with or without a meal.

When a medication (any medication) is supposed to be take with a meal, it's usually for one or two of two possible reasons. Either you need digestive fluids present to break it down and make it available for the body, and/or you need to have something in your stomach to prevent nausea.

When you specifically need to eat a high fat meal, it's because you need digestive fluids present that specifically break down fat.

Hi Ann, 

My understanding was the Stirbild does NOT contain Rilpivirine.  This is why I changed from Complera to Stirbild as I have a resistance to Rilpivirine.   

STRIBILD® (elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate).

COMPLERA® (emtricitabine/rilpivirine/tenofovir disoproxil fumarate)
« Last Edit: November 13, 2013, 10:48:34 AM by aaware72 »
"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline Ann

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  • Member
  • Posts: 28,140
  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Stribild and empty/full stomach
« Reply #8 on: November 13, 2013, 10:54:43 AM »
Hi Ann, 

My understanding was the Stirbild does NOT contain Rilpivirine.  This is why I changed from Complera to Stirbild as I have a resistance to Rilpivirine.   

STRIBILD® (elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate).

COMPLERA® (emtricitabine/rilpivirine/tenofovir disoproxil fumarate)

Arrgh! You're right. This morning when I was looking into this, I used this site's Drug Info pages and Complera and Stribild are listed one after the other. My eyes must have glazed and I read the wrong line for the wrong drug. It is indeed Complera that includes rilpivirine.

Good catch. Thanks.

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 Schnauzer

  • Member
  • Posts: 38
Re: Stribild and empty/full stomach
« Reply #9 on: November 17, 2013, 06:24:42 PM »
Here's an answer I feel comfortable with - from Dr. Benjamin Young at TheBody.com

Hi and thanks for posting.

It is recommended that Stribild be taken with food. Taken with a light meal, the absorption of tenofovir and elvitegravir is increased by ~30% (compared with fasting), if the meal is a large fat-containing meal, the levels of tenofovir and elvitegravir are increased by 23 and 87%.

In sum, the level of tenofovir isn't changed much by a fatty meal, whereas elvitegravir levels are increased by roughly 50%. For people without drug resistance (where Stribild is most likely prescribed), the differences with a fatty meal are unlikely to be of any relevance.

Hope that helps, BY
One good turn gets most of the blankets.

Offline wolfthorn

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  • Posts: 85
Re: Stribild and empty/full stomach
« Reply #10 on: November 22, 2013, 06:48:51 PM »
My solution to this is to take the pill with a tablespoon of olive oil when I haven't eaten yet... having the drug dissolved in fat will allow for greater absorption of the integrase inhibitor component. just take a shot of olive oil with it if you're not eating. It should increase bioavailability.
7/10/13: Oraquick at Home (+)
7/11/13: CD4 <20, VL 286,000
7/26/13: Start Stribild, Bactrim, Azithromycin
8/13/13: CD4 64, VL 1194
9/11/13: CD4 87, VL 511
10/14/13: CD4 164, VL 34
10/15/13: Stop Azithromycin!

 


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