POZ Community Forums
Meds, Mind, Body & Benefits => Questions About Treatment & Side Effects => Topic started by: AtomicA on July 27, 2013, 03:21:38 am
-
Hi Folks,
It's been an outrageously long time since I've logged in to this website, but I'm thankful now that I knew where to turn for advice.
I can't believe that I'm in this position, as I'm normally extremely careful about this, but I'm here and there's not much I can do about it now. Been positive since 2004, on successful, zero viral load treatment since late 2004 or early 2005. For the first time in nearly a decade, I stupidly forgot to pick up my medication refill before the pharmacy closed for the weekend, and I ran out of one of my meds this morning. I know I know, I'm a complete idiot, I have no one to blame but me. I ordered the refill earlier in the week, meant to go today, but there was a landscaping catastrophe in my back yard, followed by major drama with the surrogate agency my partner and I are working with, and then suddenly it was 7pm and I was just realizing I hadn't gone to get the pills and the pharmacy is now completely closed.
Here in Calgary there is only a single pharmacy for the entire city that carries HIV medications (publicly funded HIV medications have the benefit of being free, but are only available in one place), and they are closed closed closed on the weekend.
I am presently taking Kivexa and Nevirapine. I have enough Kivexa to last the weekend, but I'm completely out of Nevirapine. However, I do have half a bottle of Sustiva left over from when I switched to Nevirapine (Sustiva is an evil, evil drug - why I put up with it for so many years is a testament to my conservatism) late last year. Should I take Kivexa and Sustiva for the next two days, just Kivexa, or nothing at all until I can get a refill of my Nevirapine prescirption on Monday?
I've only gone 24 hours without taking all of my medications in the past 8 years once, and that was because I absent-mindedly left my meds in checked luggage (normally keep it in my carry one) that never arrived like 5 years ago. At that point I went 28 hours between doses, and I was freaking out the whole time. As you can imagine, I'm having a minor melt down right now.
I only know one other HIV+ person in this city, and we're on different meds, so I can't get any from them. How bad is it to switch between NNRTIs in such a short time span like that?
-
I would be inclined to take the Sustiva until you can get your refill. They're both NNRTIs, and you switched for reasons other than resistance, so I can't see why it wouldn't be ok for such a short term. It would be better than risking resistance.
Can you ring your doctor to get a second, medical opinion? Or does the pharmacy have an off-hours emergency number you can call? Any knowledgeable doctors at your local hospital?
Good luck. I can't really see a problem with the short-term substitution, but I'm not a doctor. (although I do know a lot about how the meds work)
Ann
-
Thanks so much for replying Ann! The friend I have here who's on different meds called me this morning and told me that the Foothills Hospital here in Calgary keeps a supply of all HIV medications in their In Patient pharmacy. It's not too far from my house and they were able to set me up with a supply for the weekend. Phewf! I really didn't want to have to mess around with this or spend two mornings feeling like I'd been hit by a bus!
Never will I ever let that bottle run dry again!
-
Great news, Atomic! I'm really happy to hear you got this sorted out.
Pro-tip; get yourself a pill tray. If you get one that has separate compartments for each day of the week, with four compartments for each day, you can fill it up for a whole month (28 days) and you'll see well in advance exactly how much you have left until you need a refill.
The daily removable compartments are usually labelled "morning", "noon", "evening" and "bed", so the first week you take the "morning" pills, the second week the "noon" pills, and so on down the tray.
I have two trays like this - one for hiv meds and one for other meds I take once a day. I have to submit a refill request for one of my non-hiv meds every month, and this system has been a life-saver many a time.
Before I started using this system, I left my monthly refill script too late a few times and ended up without those meds for a couple days. At least they don't carry the resistance issues that hiv meds do, but it's not good to go without them nonetheless.
This system will also give you two days worth of hiv meds (because the bottles contain 30) that you can use in a smaller container to take out and about with you, just in case you're away from home when it's meds time. Just make sure you rotate the extra ones out every month or so to insure they're not going out of date if you don't need to use them.
Having those extra two pills every month can also be used as a way to build up an emergency stash - again make sure you rotate so your stash doesn't go out of date.
Again, it's great to hear you got this sorted out. :)
-
If you are under Kivexa and Viramune, and UD for a long time, as I suppose? then a 2 days treatment interruption should not do you any harm.
First, Kivexa is relatively slow in its instantenous pharmacokinetic decay
On the other hand Viramune (nevirapine) has a fairly quick decay. But, a recent review of the SMART study showed that a lot a patients still had a lot of NVP after one week (can't remember but the link is here:
http://www.ncbi.nlm.nih.gov/pubmed/23874928
)
still had a lot of NVP.
This is favorable in your case of a short interruption.
This is unfavorable in case of a long interruption since NVP will remain (as long as 4 weeks !) BUT underdosed, thus, making resistance easier
Many studies have shown that short term interruption (for reservoir research for exemple) with immediate re-use of the same drug is safe
Many years ago, I read stories of young HIV POZ getting crazy because their country was on general strike for 3 weeks and they could not get their supplies.
Same problem in Greece right now.
Lesson learnt, I have 4 months ahead of me ;-)
Hope this helps
Eric