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Author Topic: worried about missed doses  (Read 937 times)

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Offline tallslenderguy

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worried about missed doses
« on: April 15, 2018, 12:23:56 pm »
Eek, i noticed Friday that i ran out of meds. i take Truvada and Tivicay and have taken it the same time daily for two years now and am undetectable. i use a weekly pill box and went to refill it Friday and realized i had run out. i work 13 hour shifts, so forgot to call in my refill until Friday, but it takes 2 days for my pharm to get the meds and it is closed on Sunday, so my meds won't be available till tomorrow (Monday). I had an extra Truvada and took that Saturday, so i will have missed 2 doses of Tivicay (Sat & Sun) and one of Truvada (Sun) and feeling kinda stupid. i haven't found much up to date info on the effects of missed dosing (did find this though https://www.medscape.com/viewarticle/743566, but am feeling kinda vulnerable and stupid right now. sigh

Offline JimDublin

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Re: worried about missed doses
« Reply #1 on: April 15, 2018, 01:28:57 pm »
Okay, shame you missed 2 days.

but to be honest I would not expect any issues at all, learn from the error and try to avoid a repeat. I would not worry or stress about this once off issue,

If you're really concerned talk to your doc but I think that would be over the top, just mention it next time you see them

Jim
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Offline tallslenderguy

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Re: worried about missed doses
« Reply #2 on: April 15, 2018, 01:35:13 pm »
Hi all,
i've been taking Truvada and Tivicay for 2 years (was diagnosed poz in 2016).  The last year or so i have been experiencing muscle and joint pain, stiffness in my legs and was wondering if it might be the meds? i haven't read of this side effect anywhere, so am thinking it might be something else causing it, but it has gotten worse as of late. It helps after i have walked awhile, but never quite seems to go away lately. Have also tried some yoga postures, which seems to help as well.

Wondering if anyone else has had this issue or heard of it as a side effect, or if it is an unrelated issue?

Offline JimDublin

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Re: worried about missed doses
« Reply #3 on: April 15, 2018, 01:58:27 pm »
I removed your other thread as its a duplicate or at least in the sense its tge same topic

Stressing about adherence is exactly what doctors are suppose to do and you should be aiming for 100%

That said in the real world sooner or later you will miss a dose, adherence for most doctors is defined as taking 95% of the medication or more timely, now  it happens to the best of us that we miss one in a blue moon, its happened to me whilst traveling

Modern therapy has a long half-life and is forgiving to a point. Missing a dose or in your case two is not an issue as long as it not a habit or routinely happening.

Relax, you can't change it and if you have otherwise been adhered it should be fine.

I would post more but I'm on the phone and my thumbs don't type very well

Jim

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Offline JimDublin

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Re: worried about missed doses
« Reply #4 on: April 15, 2018, 06:38:32 pm »
Quote
I would post more but I'm on the phone and my thumbs don't type very well

Back at the laptop I can clarify a bit more than I could this morning, typing from the mobile phone has its limitations.

I also moved your entire thread to the " living with HIV" section, it normal for new members to post an introduction thread first and moving you thread and posts means it can work as that.

I've induced a few more references on the topic as adherence but basically your medication is more forgiving that you think, that said we should all try for 100% adherence but no panic or stress is needed over a missed dose when it does happen. That's life, and it happens to the best of us.

Quote
The last year or so i have been experiencing muscle and joint pain, stiffness in my legs and was wondering if it might be the meds? i haven't read of this side effect anywhere, so am thinking it might be something else causing it, but it has gotten worse as of late.

Why do you think it from the HIV medication? Look you should not be experiencing any or anything unmanageable and looking up side effects is not going to give you an answer. If you ever did have side effects than you should not be accepting them, plenty of combination to choose from nowadays.

That said joint pain, stiffness could be caused by a large number of conditions totally unrelated to HIV or HIV medication, people get sick regardless of HIV status so do what you normally would do when feeling ill or concerned about health speak to your primary doctor (GP) about it so they can asses the concern and start from there.

Take it easy

Jim

http://www.aidsmap.com/Adherence-of-80-95-not-good-enough-for-long-term-treatment-success-in-British-Columbia-HIV-patients/page/1432764/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632027/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4839839/
Irrespective of the cut-off point for optimal adherence, our findings support the tenet that optimal adherence to ART is associated with positive clinical outcomes. The threshold for optimal adherence to achieve better virologic outcomes appears to be wider than the commonly used cut-off point (≥95% adherence). Though patients taking ART should be instructed to attain ≥95% adherence, apprehensions of slightly lower adherence should not deter prescribing ART regimens at an early stage of HIV infection.
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You can read about HIV prevention here:
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Offline BKKKevin

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Re: worried about missed doses
« Reply #5 on: April 15, 2018, 09:52:28 pm »
Not sure what country but most places allow you to fill your prescription a few days before you run out... Many do this regularly as a strategy to build up a reserve of meds of a month or two... Ask your pharmacist what your refill policy is and try to build up a reserve of meds...

Offline tallslenderguy

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Re: worried about missed doses
« Reply #6 on: April 16, 2018, 01:57:00 am »
Hi BKKKevin,
i can refill my script a few days early too, i just failed to do so. I took my last dose on Friday and called it in on Friday, it was my neglect. work 13 hour shifts and filled my pill box the previous week before my work wee started, then forgot to call for the refill.

Thanks for the input JimDublin. I agree that 100% is appropriate, i work in healthcare so understand the importance of compliance which is why i was feeling pretty stupid. From the article i cited on MedScape, different meds have differing efficacy when it comes to half life and suppression, thought that article didn't get into specific meds, it did note that "...load detectable after just two days..." so it definitely got my attention. My guess is that is not enough time to promote resistance, but i don't want to be guilty of giving my strain an opportunity to mutate.

As to my leg issues, i don't "think it was from the HIV medication," (actually said: "am thinking it might be something else"), just going through a process of elimination and was wondering if anyone else taking the meds had experienced similar symptoms.
Thanks for your reply.

Offline CaveyUK

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Re: worried about missed doses
« Reply #7 on: April 16, 2018, 07:43:37 pm »
I was driving to work today and found a container that I sometimes decant my meds into if I'm going out and need to take them discretely. I was shocked on opening said bottle, to see my pills in there - which means I must have missed a day. I have no idea when. It happens and you should be fine. The risk of resistance is low generally on that combo, but if it turns out there is a problem there are plenty of options open to your doc. I stress that I doubt this will be an issue though.

Regarding odd muscle issues. I am on the same combo and went through the same thought process, as in the 2nd year of taking them I had a variety of odd muscle pulls and joint stiffness which were quite alarming. I mentioned them to my HIV doc who ran some additional tests (I don't recall what these were) and the outcome of the tests were fine, so she didn't think it was meds related. I'm now in the 3rd year and don't have any of the muscle/joint issues, so either it was a transient problem that resolved over time or more likely - it was related to something completely different. Either way, I would just hang in there and see if over time the problems resolve. If the problems are really affecting quality of life then by all means discuss with your doc.
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