How do you take Isentress

[ad2san]

I there, my doc would like to switch me to Isenstress (twice daily). I am not very good in taking meds at a given time and would like know how you, Isenstress users , do this 

Cheers

[synergyhomepage]

I just swiched off of Isentress, in hope of getting to undetectable, Isentress does not need to be taken with food, therefore I would take one in the morning with my coffee and a couple of antibiotics thrown in on top.  then my evening pills before bed.  I should be taken at roughly 12 hour intervals.  many free apps and online reminders can be found here on poz.  To be sucsessfull keep your routine as normal as you can, find a way to fit them into your life rather than rewriting your life for pills.  I usally dont screw up more that once a month,  GOOD LUCK

[Miss Philicia]

Unlike the previous post, I take Isentress with other things that need food, so the easiest solution for me is to take everything at breakfast and dinner, and I make these two events at ~12 hours apart.

[mecch]

I believe you should ask your doctors recommendation to suit your particular infection history and case, and not learn from others.

Because in some instances its ok 1x a day. In others, the preference is 2x a day. 

That said, no doc ever said I had to be anal about timing, when I had the 2x a day direction.  But a good distance apart. 

The doc also said "just get the two pills into you every day", thats the most important.  Cause if 2x a day dosing might lead to a missed pill, thats bad.  If that is your fear:

1) Get a pill box
and/or
2) ask permission for 1x a day dosing.

[ad2san]

I believe you should ask your doctors recommendation to suit your particular infection history and case, and not learn from others.

Because in some instances its ok 1x a day. In others, the preference is 2x a day. 

That said, no doc ever said I had to be anal about timing, when I had the 2x a day direction.  But a good distance apart. 

The doc also said "just get the two pills into you every day", thats the most important.  Cause if 2x a day dosing might lead to a missed pill, thats bad.  If that is your fear:

1) Get a pill box
and/or
2) ask permission for 1x a day dosing.

Well sorry but my question is not rather take it once daily or twice daily but what tolerance you may have in relationship to the 12 hours windows.

Take care

[mecch]

Far as I know, as directed, there is plenty of leeway.  Thats per my doctor's instructions to me.

[Miss Philicia]

Because in some instances its ok 1x a day. In others, the preference is 2x a day. 

Got a link for that? Because once daily failed in studies when they were conducted in 2010.

[buginme2]

If Isentress had such a small margin of error in timing that you had to take it exactly 12 hours apart there would be a lot of Isentress resistance running about.

Find a rhythm that works with you such as (Breakfast and Dinner)  if breakfast is at 7 am one day and 10 am the next day..as long as you are taking it,, youll be fine.

[mecch]

I am aware of that.

I got the OK from my doctor, as explained. I specifically said -- ask your doctor the best instruction based on your own needs and case.   

My doc is a researcher, prof, and doctor in infectious disease and HIV, and mentioned the same research, and still gave me these instructions.  Gave ME.

Me, Mohogany.

[Miss Philicia]

anonymous guy on the internet vs. clinical trials

[Dachshund]

Got a link for that? Because once daily failed in studies when they were conducted in 2010.

Oh shit, I better tell my doc cuz he's had me on the 1x a day dosing for years. Ah fuck it I've been undetectable forever.

[mecch]

anonymous guy on the internet vs. clinical trials

Seems to be Miss Understood here.
Miss P, its good to know the research.  And its good to trust ones doctor and follow the doctor's instructions which are given to you.
I precisely agree with you - why should the OP apply YOUR directions, or my directions, or Dachunds directions, which each of us got from our own freaking doctors, based on their expertise and for our own needs. 

[Miss Philicia]

You're the one being given an "off label" use, not me. My doctor is following the approved use so I don't need to explain anything, and I'd expect that a professor would understand that.

I have no problem with off label use, but if I was given that I'd want to know why. Obviously neither of you know why, or care to. Would you also sniff glue everyday if your doctor told you to?

[mecch]

Precisely.

So now the OP has three pieces of information and should probably ask his doctor for instructions precisely on this point and make up his own mind what to do for his own situation.

[Miss Philicia]

Precisely.

So now the OP has three pieces of information and should probably ask his doctor for instructions precisely on this point and make up his own mind what to do for his own situation.

If you read his first post it seems the doctor has already made an assessment on the dosing frequency. Are you questioning his knowledge base?

[mecch]

I there, my doc would like to switch me to Isenstress (twice daily). I am not very good in taking meds at a given time and would like know how you, Isenstress users , do this 

Cheers

Miss P, why is this so contentious for you.  The OP asked how users take their doses.  I explained how I do. I explained what my doctor said.  You explained the research. You explained what you do.  Dach explained what he does.

I am not a doctor, don't make recommendations and certainly don't have anything to say about the OPs doctor.  Don't put words in my mouth. 

What is the problem?

You've made yourself clear - the trial says 2x a day 12 hours apart. And thats what you do.

He asked for info about flex timing and dach says what he does and I said what I do and we both said our doctors gave the ok.  We didn't make any claim that trials support this.  We clearly said thats what our doctors said.

[Ann]

Those of you who are taking Isentress once-a-day have to remember that you were already undetectable when you switched to a combo containing Isentress.

I would be less cavalier when telling a treatment naive person that it's ok to take it once a day because "my doctor said I can". 

That said, Ad2san is not treatment naive and has been UD for around three and a half years.

He's going to have to talk to his doctor about once-a-day vs twice-a-day dosing, rather than possibly screwing up due to listening to off-label anecdote.

Ad, there are other once-a-day combos, such as Prezista, Norvir and either Truvada or Kivexa. I see you were once on this basic combo with Reyataz instead of Prezista, but from what I can tell, Prezista is better tolerated. I'm on Prezista, Norvir and Truvada since last summer and so far so good.

I understand the worry about missing the second dose in twice-daily dosing (that's why I went with a once-a-day combo). Explain your worries and talk to your doctor about other combos available.

[ad2san]

@ann: you perfectly right I am interested by Isentress  but not thrilled about the 2 a day 

my doc mentioned that a 1 a day possibility exist but that the trial was not conclusive.

I would rather have a once a day therapy no matter how many pills and one to be taken in the morning since this is when I best manage my time (and without drinking alcohol LOL). I will discuss the prezista/r combo option with him. We spoke about it but my kidney issue remained in my doc memory and he mentioned that it was a risk with PIs. Anyway, I will discuss it next week with him + the Kivexa - Intelence option. My routine blood work came back again with a very elevated Gamma GT (3 x max) and moderately elevated AST ... I am not willing to wait 6 month to reach the 5 x max gamma gt level to switch and as my stock of Nevirapine comes to an end I'd like to  switch now.

Cheers

[mecch]

That said, Ad2san is not treatment naive and has been UD for around three and a half years.

(And.....)

I understand the worry about missing the second dose in twice-daily dosing (that's why I went with a once-a-day combo). Explain your worries and talk to your doctor about other combos available.

This and This. 

For my part I didn't "tell" anyone to "do" anything.  I know the difference between first timers and undetectables switching.  Because I learned it here, and because my doc told me.

Which is why my suggestion was from the GET GO that someone should follow the doctors directions if he/she trusts the doctor. Because the doc knows all this and is giving the directions that fit the person's circumstances.

[Dachshund]

I shouldn't have been so cavalier with my response and I should have read the thread carefully. I actually take Prezista, next time I'll pay more attention.

[Ann]

Ad, the Prezista based combo has one small caveat - it needs to be taken with food. You don't have to eat a whole lot, just enough to get your gastric juices flowing because Prezista needs stomach acid. For this reason, you're not supposed to take antacids for two hours either side of taking Prezista.

If you're taking it in the morning, you can take it with breakfast if you're a breakfast person. (I'm not, I take it with lunch.) Even just a slice or two of toast will suffice.

I shouldn't have been so cavalier with my response and I should have read the thread carefully. I actually take Prezista, next time I'll pay more attention.

hehehe... I have to admit you had me scratching my head - I thought you were on Prezista and wondered if maybe you switched to Isentress and kept it a secret.

[jb1973]

I do it twice a day. A pill box works wonders. I usually try and take them around 6a and 6p. Occasionally, on the weekends the morning pill may be pushe back a few hours.  Also, I keep a couple extra doses in my car, and on a keychain for those instances where I happen to be runnin late an not at home by 6 pm. Honestly, they have come in handy more than once.

[ad2san]

Hi Guys, thanks a lot for participating to the poll and for your comments.
I got a box of Isentress today and tomorrow morning I will drop Viramune XR and Start K+I (E+I) ...

Cheers

If you guys that take it "once daily" can PM me I would appreciate. Cheers

[klassykitty]

Adsan.

I take my Isentress 2x a day. Between school and work I may take it 9, 10, or even 13 hours apart.  There have also been times when I have taken my morning one at 6am and my evening one at 11pm.  When I expalined to my doctor about my wacky schedule he said the important thing is to take it and be less concerned about when, just not to close together.

I take one in the morning by itself, that is about the only regular time, and then again at night when I go to bed, or after work.  Because I often until 11pm, I usually take my evening Isentress and my truvada after work in the parking lot.   

Like JB, I also keep some in a pillbox, although mine are in my purse. He is right, it helps when you can't be home at a decent time.  I don't leave them in my car all the time because I read that the cold, or hot weather can make them work less.  Not sure if that is true, just something I read somewhere.

Good luck with it.

michelle

ps I guess my answer should have been, just 2x a day whenever.

[ad2san]

Hello Klassykitty and thanks for your answer. I am going the flex way as well 

Take care.

[freaky_dream]

For the original poster I am on Isentress and usually take it 12 hours apart. however not always so. Sometimes I forget and take it late but take my second dose at my regular time. I have been undetectable the entire time. The key is to adhere to a set schedule until you are undetectable, if you aren't already. I usually have a few days of the year where I will miss one dose, just being absent minded, but have had no blips and remain undetectable.

As to one a day Isentress, from what I recall of the study it was done on treatment naive subjects and not already undetectable. The study had good results, however it was just inferior to twice a day and hence could not get approval as an alternative dosage option.

From CROI, March 2011: Isentress (raltegravir) is currently taken twice a day, the only drug that’s dosed that often as a preferred drug in the US Guidelines for people new to HIV treatment. Lab study of the drug has shown that taking it once a day may suppress HIV just as well. So, in an effort to simplify its dosing, the QDMRK study randomized nearly 800 people to take Isentress either once a day (800mg) or twice a day (400mg), together with Truvada.

None of the participants had taken HIV treatment before and all had viral loads >5,000 (2 out of 5 were >100,000), with no resistance to either drug in Truvada. A total of 382 people took Isentress once a day while 388 took it twice a day. Most were men and average age was 38. Average CD4 counts were just below 300, with about 1 out of 4 who were <200.

After 48 weeks, about 86% who took Isentress once a day and 91% who took it twice a day had viral loads <50 copies. However, when looking only at people with viral loads >100,000, 84% on twice-a-day and 74% on once-a-day were below 50 copies at week 48. As for those whose viral loads rebound above 50 copies, only 9 occurred on twice-a-day vs. 18 on once-a-day.

Although the overall results are generally good, and actually some of the best of recent HIV drug studies, they failed to meet a pre-specified viral load goal of the study which led to once-a-day not being “non-inferior” to twice a day dosing. This means it’s not as potent and failed to be equal to twice a day.

Side effects were similar between the two groups. Nine people in the first group and two in the second also developed resistant HIV to Isentress. Most of these cases developed in people who started at higher viral loads. Although Isentress dosed once a day had higher overall drug levels in blood, it fell lower in minimum blood drug levels (called trough concentration) compared to twice a day, which may be one reason why resistance had developed.

[ad2san]

Thanks you very much freaky dream. Take care