Changing meds

[klassykitty]

I had my 3 month doctor visit yesterday and told him that with my job schedule it is hard to take my Isentress 2x like I'm supposed to. 

So he asked me if I wanted to switch to that new pill Tivicay instead of my isentress, apparently I would only have to take the Tivicay once a day.

Has anyone taken this yet?  I have a month of Isentress left so I have about 2 weeks to decide. 


On the plus side, doctor has decided that I can go off the Zithromax after I'm done with the bottle I have now.   (I do however have to stay on Bactrim until the end of time).

thanx
Michelle   

[ad2san]

Hi Michelle,

just fyi, I take Isentress 2 pills once a day. No problem. Maybe you can discuss this option with your doc.

Cheers

[mikeyb39]

Hi Klassy, I haven't tried it myself, but hope you tell us how it goes.  I take issentress  now 2x /day, but would like to do the trivicay once a day.

Please keep us posted.   might be something I discuss with my doctor at some point

[eric48]

I was on 2 x daily (not issentress but Viramune 200mg)

I took the 2 x 200 mg OFF LABEL for ca. 6 months (2 x 200 mg once daily proved non inferior in one clinical study but the manufacturer did not bother file with FDA)

Then when 1 x 400 mg came to the market I moved to it (official once daily)

Once daily 2 x Raltegravir (Issentress) proved somewhat inferior in trial, which does not mean it can not be done, but there is a marginal risk of failure. The known issue is wide variability in adsorption between patients.

I can therefore confirm that YES once daily is MUCH better in terms of QoL

Since your doctor has suggested this Once daily in the same class, I would not hesitate ...

This is not a drastic switch, just a mere adjustment, but you will like the once daily

In the interim, should you go once-daily-2-pills RAL ?

If this is for just one month, why take the risk (even if this risk is small...)

Eric 

[newt]

Once daily 2 x Raltegravir (Issentress) proved somewhat inferior in trial, which does not mean it can not be done, but there is a marginal risk of failure.

...for people starting treatment, not with supressed viral load. It was pretty good 1 x day anyhow (better than some others).

Tivicay seems simple, and is a small pill, why not? I would

- matt

[Ann]

...for people starting treatment, not with supressed viral load. It was pretty good 1 x day anyhow (better than some others).

Once again, Eric misrepresents study findings. Once could be forgiven for thinking he doesn't really understand the studies he reads. Eric, your posts need to come with a disclaimer such as "cannot interpret data accurately".

[wolfter]

You're really considering a med change because of convenience?  If your current combo is working and you're tolerating it, why take the chance of issues with a different med.  I have a very confusing work schedule and work all 3 shifts throughout the week depending on the duties I'm performing.

It has never hampered my ability to find 20 seconds to ingest a couple of pills. 

take care
wolfie

[eric48]

What I had in mind is this paper:

http://www.natap.org/2013/EACS/EACS_25.htm

I had not really gone in the details, but, since the authors, as of Oct 2013, where concluding:

The Paris team proposed that switching virologically suppressed people to once-daily raltegravir is effective through 48 weeks as long as raltegravir is taken "with a fully active backbone regimen." Switching patients to either once- or twice-daily raltegravir, they cautioned, requires "access to the entire antiretroviral history and all previous HIV genotyping test results." Even with these precautions, the high proportion of people with low raltegravir minimum concentrations may worry some clinicians.

This was my rationale for saying, that, if the switch to Tivicay is to be made soon, there was no real reason to change the current RAL dosing in the interim

That been said, I do not mind being corrected whenever I have overlooked something.

Eric

modified to add: it happens that I did have this discussion with my own Doctor,when considering RAL as plan B, when my VL was taking so long to go down. That was back in 2011. At that time he was insisting on twice daily.
May be this opinion should be revisited. In any case I did my best in order to stay on once daily. With the most recent data, I would not mind taking once daily, but, I would seek Doc's opinion before that
 

[klassykitty]

Wolfter--My doc talked to me last year about this but I wanted to wait until it was out for a few months before the switch.    It's more the upset stomach and not being able to sleep (although that could be the truvada or the combo of the two).  He thinks the tivicay won't upset my stomach as much.  So it's more the tolerence thing than the convienence, right now I take my second one in the parking lot at work when I'm done. 
there is no way I could work all three shifts in the same week, I've done it before and it's worse then third shift.

Eric-I've been on ISentress since my diagnosis in 2011,  I just refilled my Isentress last week so my doctor told me to think about it for a week or two.  My viral load has been undetectable since april of 2011, or somewhere around there. 

Adsan- Taking one at a time hurts my stomach I wouldn't try both at the same time.

Ann--Eric had to many stats for me to follow what he was saying (sorry Eric)

Newt-it's hard to believe but my muti-vitamin is larger than the isentress, today I asked the pharmacist guy if he knew what the tivicay looked like and he showed me the pill, it''s a pretty yellow amd smaller then the bactrim.

YEA!! for the first time since may of 2011 I didn't have to pick up zithromax this month.

I may try it and see how it is on my tummy and if I can sleep better.

Michelle

[wolfter]

That's a little different than what it appeared your reason for the change was.  I had severe insomnia for several years and couldn't get any relief.  I finally had to insist on a med change as I thought I was loosing it from the total exhaustion.

We had planned on switching to Trivicay but my damn resistance issue stopped that.  My doctor believed it was My Isentress and not the Truvada that was causing the problem.  We switched it out for Prezista and Norvir.  Immediate relief.  All I could do for a solid week was sleep.

take care of yourself
greg

[eric48]

(sorry Eric)

Don't be...

I think the bottom line is that this minor adjustment will make your life easier. This is worth the inconvinience of temporary stomach upset (if any...)

This is a 'within class' switch so your concerns about doing this , this early into treatment , for convienience, can be put to rest

So I think you should follow your Doc advise and do the switch

Has you doc made some comments about whether you should plan a few days of overlap or just switch cold turkey ?

Eric

[emeraldize]

KK

Like others here, I takes my Issy once a day.

And it works.

My medical person knows I do this and is fine with it.

I've been doing it this way quite a while.

Edited to add :  Truvada was just starting to do a smidge 'o damage.

So I switched to Epzicom and things settled down.

[mikeyb39]

Hi Em, I do the same thing a lot of times only do 1 issentress per day even-though it calls for 2 per day.  nothing ever happened with my VL, but my CD4's jumped quite a bit.

i'm on bare amount of hiv drugs at this time, the less the better

[emeraldize]

Hey Mikey

I don't lower the dose I take both plus the Epzicom at once.

If you 're gonna do it, ya still gotta get the full dose in.

Dare devil.

Em

[eric48]

Thanks for your testimonies.

I now consider RAL, which is my plan B, as once daily. If I ever had to switch to it , and since Tivicay is not available here, I 'd go 6 months Twice daily, confirm UD, then move to once daily

Once daily is so much easier!

Thanks again

Eric

[eric48]

If you 're gonna do it, ya still gotta get the full dose in.

Not so true... Lots of people around me are taking 5/7 (FOTO) and ANRS W 185 aka 4/7 is expected to confirm this...

The trial has not started but expected to start this fall (pending funding) and we should wait for the results

As far as I understand, RAL (Issentess) has been excluded from the less than 4/7 trials (due to Pharmacokinetics and failures in the pretrial) but not from the 4/7

Well this is another topic

Eric

modified to add: the protocol to be tried (not yet tried, I should insist) includes RAL twice daily 400 mg not 200 mg