What happens when medication adherence is off?

[magnoman]

My partner takes one pill every morning and two every evening. In theory they are meant to be at the same time, I believe.

He has been doing this for around three years... Periodically he might miss a dose (generally no more often than once a month, although I believe this month he has missed the morning pill twice) and the timing of his pills might vary by a couple of hours, especially the morning one.

I want to be a supportive partner without being a complete nag. So was wondering is this something I should be making more of a thing about, or is it not that big a deal so long as he misses very few doses.

[AusShep]

The timing of a few hours doesn't matter at all if he's generally adherent and undetectable. 

While missing a dose once a month is probably ok, he should try to do better. 

My partner and I have pill organizers that we leave by the sink so we can both check on each other.  Setting a phone alarm is another way.  Try to find a way to make it part of your routines without nagging. 

My current meds are ok to take 12 hours late for a missed dose, so the couple of times I've had an oh shit, I forgot to take my meds in the morning moment over the last few years, I just pop them in the evening and get back on schedule the next morning.

Some studies have suggested that low level resistance can build up over time, so even if he doesn't have immediate treatment failure, it could be a contributing factor later.  There was no proof of this, BTW, it was conjecture by the authors due to increased numbers of failures at all levels of adherence. 

Those with 99% adherence had more failures than those with 100%.  Those with 95% had more failures than 99%, etc.  so even though missing a dose a month isn't the end of the world, missing just one every 3 months is better, never missing them is even better.   I think the general consensus here is to have at least 95% adherence; so no more than one missed dose every 3 weeks.

[magnoman]

Thanks. That is what I hoped. The few times I do remind him about his pills tends to annoy him and his adherence is generally good.  Just occasionally he will avoid taking them if he has a heavy drinking night which is only 2 or 3 times a year.

Appreciate the reply.

[harleymc]

It will depend on the medications. Some of the medications have longer half-lives in the body than others.

One missed dose per month, that would be 718 dosings per year out of 730, better than 98% compliance. Depending on the medications, a lot of ID doctors consider anything above 85% to be a safe level of compliance but clearly the higher the number the better.

Don't sweat it about a couple of hours one way or the other.

My poz ex-partner was cool with me asking if he had taken his pills once per occasion only, but to ask a second time or to tell him to take his pills was a no-no. I have the same boundaries.

You need to ask your partner's limits around what is welcome and what is unwelcome, don't ask us.

[harleymc]

As a little post-script...
The deal with my ex regarding asking about, not nagging about medications was explicitly negotiated. The boundaries around what is welcome and unwelcome were not assumed.

[wolfter]

I want to be a supportive partner without being a complete nag. So was wondering is this something I should be making more of a thing about, or is it not that big a deal so long as he misses very few doses.

Relationships are so different that it's difficult to respond.  He's the one you should be asking and listening to.  His feelings and opinions matter more than ours.  That being said, you did ask here. 

I'm such a smartass, that I'd answer then ask him if he brushed and flossed yet.  It's equally important and of course I already know the answer but could you imagine a partner asking you that repeatedly?

[magnoman]

Many thanks for your insights.