Atripla Dosing Times

[Gambit]

I KNOW this question has probably been asked a million times.. but a search didn't really help and this forum only has one page.  But my question is about whether or not its ok to sort of change your dosing times on occasion. 

I work nights and usually take my Atripla around 3am (give or take half an hour or so).  But sometimes I have things going on when I can't be up that late (if I'm sick, have an appoint at the crack of dawn, or like right now.. when its 10:45 and I am SO TIRED I feel like I am going to fall over).  My doctor told me to keep things within 2 hours, but what am I supposed to do if I really can't stay awake that long all the time?  I know I can take the pill earlier when I get off work, but it usually makes me really light headed after about an hour and I can't stand to be up doing things when I feel like that, so 3am really works out for me.

So can I take a pill normally at 3am, then occasionally take it at 11pm?  Maybe scale my way back to 3am (take it at midnight tomorrow, then 1am the next night, etc).  Is this ok?  I know its better to take the pill at a different time than to, lets say, fall asleep and not take it at all, but how safe is it really?

[Hellraiser]

The reason you're dosing every 24 hours is an attempt to maintain a constant level of the drug in your system.  Your body will tolerate the drugs fine if you put a little bit extra in by dosing early.  The problem occurs when you start stretching the time beyond 24 hours.

So if you take it at 11pm one night and say 3am the next time, you've now gone 28 hours instead of 24.  I do this sort on occasion but my viral load has reached undetectable so I feel comfortable moving within a couple of hours every night.  I don't think moving within a 6 hour window every once in a while is too bad, but it's really up to you.  I would discuss this with your doctor and you may want to go over to thebody.com and ask their doctors.  There is a successful experimental study of taking Atripla 5 days on, 2 days off and this would seem to suggest that once your virus is controlled you can adjust the dosing quite a bit and still be alright, however the suggested dosing schedule is still 1 pill every 24 hours.

[Inchlingblue]

The timing does not have to be exact, this is what thebody.com has to say (I think it's best to be undetectable before playing around with timing):


time to take atripla
Feb 26, 2009

Is it important to take atripla on exactly the same time everyday, or can i just take it when i go to bed, even if that would be at a different time each day?

Response from Dr. Young

Hi and thanks for your post.

It's ok to take your bedtime medications (Atripla) with some fluctuation in time- just make sure to take it every night.


LINKS:

http://www.thebody.com/Forums/AIDS/Meds/Archive/FirstLine/Q199683.html

http://www.thebody.com/Forums/AIDS/Meds/Archive/Adherence/Q193645.html

http://www.hopkins-aids.edu/s.html?siteId=7151&publicationId=7147&navDepth=..%2F&queryString=atripla+dosing&image.x=0&image.y=0

http://www.thebody.com/Forums/AIDS/Meds/index.html


You can also go to Dr. Gallant's site or thebody.com, as Trey suggested, and do searches since this question has been asked many times and you can get an idea of what the consensus is. On Gallant's site the search function is not that great, you should just search "Atripla" without any other words or the results are not complete.

[Gambit]

Thank you for the replies.  I ended up changing the time I take the pill.. I'm glad I'm not the only one who isn't able to stick to an exact on the hour schedule (I'm only human..). 

[BlkRedBonenla]

There is a successful experimental study of taking Atripla 5 days on, 2 days off and this would seem to suggest that once your virus is controlled you can adjust the dosing quite a bit and still be alright, however the suggested dosing schedule is still 1 pill every 24 hours.

Really? I assume this 5 day rotation is after your VL is consistently undetectable and cd4 ... how high is high enough to begin this? I spoke with my doctor when I started ATRIPLA how soon I could go OFF, and she said to the extent we would even talk about that it would have to be @ 500. Even then she explained the risks of the drug becoming ineffective and I would have to go to a [stronger] drug next time.

[Inchlingblue]

Really? I assume this 5 day rotation is after your VL is consistently undetectable and cd4 ... how high is high enough to begin this? I spoke with my doctor when I started ATRIPLA how soon I could go OFF, and she said to the extent we would even talk about that it would have to be @ 500. Even then she explained the risks of the drug becoming ineffective and I would have to go to a [stronger] drug next time.

Going off as a treatment break is not a good idea, even if CD4s are above 500. People who take breaks have been shown to have higher incidences of certain cancers and of other complications.

If you hang in there, there is likely to be treatment in the future that does not require meds every single day.

As far as the Atripla study that Trey refers to, it's called FOTO. If you do a search on here and/or on Google for "HIV FOTO study" there is a lot of information. And yes, this was studied on people who had been undetectable for, I believe, at least six months already.

[ruralguy]

Once you have been on it for a while you can take it whenever you like so long at it is a regular schedule.  I take it when I first get up in the morning....