dosage discrepency

[minismom]

Mini got her new meds and we started her Viramune last night.  The prescription was written for 15ml 2x/day.  However, after reading the information insert, it says that the dosage should be 1x/day for 14 days and then raised to 2x/day.  We called her PID today and the nurse said that the doc is out of town until the 23rd.  There are no other ID docs .  The nurse said that we should stick with what the doc prescribed because the doc "is pretty good about things like this."  The nurse didnt' even know what the heck the med was for!  Explaining it was a truly charming experience.  So, anyone else on Viramune: did you start out with 1 dose / day for 14 days or did you go straight to the 2x/day?

Mum

[penguin]

Viramune needs to be dosed once daily for the first 2 weeks - this is very important, as it helps to reduce the chance of serious allergic reaction. Mini also needs ot be having her liver function monitored regularly, especially at he start of taking nvp - every 2 weeks in the first two months,then at the end of the 3rd month, then every 3-4 months if they are within normal limits.

if she has no allergic symptoms, & liver function tests are ok,then she can increase to the twice a day dose in 14 days time. The allergic symptoms to watch out for/other info are listed in the prescribing info, and here, from ibase  (the chance of this happening is very small,but it is important to have the information)

hope that helps - kate

[Damien]

What I have done when I have a BIG drug question like this and my ID doc is out of town is to do some research and find a close by ID doc and call and ask for a second opinion consult over the phone.

Other ID doc's are understanding when your doc is out of town. I just call and beg the nurse to relay a message, sometimes they might ask for you to contact your docs office so they can let some lab work faxed over. All insurance companies cover second opinions (the one I have worked with).

You need to get the expert advice for Mini's sake.

Any AIDS Service Org's can tell you the names of other ID Doc's they know of.

I hope this helps.

Yours,
-Damien

[Winiroo]

I absolutely agree you should get another doctor who is familiar with HIV treatment to confirm the dosage.
My late husband was prescribed 8 Bactrim a day for 14 days by a doctor who did not specialise in HIV while hospitalised for chronic lung infections. Needless to say it destroyed his liver and started him down hill to his eventual death.
It never occured to us back then to question a doctors order.

[minismom]

I'm going to look around tomorrow and see if there is an HIV specialist in PA.  There isn't another one here, in WV,  that I know of and the nurse didn't seem to know anyone i could talk to.  But then again, she really didn't know a whole lot about anything.  We don't have an ASO that I've been able to find or that DHHR knows about either.  Kate (penguin) suggested we ask Caratas House.  They came to the house and helped out / gave information (and humored at our ill-education) when Mini was born, even before she was tested.  So, I'll give them a call if I can't find another doctor.  Her last med check was in November and it was normal.  Her PID said that Mini didn't need to come back until her regular appointment on May 5th, and I asked SEVERAL times about checking her between to make sure her VL behaves itself.  We read all the info. on the sheets and it didn't say anything about the liver tests.  We'll ask whomever we can find to talk to tomorrow.

Thank you so much for all of the advice.  It has helped a lot.

mum

[Damien]

I did a little google research....

Here are the ID docs I found near WV

Dr. Melanie Fisher - West Virginia University, Morgantown, WV

Dr. Sandra Y. Elliott -  Charleston, West Virginia

Dr. Fred T. Kerns - Charleston, West Virginia

Dr. Wannetta S. Matulis - Charleston, West Virginia

Dr. Roger D. Anderson- Parkersburg, West Virginia

This is just a partial list ... you might be able to find more on Google.

Hope this helps. Send me a private email if I can be of any help ... (use the link in my profile)

Yours,
-Damien

[minismom]

After being told by doctors that they are adult ID doctors and aren't "comfortable" answering a question about pediatrics, I found someone who would at least TRY to help answer our question.  What ticks me off is that this doctor is in the SAME building as Mini's PID and the idiot nurse didn't even know this doc existed.  Anyway, the nurse pulled Mini's records and will hand them to a doctor.  We should be getting a call this afternoon.  I'll let you know what they say.

Mum

[minismom]

Good grief!  Someone called us back earlier this afternoon.  But, when I answered the phone, the kind doctor told me that he was a general pediatrician.  I said, "you do understand this isn't a general pediatric question?"  He said that he understood and stated that the other ID doctor we called in turn called him because he works with peds.  WHAT???  Ok, somehow in this place a doctor who deals with snotty noses who KNOWS a PID is now qualified to make dosage decisions of an HIV+ peds patient.  I told him the name of the medicine and then quizzed him about the drug: what is it used for, what class of drug is it, do you understand why we switched to this drug, do you understand her combo history,....He was having flashbacks of medschool, I'm sure.

Bottom line, he looked up the med and made the decision that Mini should be on 1 dose 1x/day for 14 days then moved to 2x/day.  He said he'd put a note in her file on the computer and e-mail Mini's PID.  I asked about a liver function test.  He got really quiet.  I thought maybe his head had exploded.  *sigh* I told him never mind, I'd ask Doc when she got back in town.

I'm so very glad that this wasn't a terribly serious emergency since no one else at that hospital seems to be qualified to deal with a jr. pozzie

mum

[J.R.E.]

Hello Mom,

When I was started on Viramune you are started on half the dose for two weeks. After that time, both viramunes are taken 12 hours apart.

This is according to the lessons on this site :

"Viramune can be given to children, using their size or their body weight to determine the dose. Most experts prefer to use body weight as the method for selecting a Viramune dose. Children under the age of eight should receive 7 mg per kilogram of body weight every 12 hours. Children eight years of age and older should receive 4 mg per kilogram of body weight every 12 hours.

 Note: For the first 14 days of therapy, Viramune should only be given once a day, meaning that half of the regular dose should be used. This can help prevent rash – a common side effect of Viramune treatment."



Ray

[minismom]

That's what we had read, but it's not the way her doctor wrote the RX.  We also noticed that the lesson says to dose according to wt and the doc told us that it is supposed to be doses according to height (meters squared).  By her wt, she can take the 200mg pill.  By her height, she needs 166mg per dose.  She's back in town on Wed and we'll be giving her a call.  I've never had a problem like this with dosing before.

Mum

I was just thinking, though. She may have dosed it this way because Mini will be 8 the end of August and with the drop in dosage, by almost half per kilo, Mini would probably need to be put back on the liquid in just a few months.  She weighs 45lbs and is 46 inches tall.

[newt]

It is important Mini starts Viramune at half (1 x day dose) regardless of what this is to reduce the risk of a bad reaction

If all is okay in 2 weeks of so she can increase the dose to 2 x day.

This applies for adults and children regardless

- matt

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