Dosage Shortage! Advice?

[IgotTigerBlood]

I'm on the Truvada and Isentress combo.

For some reason, I had an odd number of Isentress pills in it's container, and was on my last day before getting my refill tomorrow.

Is it ok to take just one Isentress for the day with my Truvada, opposed to not taking anything at all, and missing a dose.

Are there risks to taking my twice daily Isentress ONLY once today with my once daily Truvada? I need to know because that's what I just did.

Thanks a million!

[mecch]

Gee I really dont know.  But being on the same combo it would be good to know.
The way i see it, you got almost all the combo in you today, and tomorrow you will take all 3 pills, right? So its not like you skipped a day.  And as far as I understand, skipping a day a few times a year isn't that dangerous. I wouldnt be worried.

[Inchlingblue]

Chances are that it's OK especially if you are undetectable.

I am on the same combo (since July 2009) and have been totally adherent except one day I forgot to take the morning dose of one Truvada and one Isentress so for that whole day I only took the evening Isentress. In my case it turned out OK. Obviously one doesn't want to make a habit of it.

I recommend you try and fill your Rx as early as they allow you to, which is usually every 24 days or so, so that you can build up a bit of a supply.

Yesterday I actually double dosed on Truvada. I took it both in the AM and in the PM, along with Isentress. I'm going to skip Truvada today and I'm hoping that'll be fine.

[mecch]

The logic of half lives would not suggest skipping a day after a double dose.  The point of taking it everyday is to keep up the level in the blood stream.  I dont think a double dose equals 2 times the duration in the blood stream.

[Inchlingblue]

The logic of half lives would not suggest skipping a day after a double dose.  The point of taking it everyday is to keep up the level in the blood stream.  I dont think a double dose equals 2 times the duration in the blood stream.

I appreciate what you're saying and you have a point but I wasn't entirely going by the logic of half lifes.

I'm hoping I'm not wrong but I based my decision on things like the FOTO study (even though that was Atripla, Truvada is part of it) and the fact that several people I know of who are undetectable and on a combo involving Truvada, such as Shawn Decker, don't take it every day (I think he takes his meds one week on, one week off, Reyataz/Norvir/Truvada). I was weighing that against the damage that too much Truvada in my system at one time can do to my kidneys.

As far as half lifes (I think that's the plural version when used in pharmacokinetics?), even though double dosing one day would not suggest I have the correct levels for the entire next day, I do think the levels will last longer than skipping a day altogether following a day of a single dose.

It's still not too late, I can take a Truvada today, maybe I can take it in the afternoon to spread out the schedule and go back to AM tomorrow.

It's frustrating when this happens since one wants to do the right thing, uggh.

Didn't mean to hijack the thread, Igot.

[Tim Horn]

Inch:

As a rule of thumb, even when a double dose of a medication is taken accidentally, it's usually best to take your next scheduled dose. While a double dose can definitely increase the drug's Cmax (maximum concentration), it won't necessarily slow the clearance of the drug -- the levels of tenofovir and emtricitabine in your blood (and cells) 24 hours after taking the double dose of Truvada may not be any higher than they would if you'd only taken a single dose of the combination tablet.

I wouldn't worry about kidney toxicity -- this is something that tends to develop, in some people, when the drug is being used on an ongoing basis. There's no evidence that someone can give themselves acute kidney toxicity after a double dose.

All of this said, Truvada IS a "forgiving" drug in that a rare missed dose should be a problem. But this really isn't necessary here, given that the double dose shouldn't be much of an issue in the first place.

Cheers,

Tim

[eric48]

Inch:
All of this said, Truvada IS a "forgiving" drug in that a rare missed dose should be a problem.

I suppose there is a typo here and one should read : ...rare missed dose should not be a problem.

Am I right ?

Eric

[Inchlingblue]

Thank you Tiim!@@

I think I know what I'll do: last time I opened a fresh new bottle of Truvada I noticed there was a lone pill that was only slightly more than half-way broken (just like me!), and I didn't know what to do with it so I'll just take it today. Down the hatch.

[IgotTigerBlood]

The way i see it, you got almost all the combo in you today, and tomorrow you will take all 3 pills, right? So its not like you skipped a day.

I asked my pharmacist about it, she said DO NOT take 3 doses the following day, just continue the regular amount (2)  of Isentress you usually would take.

I've had a really shitty day! My pharmacy failed to deliver my medication now also!! and now their closed until tomorrow

Another day in the life.....

[buginme2]

I think more importantly is that you are cutting it close to the point if something happens on your last day of your medication you don't have any options to obtain more medicine.  Can your pharmacy refill the prescription a little early each month so you begin to carry over pills each month and build up an extra supply.  The pharmacy I use mails my medication to me each month but they also fill it the earliest it is available.  I have only been on meds since december but I have already built up buffer incase something like this happens (and I haven't missed any days).  Not sure where u live but maybe there is an HIV specialty pharmacy in your area.  The one I use is great.

[IgotTigerBlood]

Chances are that it's OK especially if you are undetectable.

That's good to know

I recommend you try and fill your Rx as early as they allow you to, which is usually every 24 days or so, so that you can build up a bit of a supply.

Good advice, I usually get it delivered though. I'll ask if they can deliver it that early for me. I'm sure we could work something out.

[IgotTigerBlood]

Can your pharmacy refill the prescription a little early each month so you begin to carry over pills each month and build up an extra supply.  The pharmacy I use mails my medication to me each month but they also fill it the earliest it is available.

Ya I'm definitely going to call tomorrow to set something up earlier delivery routine. They should be able to do it. It's just they'd never let me down before, but I guess everybody makes mistakes, so now I can't just rely on my history with them.

[surf18]

After I couldn't get refills in time(ended up borrowing a couple pills from a bud), I said never again.
I use a mail order company and call them about 9 days left in prescription and tell them to send them. So then I take the extras out and stash them just in case I need them. I just don't trust anyone with this. It's two impt and so many things can mess up your delivery. Like my last order they didn't send in time.
And one of my meds selzentry is not able to get locally. No one has them.