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Author Topic: Norvir dose size  (Read 2153 times)

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Offline BlueJ

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Norvir dose size
« on: January 04, 2007, 06:16:51 PM »
I had previously posted asking about triglycerides because mine were high.  My viral load has been undetectable and my t-cells slowly rising.  My doctor, whom I trust and respect lowered my Norvir boost to 1 pill.

I am receiving treatment at the county hospital, and my previous doctor has left.  My latest labs (4 months on the single Norvir) shows an undetectable viral load and the largest gain in t-cells yet - not by much, but still the largest and no real change in my triglycerides.

My new doctor wants me to start takin 2 Norvir again.  Her reasoning was that "taking 2 Norvir with Lexiva is the standard," and that I should take some fish-oil caps and see how that effects my triglycerides.

Here are my problems:
1: I dont' want a doctor making decisions based upon "the standard."  I mean, the first doctors that used Norvir as a booster rather than a stand-alone PI treatment were not following "the standard" and look how good that turned out?  Don't get me wrong, I don't want a doctor making wild unfounded decisions, but that's why we have HIV specialists, right?  I mean, anyone can read the FDA papers.

2: If it's working, why change it?  Again, with the largest t-cell increase in a 4 month time ever why put more of a drug into my body than it needs?  This stuff isn't broccoli, it's mini-poison.

I didn't get a favorable impression of my new doctor, which I'm certain is what has me questioning her decisions so much.  Maybe she's great, maybe my first doc was a quack.  I also thought it was ood she wanted me to start taking dapsone again, because my old doctor had me stop taking it once my t-cells were above 200 for six months.  She said "300, better to be cautious." 


Offline newt

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Re: Norvir dose size
« Reply #1 on: January 04, 2007, 07:29:00 PM »
Hey hello

Indeed, the "standard" dosing for Norvir booster with Lexiva is 200mg.

However, this is something of an educated, if well conceived and properly studied, guess.  The 200mg dose was selected for an important study to see if Norvir boosting meant less Lexiva could be prescribed. Since the outcome, both for 1 x day and 2 x day boosted Lexiva was good, the 200mg boosting dose found its way into the prescribing information. 

But some people will be fine with less, because (1) Norvir boosting, to a large extent, does not depend on the dose of the drug for its effect, your own liver genetics are an important factor (2) how Lexiva drug behaves -  especially at the end of a dose - varies considerably between people. 

One way to evaluate this is to order a drug level test, which will settle the matter. If you have enough Lexiva in your body at the end of the dosing window, then you don't need the extra Norvir.

I also understand that CD4 of 200+ for 6 months+ is a "standard" point for stopping PCP prevention meds. So that's one standard recommended, one ignored  :D

POSTSCRIPT - Aha, indeed again, using 100mg Norvir has been studied a little, with good results  - see: ICAAC: Norvir-Boosted Lexiva vs. Reyataz (by Tim Horn).  The study reported compared Reyataz + 100 mg Norvir, the standard dose, to Lexiva + 100mg Norvir. After 24 weeks, 79%  in the Lexiva group had viral loads below 50, in the Reyataz group, 83% had viral loads below 50, basically the same

- matt

« Last Edit: January 04, 2007, 07:39:05 PM by newt »
"The object is to be a well patient, not a good patient"

Offline Catman

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Re: Norvir dose size
« Reply #2 on: January 08, 2007, 09:05:17 AM »
Well I've been taking two Norvir pills twice a day with Aptivus which is also 4 pills a day. Though I have become "undetectable" with this treatment my triglycerides are always high and I think I read that Norvir is also responsible for advancing lipoatrophy. I still have to find out about the second said comment, if it is true, I may ask my doctor to see if we can  take two Norvir pills a day instead of four. Any comment is welcome, Newt.

Meow to the birds
Meow to the tree's
Meow to the end
of this dreadful disease...

Offline newt

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Re: Norvir dose size
« Reply #3 on: January 08, 2007, 09:20:31 AM »
With Aptivus perhaps not so good to reduce the Norvir...

...because Aptivus pharmacokinetics are, how shall we say, quirky. While Norvir boosts PI levels by reducing drug excretion, it does this by blocking a pathway in the liver called CYP3A4.  Aptivus on the other hand makes this pathway overactive, meaning drugs get excreted faster...hmmm.

I am assuming you are on Aptivus because of some kind of resistance. The new PI Prezista may be an alternative, something of a resistance-buster this drug, indeed scores better in this respect, both in terms of robustness and durability, than Aptivus (though data still limited).  Prezista is boosted with 2 x 100mg of Norvir a day, half the amount used for Aptivus.

- matt

Now playing: sirens from the Metropolitan Police again
"The object is to be a well patient, not a good patient"


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