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Delayed dosage and Missing one dose of Combivir
Jul 28, 2007

I have started nPEP for 3 days so far, from Tuesday 17th. Last night (Thursday 19th) when I took Sustiva at a regular scheduled time (9.00PM), I fell sleep and missed my Combivir at 11.00PM, so I took it at 3.00AM. Question 1: Would that be OK if I took the pill 4 hours later than my schedule for Combivir?

Having taken the dose 4 hours later than schedule also made me worried and wondered, so I went and checked the numbers of Combivir and counted them and it turned out that the number of the pills was odd. That made me wondering and suspecting whether I had missed the morning dose at 11:00AM. [This could be a miscount on a pharmacist's part.] Now my other question is (2) if I did miss that morning dose (which I doubt) and took the next one 4 hours later, would that cause a problem with my regimen?

I am going to take the next pill at my regular schedule and adjust my schedule so that I take the evening one together with sustiva to minimize this chance in future.

Could you please let me know ASAP?


Response from Dr. Frascino

Hello Worrisome,

This is another example of why I suggest that folks who have had a significant enough HIV exposure to warrant a course of PEP be followed by an HIV specialist if possible. The HIV specialist could accurately document HIV risk, optimize the PEP regimen, handle any dosing inquiries, manage any PEP-related toxicities or side effects and arrange for and interpret post-PEP testing.

Your four hour delay in taking Combivir is not a problem. Similarly if you missed a single dose, you should just continue on with your 28-day regimen as prescribed. Certainly we strive for 100% adherence to the dosing regimen, but begin human mistakes sometimes happen ("manure occurreth"). I do not believe you significantly harmed your chances of PEP being effective.

Good luck.

Dr. Bob


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