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Missing doses--sort of.

Nov 6, 2000

Thank you for this service. My question is about missing doses. I take my medication everyday, twice a day as instructed. However, I rarely take my medication exactly 12 hours apart. More often, I will take one dose at around midnight, and another around 3 in the afternoon. Also, at least one dose a day is not taken with food, as it is supposed to be in an "ideal situation" according to my doctor (I am on Viracept, Zerit and 3TC.) Would this be considered noncompliance and am I at risk of a viral rebound? Thanks again.

Response from Dr. Cohen

Well, glad the meds are working well for you. If your viral load is below 50 copies on them, whatever you are doing is working well. So far. People do vary a bit in how we process these meds -- so in general we suggest that they are taken about every 12 hours apart. However, most of these meds are not that strict and most will see benefits even with some "wiggle" room around these time demands. So if you are taking your meds with a 9 and 15 hour window on some days, and your viral load is controlled, you are probably OK with this schedule. Others however might be at a higher risk of viral rebound with this schedule -- which is why we suggest getting as close to every 12 hours as possible. For some it is less necessary and we can't yet easily tell for whom these times are less critical -- except after the fact. If it is working on your current schedule, odds are good it should continue to work. There is consideration for getting drug levels to check these things -- and perhaps in the next year this may become more widely used, to assist us in knowing if YOUR schedule works for you.

As for food -- viracept does require food to be adequately absorbed. Again keep in mind that for some, particularly those who had lower viral loads when starting, or just those who are better "absorbers" -- the food issue may be less critical to seeing success. But, for some, taking viracept/nelfinavir without food is exactly why they have viral escape, even despite otherwise excellent medication adherence. It is all about maintaining adequate drug levels -- and some meds require food to be absorbed adequately. (Note an answer to another recent posting -- detailing that neither beer nor whiskey count as food here.)

Hope that helps.


Cal Cohen, M.D., M.S.

A failing cocktail?

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