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Time Zone Changes and Regimen Timing
Oct 6, 2000

I am currently taking Zerit and Epivir two times daily (7am and 7pm) and Sustiva once daily at bedtime. My Dr. has stressed the importance of taking the twice daily drugs at 12 hour intervals and the Sustiva at 24 hour intervals. Is there a recommended treatment adjustment if one is traveling to a different time zone temporarily -- in my case to a time zone 8 hours later than my current one, for a two week period. If I stay on the same intervals in the new time zone, I would need to take the Sustiva in the morning (which I was told to avoid doing) and the second daily dose of the other two medications would need to be taken in the middle of the night. Is this preferable to skipping a dose to adjust to the new time zone or is taking an extra dose of each to adjust to the new time zone preferable to either of the other two options, or doesn't any of this matter? Any suggestions?

Thank you,

Jim

Response from Dr. Stryker

This question comes up often, so lets see if we can come up with simple general rules that should be applied in most cases.

The most important thing is consistency, so do not try to make elaborate and complicated new schedules for your meds when you change time zones. This will only lead to confusion and hassle, which is to be avoided. In general, I'd suggest you convert to the "local" time immediately on arrival, and take your meds at the same clock time as you normally would. This rule applies strongly to time-zone changes of 3 hours or less.

For time zone changes of more than three hours, you might move your medications up or back as necessary by a few hours on the first day only, then convert to local time for the rest of your stay. Do the reverse when you return. This rule applies most strongly for time zone changes of 6 hours or more. Of course, for extreme cases consult your individual physician.

Now a word about specific drugs.

Sustiva stays in the body for a long time after each dose, and this is why once-daily dosing is possible. Adjusting the timing forward or backward by several hours should have no significant effect on levels in the body. Use the above suggestions, or just take it at bedtime as usual. Never double the dose or take extra -- just get back on schedule if you miss.

Protease inhibitors, in general, don't last in the body for as long as Sustiva. If you stick with something close to your usual schedule, using the above guidelines, there will not be a problem. The main thing is not to miss lots of doses. Again, you should not need to double doses or take extra, as it will just increase the possible side effects.

The NRTI's, like zerit and AZT, are most important inside the cells of the body, so changes in blood levels (eg, from being a little late with the dose) are buffered to some extent. Don't fret about a slightly early or late dose.

Hope this helps, and enjoy your travels. RAS

Rick Stryker, M.D., M.P.H.



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