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RE:videx/viread dosing and meals
Nov 9, 2002

An eariler posted question:

"I noticed your earlier response to a question about videx/viread dosing and you mentioned that you do use this combination with the lower dose of videx as recommended. My doctor has suggested we also start this regimen and he too recommends the lower dose (250mg). This woiuld be part of a triple NUC regimen given only once per day (so easy!). My question is: what about the meal restrictions between videx and viread? Videx is supposed to be taken on empty stomach. When used in combo with Viread can it be taken with food at same time or do I need to wait until 2 hours after a meal for the videx? Otherwise it kind of defeats the purpose of the once per day if i need to have a 2 hour window between pills."

Dr. You really didn't answer this persons question. When you perscribe this combo, do you have them take it with food? I am so confused about this combo now. I take it with Sustiva + 3tc. My Dr. said to take all four pills with food at the same time. One Dr. says it's a dangerous combo, another one says it's fine if taken with the 2 hour dosing interval bewteen Videx and Viread. With food? Without food? Good? Bad? How are we as patients supposed to know what to do with so many different instructions? Who am I supposed to trust?

Very Confused!!!

Response from Dr. Aberg

I can easily understand your confusion. I did address the dosing issue betwen Viread (tenofovir, TDF) and Videx (didanosine, DDI)in my previous response. I stated,"You are correct about the need for the 2 hour dosing interval between Videx EC (didanosine, DDI) and Viread (tenofovir, TDF). It still is a potent regimen although not a true once-daily regimen. If Epivir (lamivudine, 3TC) is an option, one could take 3TC/TDF with a non-nucleoside reverse transcriptase inhibitor (NNRTI) such as Viramune (nevirapine, NVP) or Sustiva (efavirenz, EFV."

I think the confusion is about 2 different regimens. One that is a true once daily regimen and one that is not. Let me see if I can separate the 2 regimens to clarify.

One regimen that is a true once a day consists of sustiva (efavirenz, EFV), epivir (lamivudine, 3TC) and viread (tenofovir, TDF). This would be 4 pills once daily and there are no significant food restrictions but best to avoid a real fatty meal as this may increase the sustiva levels and have more side effects. This is what you say you are taking and you are taking it as your doctor says.

The regimen the other person asked about was viread and videx combined. This is different from what you are taking and much more complicated. Videx (ddI) should be taken on an empty stomach. Because of drug interactions, viread (TDF) should be taken 2 hours apart from videx with viread first as viread is best taken with food. The separation difference is important because viread interacts with videx and can increase the level of videx which could potentially lead to side effects such as pancreatitis. I do know there are patients taking the videx and viread at the same time but that is not the recommendation from the companies making these drugs. The formal recommendations are if you are taking videx you should take viread 2 hours before or 1 hour after videx. As far as food restrictions: Viread should be taken with food, preferably a full meal containing some fat. But as noted above, you do not want to take high fat meals if combining with sustiva.

The best source of information is from your pharmacist. Every pharmacist gives patients counseling on how best to take meds. I strongly recommend that everyone go to their pharmacist and go over all their medications and discuss all the dietary restrictions as well. HIV therapy is complicated and if someone is taking other medications including over the counter drugs, the pharmacist and doctor need to be aware. All we can do is tell individuals the best way to take them, which is based on the data from the companies and approved by the FDA. I am quite aware of people taking all their medications such as videx and viread at once and seem to do fine but we do not have the clinical data to support alternative dosing practices. Adherence is a major problem and one most likely responsible for the medications not working so dosing is very important. I would love to think that everyone follows all the rules perfectly but we do not live in a perfect world nor have we conclusively done all the studies regarding all the combinations and diets. The recommendations are based on the best information available. It may be that there are other dosing instructions that work but may not have been tested clinically yet.

Physicians depend on pharmacists for medication counseling. This is a specialty all to itself. I strongly encourage you to meet with your pharmacist. I also encourage you to search The Body for our drug fact sheets. There is a wealth of knowledge on this site with very well written information regarding each medication. The hard part is when one combines these meds particularly with other non-HIV meds. I cannot do this on a web site. You need to have individual counseling to address issues particular to you. Proper management of your medications is critical. Your questions are very important and everyone needs to talk with their pharmacist about proper dosing and food restrictions.

Thanks for the opportunity to address this issue.



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