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Viread, Videx-EC, & Viramune
Dec 20, 2002

My physician recently prescribed the following triple-combo regime for me (Note: I am treatment nave with over 300 CD4 and 100K VL) to take once-a-day with breakfast: 1-Viread 300MG, 2-Viramune 250MG (Note: 1 tablet for the first 14-days on therapy), and 1-Videx EC 250MG. My questions regarding this regime are as follows: The package insert for Viread indicates that one should take Viread with a high-fat meal. In fact, it reads that study participates took Viread following a high-fat meal of between 700 Kcal to 1000 Kcal containing 40-50 fat. How many grams of fat are sufficient for proper absorption of Viread? Second, I understand that co-administration of Viread and Videx-EC increases blood-levels of Videx-EC by approximately 50. As such, my physician reduced the Videx-EC dosage from the recommended 400MG (Note: I weigh 150 lbs) to the 250MG capsules to compensate for this expected increase. However, the package insert for Videx-EC indicates that food significantly decreases blood-levels of Videx-EC. My physician informs me that Videx-EC levels are increased by approximately 50 when combined with Viread whether the Videx-EC is taken with food or on an empty stomach. Is this true? And, even if it is, an approximate 50 increase of the Videx-EC 250MG capsule brings its total strength to approximately 375MG not to the recommend 400MG dosage strength. Is this any thing for me to worry about? Finally, does Viread cross the blood brain/spinal fluid barrier? Thank you for your response.

Response from Dr. Young

Thanks for your question.

There has been much recent attention about the interactions between tenovovir (Viread) and didanosine (Videx). We know that conventional dosing of the two medications results in significant increases in the levels in didanosine (but no changes in tenofovir).

As a result, newer studies were conducted to look at the combination using the lower dose of didanosine, 250 mg-- the dose that your doctor has prescribed. Long story short, it appears that the two medications can be taken together, without regard to meals, and has drug levels that are comparable to normal. The differences that you allude to are probably not clinically significant, since there is a lot of person to person variation in levels.

Hope that this helps, happy holidays. BY

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