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One size fits all?
Mar 20, 2001

Why must I, who weigh 155 lbs, consume as much Viracept (2x5/day) as someone who weighs 1000 lbs? What if I lower daily consumption to, say, 2x4? Would resistance leap into the game?

Other data: Male, Ts = 650; load = undetectable; asymptomatic, "healthy".

Response from Dr. Pavia

Great question. One size never fits all. However, the standard dose is determined on very average size people, like you, so it is more likely that the really large person needs more than that you need less.

We have pushed the need to individualize therapy in terms of the best choice of drugs and time to start for a while. We know that what determines success of antiviral therapy is much more a question of the level of drug in your blood stream and inside of your cells throughout the days, rather than the number of pills that go in your mouth. In fact, there is a fairly wide variation in the drug levels between people of the same size for some drugs. The answer to this MAY be to measure blood levels and fine tune them for each patient. This is sometimes called therapeutic drug monitoring. I think it is going to be the way things will move.

Why isn't it widely done right now? A number of reasons. There are few labs doing accurate tests. We have not determined the ideal level for many drugs. We have to figure out the exact time to draw levels in relation to the previous dose. And, most importantly, you have to be taking drug reliably for 5-7 days before getting an accurate level.

Don't cut your dose on your own. If it results in low drug levels, that is exactly what helps create resistance.

Thanks for the question ATP



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