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Taking Medication While Crossing Time Zones
Nov 27, 2004

Dear Drs:

I am currently taking Combivir at 8:30 AM and 8:30 PM, and Sustiva at 10:30 PM. Adherence since starting medication in June this year has been 100%, and I would like to keep up this total adherence. Now that I am well enough to travel, living in Asia, my upcoming travel schedule will bring me into -12 hours time difference. I would like to know whether I can "pro-rate" my Sustiva. For example, since I take Sustiva at 10:30 PM, can I take the first dose in the new time zone at 1/2 dose 12 hours later from the last dose (10:30 PM new time zone, 10:30 AM old time zone), and then resume normal 24 hours intervals? And for Combivir, suppose I fly from Los Angeles to New York, with a 3-hour time difference, my 8:30 becomes 11:30, which is a bit inconvenient. What should I do in this case? Can I early dose in NY at 8:30 NY time (5:30 LA time), and when I return to LA, take an extra quarter dose at 5:30 and one full dose at 8:30 to get back into schedule? I'm sorry if this question is a bit confusing. I'm not sure how to simplify it without losing the information. Thank you.

Asian Traveler

Response from Dr. Lee

Congrats on your perfect adherence. That is difficult to achieve and deserves note.

It is almost always better to overdose rather than underdose. In other words better to take a dose too many, rather than one too few. Do not partial dose (ie don't take a half a dose).

It is usually best to try to adhere to your regular schedule if it is only for a few days. For example, in New York, if it is only a few days, sticking with the 11:30 dosing is preferrable. If you really want to switch out, try moving up an hour or two each dose. (Again overdosing by a couple of hours rather than underdosing by waiting or holding a dose.)

Also, why do you take your meds three times a day? Could you take the Combivir at 10:30 AM & PM with your Sustiva at 10:30 PM, or move your Sustiva to 8:30 PM?

Be well.

general questions about my therapy and t-cell levels
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