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How forgiving is Epzicom?
Sep 24, 2005

Hi there,

Im at the stage of choosing my meds for the first time, my T-Cells are around 220 and VL around 80,000.

Ive already made up in my mind to take Reyataz (Norvir) but need to choose a Nuke backbone and what the Doctor suggested was either Videx and Emtriva or Epzicom. I think he favours the former because they stay in the blood for longer. I prefer the idea of Epzicom because its just one pill I can take with the Reyataz rather than waiting 2 hours. How forgiving is Epzicom? I think I would be very good at taking meds on time but know there would be the odd weekend when it would be later

A resistance test has already said Im resistant to Viread, Retrovir and the NNRTIs so I want to make sure that I choose a combination that works and will last (as I have reduced options) and if that means staggering for two hours then so be it. Other than the above concern is there anything else that might favour one regimen over the other?

Many thanks for any advice!

David.

Response from Dr. Young

Thanks for your post.

"Forgiveness" is an odd adjective for a medication- I see the question really as one about the pharmacologic consequences of missed doses. We have robust clinical trials evidence that Epzicom (or it's drug halves, abacavir and 3TC) can be taken once-daily. Varying the timing of the dose of any once-daily medication by a couple of hours is unlikely to result in any major issues (call it 2/24th's of a dosing interval).

I think the real issue for your set of choices is what you've pointed out. Videx (ddI) must be taken on an empty stomach and Reyataz (atazanavir) must be taken on a full stomach. Given this, the ddI/FTC/ritonavir/ataznavir regimen is really a two dose-per-day regimen whereas the Epzicom/ritonavir/atazanavir regimen can all be taken together once-daily with meals. If ddI is a must-use nuke, then I'd consider using fosamprenavir (Lexiva, Telzir) as the PI (with ritonavir boosting, to achieve once-daily dosing), since this PI (unlike all others) can be taken without regard to food and would allow an all once-daily dosing regimen.

Good luck, let us know what you and your doctor decide. BY



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