Fat, Sustiva and Dosing Schedules
Oct 21, 1999
I noticed the warning to not take Sustiva with a high fat meal. Does this impact the effectiveness of Sustiva or just increase side effects? Also, I'm on Epivir and Zerit. I take Epivir and Zerit in the morning, and Sustiva, Epivir and Zerit in the evening. How important is it to take these meds at EXACTLY the same time each day?
Response from Dr. Cohen
First - the high fat meal issue with the Sustiva is there because fat actually increases the absorption of the Sustiva. And the concern would be that it might increase any side effects from getting higher levels in. Practically speaking, I have not heard of anyone who has noticed much difference as a result of this issue - it appears that whatever initial side effects you get from the Sustiva wear off and if they are gone, they don't appear to come back just because you take it with a high fat meal. But it is something to consider.
As for timing - once again the Sustiva is probably the most flexible of the meds in your combo as it has a blood level that comfortably lasts for a bit more than 24 hours - so taking it once a day with some variation in the actual hour you take it should be OK. That appears to be the case with the others as well - although they should be taken twice a day, it does not have to be exactly twelve hours apart in order to maintain the right cellular levels. Of the other two, the Epivir/3tc also appears to have a level in the cell comfortably longer than twelve hours and there are studies now going on to see how well this medication will work if it is used just once a day. But since we don't have any results, it is better to take it twice a day.
The Zerit/d4T is also undergoing study - we in Boston are cooperating in an international study that is testing a new formulation of d4T that is in a time release capsule which is being given just once a day, and in this study is compared with the standard twice a day schedule. And again, there is some flexibility with the standard d4T - twice a day is fine.
This combination has become pretty popular based on the results of a study showing its success - and we'll be updating those initial results at a conference next week. So stay tuned.
Hope that clarifies. CC
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