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how to switch from daily dose of Isentress to twice daily

Oct 26, 2011

I've been taking Truvada and Isentress for the past 18 months with great results....undetectable and cd 4 count of 500 with no side effects....I was taking Isentress 2 pills once a day instead of the recommended dosage of one pill twice daily..After a phase three study was finished, Merck is recommending that patients taking once daily dosing should switch to isentress twice daily....How do i go about this to insure there is an adequate amount of isentress in my bloodstream...for fear of viral mutation and drug resistance....And do you think it was correct for my hiv specialist to suggest that i could take the once daily dose before all studies were in....and shouldn't the specialist alert me to Mercks recommendation....It doubting his judgement....thanks stan

Response from Dr. Young

Hi and thanks for posting.

Yes indeed, the QDMRK study (recently published in Lancet Infectious Diseases ) showed that once-daily raltegravir (ISENTRESS) didn't perform quite as well as when taken twice daily. [NB: I was an author on the study] The differences weren't huge, but large enough to be statistically significant.

If you're currently taking once daily ISENTRESS, just start a new day taking 1 pill in the morning and 1 in the evening. Since the drug levels are at normal levels, there shouldn't be any problem in the change.

As for whether it was correct or not to start on once-daily, it's a matter of opinion and how much clinical trials evidence it takes for clinicians to feel comfortable with a new dose or new drug. In my opinion, since we have so many well tested regimens (and doses), that there's usually little need to prematurely experiment with things that are theoretical and haven't yet been proven using good scientific method. I suspect that since your doubting the judgment of your specialist, it's time for a non-judgmental heart-to-heart discussion.

Hope that helps, be well, BY

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