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Switching from Atripla
Feb 19, 2012

Atripla is quite expensive in my country while all other meds are free. I also get drowsy from atripla, not sure what combination is causing that.Can I safely switch from atripla to another combination ?. My CD4 is 560 Viral Load Undetectable. I asked one Doctor about this and he told me I would have to take about six different tablets if I switched. I'm suspicious because he is selling me the Atripla. If I can safely switch whic is the best combination ?. Regards

Response from Dr. Young

Hello and thanks for posting.

Among the medications in Atripla, the efavirenz part is most likely to cause sleep and/or mood problems. If your symptoms off drowsiness are not attributed to any other causes (such as depression, sleep apnea) and if affecting your quality of life, a switch from efavirenz to another medication might be worth considering.

Depending on where you live, the available options might vary. It would be most reasonable to continue the other 2 medications in Atripla (tenofovir and FTC) if there's no evidence of toxicity (mostly limited to kidney and bone issues).

Efavirenz could safely be replaced with a variety of medications; the NNRTI nevirapine could be an option available to you (so long as you don't have active liver disease); other considerations would be a protease inhibitor or the integrase ihhibitor, raltegravir (though this is generally not available for first-line use in many countries).

Most of these switches should be safe, especially since your viral load is undetectable- this suggests that you don't have any significant issues with drug resistance. No matter what, monitoring your symptoms and labs after a switch is always a good idea, just to make sure that the expected actually happens.

I hope this brief discussion is helpful, BY

PEP n more pep
intelligence and hiv

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