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Surgery approaching...NPO and how to take pills
Jul 6, 2012

My poz partner (on lamivudine, abacavir and efavirenz, with good response: undetectable and CD4 in the high 400s to low 500s)has developed cholecystitis and very likely cholelithiasis (will get a repeat ultrasound tomorrow). He has had a couple of episodes of pain and vomiting, with visits to the ED. He is feeling somewhat better but he would like to have a lap cholecystectomy to get it over with and be able to go back to work and eat without being worried about pain. My question is, in case he does go ahead with the surgery how should he alter his med regimen around the surgery. He is going to talk to his doctor but I also wanted to know your opinion.

He usually takes lamivudine plus abacavir twice a day and efavirenz at night. In the case he has the surgery in the morning, he probably will have to be NPO for the previous 12 hours. Is it possible to take efavirenz a little bit earlier the night before and also skip the daytime doses of lamivudine and abacavir on the day of the surgery and take them together with the nighttime doses and efavirenz the next day when he is finally allowed to drink fluids hours after the surgery? Is there too much risk of causing resistance by doing this? Thank you so much for your answer.

Response from Dr. Young

Hi and thanks for posting.

It would be fine for your partner to take his efavirenz a few hours early (understanding the potential for side effects). I also note that he's taking his abacavir and lamivudine twice daily- the medications (available in the US as a coformulation called Epzicom and elsewhere as Kivexa) can be taken together, once daily.

The best thing to do is to communicate this concern with his surgical team to see when the latest time is that he can take pills. Frequently pills are not included in the NPO order. In any event, even missing the single evening dose of his medications won't have any significant resistance consequences.

Hope that helps, BY



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