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Complera timing/food requirement
May 2, 2013

I was diagnosed with HIV in 2010. I originally started on Atripla and did well. I became us shortly after starting treatment and got used to taking my medication each night before bed, I had not missed a dose in almost 3 years.

About a month ago I switched to Complera (the dreams and lack of sleep on Atripla just got to be too much).

The transition hasn't been the easiest, Because of the food requirement I need to carry around my medication with me so I can take it when I eat. Due to a busy work schedule my eating schedule isn't that regular. Some days I take my pill at lunch time, sometimes at dinner time. Some days I anticipate taking it at dinner but then I'm not hungry and have to try and come up with four hundred calories to take the pill.

My question is, how stringent is the food requirement? How flexible is the timing with Complera? This has become quite a hassle I am almost ready to ask to go back on the Atripla.

Response from Dr. Young

Hello and thanks for posting.

You raise an important issue about adherence, namely the ideal timing and the effect of meals (for some medications).

First, there's usually quite a bit of wiggle room with timing of taking a once-daily medication- I tell my patients not to be concerned about a 4-6 hour variation on any given day. What's much more important is to take the medication rather than time of dose, especially once your viral load is undetectable.

Second, while some medications aren't negatively affected by food (or absence of food), the rilpivirine part of Complera is poorly absorbed if there isn't a full (400 cal) meal in the stomach. This effect is fairly substantial, and given the risk of developing drug resistance on a NNRTI regimen like Complera, I'd really emphasize this aspect.

Now, if the dietary restriction is problematic for you and either effects your adherence (to both dosing and food) or quality of life, I'd be asking about other alternatives to Atripla and Complera; or perhaps a return to Atripla.

Fear not. The integrase inhibitor class of medications might offer alternatives. The newest single tablet regimen, Stribild might help- it has a less critical food requirement and is otherwise very well tolerated by most people. It might be that yet another alternative regimen would be better yet- the other integrase inhibitor(s) don't have a dietary restriction; raltegravir is currently available (Isentress) and dosed twice daily. The investigational once-daily integrase inhibior dolutegravir is likely to be FDA approved by late summer.

Hope that helps, BY



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