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Double dose of Truvada with Isentress
Oct 14, 2017

Hiya. I accidently took a double dose of Truvada at 6:30am this morning. I normally stick to a tight regime with Truvada and Isentress at 18:30pm in the evening and just Isentress in the morning. Will the double dose of Truvada have any detrimental impact on my PEP treatment?

Sincerely, very worried!

Response from Dr. Young

Hello Very Worried and thanks for posting.

There's no need to worry. At all.

A single double dose shouldn't be a problem from either an effectiveness or toxicity perspective. The safety profile of these medications is generally very good, and as long as you didn't have preexisting serious kidney issues (in which case you shouldn't have been place on Truvada in the first place), I wouldn't have any concerns.

This episode raises the issue about adherence to medications- first, one doesn't need to take the medications exactly 12 hours apart as you're doing. There's nothing wrong with doing so, but it might only heighten anxiety about a possible exposure. Rather, the PEP (or HIV treatment) medications need to be taken twice daily, and I advise my patients that target the same time of day, but if you take the meds within a 3-4 hour window, it's ok. Second, consider using a pill box- filled out for a week at a time (or buy a couple, for two weeks)- this way there's no dosing errors, and you'll know whether a dose was taken or not.

Finally, since you're on PEP, this tells me that you're sexually active (duh). If you're a sexually man who has sex with men (as many of our readers are), you should ask about getting vaccinated for hepatitis A, hepatitis B (it's already a universal vaccination), HPV (if you're under 26 years old) and meningitis (also recommended by CDC).

For HIV prevention, beyond the use of condoms (which are terrific for preventing all sorts of things, and recommended), ask if pre-exposure prophylaxis (PrEP) is appropriate for you. PrEP is very highly effective in preventing HIV infection in people who are at risk. In our APEX Family Medicine clinic in Denver, PrEP is widely offered to our sexually active gay patients, and now with over a thousand of PrEP patients, not one was acquired HIV.

I hope that's helpful, BY

dr frascino
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