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Twice the dose on PEP Help!
Aug 8, 2005

Hi Doctor, Im from Bangalore, India, after a risky encounter I met with a nice general practioner doctor who put me on PEP ( initiated 14.5 hours post exposure) with odivir - DDL + 3TC + EVF at double the prescribed the dose, after taking this for a week, I was also added D4T - stavir again at 2 times the recommended dose, is it ok can I drop to a regular dose without any fear of resistance? Or should I complete the 28 days at this double dose, and, the WHO accredited pecialists tah t Iwished to see here, one was not in town the other was not seeing patients that day, shame! I Many thanks in advance.

Response from Dr. Sherer

Yes, you should return to the normal recommended dose and complete the 28 day course. In addition, for PEP I would only recommend at most a three drug regimen, unless you have some very specific information about the source and the nature of the virus that he or she is carrying, e.g. you or your physician knew that this individual was resistant to DDI, for example - which I doubt in your case.

Whenever a mistaken dose is discovered, one should immediately notify your physician and discuss the steps that should be taken next.

I appreciate that in your case, your ability to do this was limited, and your doctor was apparently the one who prescribe the drugs in error.

There would not be an increase in the risk of resistance from an inappropriately high dose of ART. Rather, the risk is of unnecessary toxicity from the higher than expected drug levels. As you have not mentioned these, you may not have suffered from this error. It would also be appropriate to have your blood work repeated as well to look for toxicity, for example of the liver.

Is treatment failure inevitable?
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