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1 day of weird work schedule
Nov 22, 2008

I am a retail store manager and take Atripla. the day after thanksgiving my store will be open midnight until 10 pm the next day. I usually take my Atripla at 12am every night and have been on it for 5 months. I am working midnight until 7 am then coming back at 7 pm to work until that makes ideal dosing pretty impossible. It does generally make me very drowsy at some point so I am reluctant to take it right at the beginning of my busiest day of the year. So should I take it several hours before and then resume my regular midnight time when I get off work the following day...or gradually extend my dose by an hour every night until then so I can take it before I go to bed at 7am in between shifts and then re-start my regular dosing that night??? Sorry this is such a long question, but I just don't know which is the best solution.

Response from Dr. Sherer

Either option seems like a lot of difficulty for one prolonged work day. I don't like the first option, i.e. take the meds at 7pm the evening before Thanksgiving, and then again at midnight the next night, because it includes a lapse of 17 hours between doses - too long! On the other hand, I like the first option because it is only a single simple switch, which seems fitting to accommodate only one day of a change in schedule.

The second option is better, in that it offers multiple dose intervals of 13 hours over several days, but it does require close attention to the time of dosing, and a different time each night, for 5 nights in a row, which would allow several different opportunities for lapses in adherence. This plan is fine, as long as you can execute it consistently for 5 days.

So I might propose a third option: on the night before Thanksgiving, take the medications early, at 10pm. On Thanksgiving night, take it before you get off at 11pm, and return to the usual schedule (midnight) on the following night. Only 3 days are involved, and whatever the short term effect of dosing, it would be limited to an hour or so on the job.

Finally, you can always talk to your doctor about your work schedule issue. With more time and discussion, you might together find a better alternative. I also encourage you to show him or her this response as well.

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