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nPEP, timing, and adherence
Feb 13, 2007

After a moderate risk encounter and hullabaloo of the doctor forgetting the dosage on the prescription, filling out the billing info incorrectly and one drugstore not having both items, I started taking my nPEP at the 19 hour mark. My nPEP is Combivir twice daily and 2 Kaletra twice daily. So far I've had very little in the way of side effects (I'm 2 doses in) with just a minor persistant headache.

My question is, by the time I ended up taking my pills, it was 4pm. Now these need to be taken every 12 hours. I'm concerned about failing to wake up at 4am to take my meds. Is it possible for me to start adding say 5-10 minutes per dose, so that by the end of the week, instead of waking up at 4am, I wake up at 5 or 6? Or will that negatively impact the protocol?

Thank you.

Response from Dr. Frascino

Hi,

The doctor forgot to write the dosage on the prescription and filled out the billing info incorrectly. Plus the drugstore didn't have both Combivir and Kaletra???? YIKES! "Hullabaloo" indeed! Sounds more like a nightmare or the Twilight Zone to me. Once again I'll put a plug in for HIV specialists being consulted for exposures significant enough to warrant PEP. These physicians often have starter packs of PEP ready to go in their offices so that they can get the medications onboard as soon as a significant exposure risk has been identified.

Regarding your Combivir/Kaletra question, you can begin adjusting the dose times to a more convenient schedule immediately. And you can move much more aggressively than 5-10 minutes per dose. Take each dose an hour early until you adjust to the twice-per-day regimen that best suits your schedule. (An HIV specialist most likely would have provided you with this type of practical information, by the way.)

Good luck.

Dr. Bob



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