Sustiva dosing and nausea
Feb 20, 2003
I've recently restarted my HIV meds after successful treatment for anal squamous cell carcinoma with radiation and chemo. My regimen is sustiva (3 pills once a day) and combivir (1 tablet twice a day). I've had the usual tiredness, body aches, flulike feelings, light-headedness from these drugs, but these are tolerable, and I understand that these side effects should subside fairly quickly.
I am also experiening frequent nausea immediately after taking the three sustiva pills in the evening at bedtime. I was wondering if taking the three sustiva pills individually, one pill thrice daily, instead of three pills once daily, would be reasonable to minimize this nausea -- I've tried this once or twice and found no nausea from taking just one pill. Does spreading out the dose reduce the amount of drug in my bloodstream, or does it allow the amount of drug in my bloodstream to remain nearly constant ?
I had a loop ileostomy in December in order to relieve pain and help treat a rectal herpes and pseudomonas infection (abcesses) resulting from the radiation treatments. I am seeing large amounts of very liquid output (diarrhea?) in my ileostomy bag very soon after taking the sustiva in the evening and am concerned about absorbtion of both foods and drugs and dehydration.
Response from Dr. Henry
I would be concerned about spreading the Sustiva doses throughout the day (levels maintained to suppress virus adequately). You could have the Sustiva level checked to see if you run high with the once a day dosing. From what you describe it does sound like the Sustiva peak dose may cause you to feel nauseated (Marinol or Reglan might help that). You could perhaps try taking one Sustiva early in the evening and then two later to see who that goes (that should result in a more modest peak level). The AZT in Combivir can also cause nausea. Though the side effects can subside for some (? 10% or more) they don't a switch of some kind then would be considered. KH
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