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HIV+, Pregnancy & Narcolepsy
Oct 3, 2009

Hi - Thank you so much for taking the time to read my question. I'm a 32 (soon to be 33) HIV+ woman and ready to try to have a baby. I'm taking Kaletra and Combivir for the HIV (I'm told it's the safest for women who want to be pregnant); I'm also taking 400 milligrams of Provigil daily to treat narcolepsy (200 in the am, and 200 at noon). I've been told I may have to go off the provigil because the risks to the fetus is unknown - apparently no testing has been done to confirm. My problem - I can't function on a daily basis without it - I fall asleep driving, sitting, pretty much anytime and anywhere that I'm sitting still). My sleep doc and HIV doc are working together to find an OB that has experience with HIV, but they are doubtful they will find someone around my area who also has experience working with patients that have narcolepsy since we live in a rural community. Is it safe for me to continue the provigil while trying to get pregnant and during pregnancy? And if it's not safe, is there a narcolepsy medication that is safe for me to take during this time? Then the next question would be, if there is a safe drug to take for the narcolepsy (if provigil isn't), how will this affect my HIV meds? My docs are checking all their resources, but are doubtful they will find the answers easily due to the fact that we have a limited population base here so a doctor's experience with this is less likely. If we can't find any alternative medication to treat my narcolepsy - I may not be able to move forward with trying to get pregnant...it may be to risky for my safety, which would be hard to take given that I've given up the last year of my life trying to prepare for this...switching my HIV meds, finanical planning, etc... If you have any information on this for me, I'd be ever so greatful - thanks again for reading my question.

Response from Dr. Henry

There already exists concerns about interaction between Provigil and Kaletra but if you are on both already and doing OK then that is reassuring. I am not aware of any other drug used for narcolepsy that would be any more acceptable than Provigil (no drug company studies that population). If you got pregnant on your current meds I would monitor the HIV level and lopinavir levels more carefully than in the standard pregnancy. If any reader has any further suggestions/comments please post. KH



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