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May 27, 2001

Dr Boyle, I had read in one of your answers that Viramune and epivir may be given once a day.How would you prescribe the dose.Or is it still in trials.And do you think that most meds soon will be able to be given only once a day.Thank you for your time and compassion in helping people with this disease.By any chance do you practice in San Francisco.Your patients are lucky to have such a great Doc.

Response from Dr. Boyle

Neither Epivir nor Viramune are FDA-approved for once daily therapy; however, both have data to support once a day use. If the drugs are given once daily, the daily dose is the same, it is just given all at once, i.e., Epivir is given 300mg daily and Viramune is given 400mg daily (after the lead in period). Before using these medications once daily, you should, of course, discuss it with your doctor and get his/her opinion. I think that within the next few years almost all HIV medications will have data to support once daily dosing. Certainly, most of the medications in development are striving for once daily dosing (e.g., BMS-232632, tenofovir, T-1249, new nNRTIs). The trick is to make sure that the dose is tolerable (taking certain medications all at once can lead to increased side effects), safe (with a good trough/IC50 and minimal toxicity), and with low pill burden (even if once a day, you don't want to have to take a huge number of pills). There are a number of potential regimens that meet these criteria, including one that has been studied with very positive and impressive results and is currently available: ddI (Videx) + 3TC (Epivir) + efavirenz (Sustiva/Stocrin). Thanks for your comments; I practice in NYC, but I know some of the best HIV doctors in the world practice in your city. Good luck.

How Long
New meds in pipeline

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