Hospitalization May Interrupt Meds

Patients in hospitals are generally not permitted to bring in medications prescribed from outside that hospital. Instead, the hospital will reorder the prescription to be filled through its pharmacy.

Hospitals need to be able to verify the safety and appropriateness of the drugs used by its patients. Depending on how busy the hospital staff may be, getting a prescription filled may take hours. Consequently, patients risk missing one or more doses. Duplicate prescription orders also allow for cost duplication, which may affect insurance coverage.

One way to get around having to order the same prescription is to request that the hospital verify your previous prescription with your primary care doctor so that you can continue your current stock of HIV medications.

But if the hospital staff cannot establish that the medications you brought in are really HIV medications, the hospital may also refuse to make the verification call. When that happens, the only option is to wait for a new prescription from the hospital's pharmacy.

Ask your doctor!

One way to avoid a delay in accessing your meds is to check with your doctor to make sure that your HIV meds are part of your hospital drug regimen.

Of course, this could be done only if you can plan for the hospitalization. To save time, it may also be a good idea to always have your doctor's name and number with you so the hospital can verify your medications with that doctor.

Inappropriate treatment interruptions

Another hospital scenario that may affect access to medications is through unnecesary interruption in HIV medication use.

A clinician recently told me about two patients at different hospitals who stopped their antiretroviral regimens while they were being treated for an opportunistic infection. The interruption occurred to allow observation of the effects of the OI drug independent of the antiretroviral drugs. After the infection cleared up, the therapy was to be resumed. In these two cases, there was no medically appropriate reason to stop antiretroviral therapy, unless the OI affected drug absorption.

Avoid a HAART break

Most experts would agree that HAART should not be stopped routinely just because of hospitalization. According to the DHHS Guidelines for the Use of Antiretroviral Agents in HIV-infected Adults and Adolescents, interruption of antiretroviral therapy should only occur in the following cases:

Intolerable side effects

Drug interactions

First trimester of pregnancy, when the patient chooses to do so

Unavailability of drug

Because anti-HIV medications may interfere with liver metabolism, patients admitted for hepatitis who receive antiretroviral therapy may have to modify their drug regimen and begin treatment again following recuperation from hepatitis.

Antiretroviral medications may also be stopped when the medications are the cause of the hospitalization (such as pancreatitis resulting from ddI or d4T, kidney problems from adefovir, or any protease inhibitor-causing hepatitis). People who are not able to take oral medications also need to temporarily stop their antiretrovirals.

No studies and no reliable estimate exists regarding the number of days, weeks or months that constitute a clinically important interruption of one or more components of a therapeutic regimen that would increase the likelihood of drug resistance. We do know that the more doses you miss, the more likely you will increase your chance of developing resistance.

Nancy Wongvipat is a health education specialist in AIDS Project Los Angeles' Education Division. She can be reached by calling (323) 993-1511 or by e-mail at nwongvipat@APLA.org.

This article has been reprinted at The Body with the permission of AIDS Project Los Angeles (APLA).