Question about PEP

[concerned1]

Question about PEP (not PrEP).

Does the single Raltegravir tablet have to be taken exactly at the same time every day? If I sometimes take it two or three hours after the time I am normally taking it, will that have any affect on whether the PEP works overall?

I know from previously being a daily PrEP user, that for PrEP there is some rather good leeway. I mean the times you take the drug each day don't have to be terribly fixed/ rigid for the drug to still work, as long as you're taking it every day and don't completely forget doses on a regular basis. Is it the same for PEP? or do the pills have to be taken at the exact same time every day?

I'm going through a course of PEP right now, as I bareback bottomed recently, and I have taken my PEP a few hours late a few times. So i'm really scared (especially since I know PEP doesn't work as well as PrEP does and is known to fail even when it is taken within the 72 hours of exposure and even if it is taken properly every day).

Edited June 6, 2020 by concerned1

[concerned1]

No ideas?

[BootmanLA]

4 minutes ago, concerned1 said:

No ideas?

I'd say that "exact" is overkill, but in the same general range is probably advisable.

Drugs that are intended to be taken once daily do not suddenly leave your system 24 hours after taking them; they're gradually cleared from your body via various systems - your kidneys, your liver, etc. - and it takes a while to do so. Unless a particular drug is so toxic (think: chemotherapy) that taking it too soon after a prior dose may cause serious complications, then the "once a day" mantra doesn't mean exactly 24 hours between doses.

That said, it's probably wise to take them as close as possible to the same time, so that the level of the drug is maintained in your system for a long-enough period to accomplish its goal. An hour or two isn't likely to be an issue. A full day later could well be.

The reason PEP doesn't likely work as well as PrEP, of course, is that with PrEP you are building up a more-or-less constant level of the medication in your system on an ongoing basis, so that you already have a solid defense by the time HIV attempts to infiltrate your body's systems. PEP is more of a race against time to build up that defense before HIV gets embedded so deeply it's not removable. But I'd think the biggest point of worry would be in the period between exposure and beginning PEP; the longer that period is, the less likely it is to fully succeed. So the sooner your start, and if you keep at it for the first few days, exact timeliness would be less of a worry the more days that pass after exposure.

[FuckMeHarderNow]

I try to take it at the same time every day to just get into a good habit. If you miss too many doses and still want to have bareback sex you can do the 2-1-1 method; 2 2 hours before then 1 each day after for 2 days then get back on track...

[viking8x6]

On 6/6/2020 at 7:20 AM, concerned1 said:

...do the pills have to be taken at exactly the same time every day?...

It doesn't have to be perfectly exact, but try to keep it as close as possible.

You didn't mention what dose and formulation of raltegravir you're taking, nor what other PEP drugs - and that matters, too. Raltegravir was originally a three-dose-a-day medication, until the manufacturer reformulated it. The liver clears it from the body relatively quickly, and that's why it's important to take it at close to the same time. If you wait too long, the body level can drop below where it's effective. Everyone's metabolism is different, and without actually monitoring the level of drug in your blood, you wouldn't be able to tell.

That said, the way they figure out the standard dosing is that it should work well in more than 95% of cases - including a bit of leeway for variations in liver chemistry, imperfect dosing, and so on. So don't worry, just do the best you can...

 

[Guest Omnivore]

The meds in PReP have quite a long half-life.  Depending on your body mass (and I think all medications should be dosed mg/kg), there could still be enough in your system after even a day or two to be effective.  I'm not a health professional, though, so this is entirely anecdotal.  

[aklgaybtm]

Yes PEP can very likely fail.

[Guest]

 

Life is full of risks.  If you end op being poz that's not the end of the world as it's manageable by medication.

Keep us updated how this ended? And good luck bro.

 

On 6/6/2020 at 1:20 PM, concerned1 said:

'm going through a course of PEP right now, as I bareback bottomed recently,

You do know you can get HIV by topping bareback too? 
Chances are smaller but I'm getting the sense you don't want to gamble with this and take a chance.

If you're ok and still HIV-neg you probably would want to go back on PrEP.

[BootmanLA]

8 hours ago, aklgaybtm said:

Yes PEP can very likely fail.

Can fail? Yes. "Very likely"? Not at all.

When the PEP regimen (which lasts for several weeks) is begun within 24 hours of exposure, it has an extremely high success rate. True clinical studies are limited (there are ethical concerns with letting some people actually get preventative treatment while not providing it to others), but it's possible to extrapolate some information from observational reviews. In one review conducted by the CDC of 1,535 men who took PEP after exposure to HIV, 1,487 of them remained negative after PEP while only 48 contracted HIV. Of those 48, 40 were men who continued to be exposed to HIV after beginning PEP, leaving only 8 who represented potential PEP failure. That's a pretty damned good success rate (lower than one-half of one percent, not "very likely" in the least).

Of course, the caveat: you have to stick with PEP for the entire cycle; unlike regular HIV treatment, it's multiple pills daily, for 28 days straight. It's higher dosing because you're trying to prevent the infection from taking hold at all, not (as with daily HAART) trying to keep the virus under a particular level. It requires diligence, in other words.

Where available, PrEP is absolutely a better option.