Taking PrEP and Breaking PrEP

[Guest]

I posted the other day that I was considering going back on PrEP after 3 ish years and how could I take it if I have an issue swallowing tablets due to just not being able to and by taste but i can easily fix the latter. I originally stopped because I started a year or so before Covid and didn't have sex with anyone for a year and a half due to covid. The PrEP I was taking therefore ran out of date during my not taking it.

I called my sexual health centre a couple of hours ago and they have arranged a consultation to see if I am a good fit but I will be given how I sleep around and do risky stuff with anyone and everyone, anywhere and everywhere. I may be put on a waiting list though which I hope I won't be. 

My question though, the PrEP I was taking was Tenofovir and the instructions said do not crush or chew but that was my only option since I just can not swallow tablets and its not for a lack of trying. I asked my doctor and she said "Yeah you should be able to, we have people being tubefed that have it crushed down" so can it be crushed down at all or does it not work. Surely it still works as long as you get it in your system right??

Any help is greatly appreciated thank you 
IrishKinkSlut > Previously TwistedPrice94

[BootmanLA]

7 hours ago, IrishKinkSlut said:

I posted the other day that I was considering going back on PrEP after 3 ish years and how could I take it if I have an issue swallowing tablets due to just not being able to and by taste but i can easily fix the latter. I originally stopped because I started a year or so before Covid and didn't have sex with anyone for a year and a half due to covid. The PrEP I was taking therefore ran out of date during my not taking it.

I called my sexual health centre a couple of hours ago and they have arranged a consultation to see if I am a good fit but I will be given how I sleep around and do risky stuff with anyone and everyone, anywhere and everywhere. I may be put on a waiting list though which I hope I won't be. 

My question though, the PrEP I was taking was Tenofovir and the instructions said do not crush or chew but that was my only option since I just can not swallow tablets and its not for a lack of trying. I asked my doctor and she said "Yeah you should be able to, we have people being tubefed that have it crushed down" so can it be crushed down at all or does it not work. Surely it still works as long as you get it in your system right??

Any help is greatly appreciated thank you 
IrishKinkSlut > Previously TwistedPrice94

It's not that a crushed tablet becomes inactive if not swallowed whole. It's more that the absorption rate and such may be affected. Just like some meds say that you should take them with food - it's not that you need something in your stomach to cushion the pill, but that having food in the stomach helps stimulate the breakdown and absorption of the medication. I can't honestly answer whether PrEP (or any particular variety of it) fits into that category or not.

There's also the concern that if you crush the tablet before taking it, you might not get all of it - bits and pieces might fly off unnoticed, you might not scrape up all the pieces from the surface on which it's crushed, etc. That's not always a problem, but for some medications where the precise dosage is critical, especially ones where the tablet is 90% "delivery mechanism" and only 10% medication, you might miss a goodly chunk of the actual med while swallowing all the filler.

So a pill crushed might - or might not - be slightly less effective overall compared to one swallowed whole, is the net answer.

That said, with PrEP, if you are taking it daily (not on demand) protection should be pretty much as good if you only get 95% of the pill as opposed to 100% (with that 5% lost to bits and pieces you don't pick up). With a once-daily medication like this, particularly a preventative one, the level of medication in your system spikes shortly after taking it - within an hour or so - and then starts to slowly decline as it's filtered out of your body. It's not "all gone" by the time your next dose is due; rather, by the time the next dose is due, your body's just starting to get below protective levels. So if you keep taking it, day in and day out, your system is going to reach an equilibrium of an effective level in your system, even if a small part of the tablet is lost due to crushing.

[Guest]

On 9/9/2022 at 12:52 PM, IrishKinkSlut said:

I posted the other day that I was considering going back on PrEP after 3 ish years and how could I take it if I have an issue swallowing tablets due to just not being able to and by taste but i can easily fix the latter. I originally stopped because I started a year or so before Covid and didn't have sex with anyone for a year and a half due to covid. The PrEP I was taking therefore ran out of date during my not taking it.

I called my sexual health centre a couple of hours ago and they have arranged a consultation to see if I am a good fit but I will be given how I sleep around and do risky stuff with anyone and everyone, anywhere and everywhere. I may be put on a waiting list though which I hope I won't be. 

My question though, the PrEP I was taking was Tenofovir and the instructions said do not crush or chew but that was my only option since I just can not swallow tablets and its not for a lack of trying. I asked my doctor and she said "Yeah you should be able to, we have people being tubefed that have it crushed down" so can it be crushed down at all or does it not work. Surely it still works as long as you get it in your system right??

Any help is greatly appreciated thank you 
IrishKinkSlut > Previously TwistedPrice94

I think you're ok, following the advise or your doctor.

I'm not one, and I don't think there are (a lot) of open members on BZ who are doctors of medicine. 
What you tell about his answer sounds reasonable, and like @BootmanLA said taking it daily sounds like a good idea in your case. Often people should experience less side-effects after a month or so, of someone does. So that's a bonus.

[VersGuyAnon]

On 9/9/2022 at 11:52 AM, IrishKinkSlut said:

I posted the other day that I was considering going back on PrEP after 3 ish years and how could I take it if I have an issue swallowing tablets due to just not being able to and by taste but i can easily fix the latter. I originally stopped because I started a year or so before Covid and didn't have sex with anyone for a year and a half due to covid. The PrEP I was taking therefore ran out of date during my not taking it.

I called my sexual health centre a couple of hours ago and they have arranged a consultation to see if I am a good fit but I will be given how I sleep around and do risky stuff with anyone and everyone, anywhere and everywhere. I may be put on a waiting list though which I hope I won't be. 

My question though, the PrEP I was taking was Tenofovir and the instructions said do not crush or chew but that was my only option since I just can not swallow tablets and its not for a lack of trying. I asked my doctor and she said "Yeah you should be able to, we have people being tubefed that have it crushed down" so can it be crushed down at all or does it not work. Surely it still works as long as you get it in your system right??

Any help is greatly appreciated thank you 
IrishKinkSlut > Previously TwistedPrice94

You might want to go into a pharmacy and enquire about the effect of crushing tablets, so you can take them more easily. There'd be no need to make any reference to any particular medication. Just ask in general terms. A pharmacist is an expert when it comes to the dispensing of medicines, so they would know how they should be taken and logical, safe alternatives.     

[BootmanLA]

4 hours ago, VersGuyAnon said:

You might want to go into a pharmacy and enquire about the effect of crushing tablets, so you can take them more easily. There'd be no need to make any reference to any particular medication. Just ask in general terms. A pharmacist is an expert when it comes to the dispensing of medicines, so they would know how they should be taken and logical, safe alternatives.     

But as I noted above: some tablets absolutely should not be crushed, while others it's safe to do so. It's very much medication-specific, so I don't think any pharmacist is going to be able to give a thorough answer without knowing the "particular medication." (And that's information I got directly from my pharmacist, and it confirms what I learned decades ago when I was a pharmacy tech, in what seems almost like another lifetime).

There's no shame in admitting one is on PrEP. 

[VersGuyAnon]

1 hour ago, BootmanLA said:

But as I noted above: some tablets absolutely should not be crushed, while others it's safe to do so. It's very much medication-specific, so I don't think any pharmacist is going to be able to give a thorough answer without knowing the "particular medication." (And that's information I got directly from my pharmacist, and it confirms what I learned decades ago when I was a pharmacy tech, in what seems almost like another lifetime).

There's no shame in admitting one is on PrEP. 

Fair enough and you're obviously much more qualified than I am (I'm being genuine not sarcastic). I only referred to no need to mention the medication in case he felt reluctant to do so, but you've made very good points. As for no shame re PrEP, again I absolutely agree.

[viking8x6]

I'm not a medical doctor, but I am a PhD in a relevant science (Chemistry), have worked in the pharmaceutical industry, and have a decent understanding of basic pharmacology principles.

On 9/9/2022 at 6:52 AM, IrishKinkSlut said:

My question though, the PrEP I was taking was Tenofovir and the instructions said do not crush or chew but that was my only option since I just can not swallow tablets and its not for a lack of trying. I asked my doctor and she said "Yeah you should be able to, we have people being tubefed that have it crushed down" so can it be crushed down at all or does it not work. Surely it still works as long as you get it in your system right??

As long as you get it into your system, it will work. The dose is sufficient that a possible small loss in the crushing would not be significant to the effect. The drug is an immediate-release formulation, so crushing it is not going to cause any problem with absorbing it.

The tablets are coated (which is disrupted by crushing, of course), but the coating dissolves in your digestive system to release the drug. This happens relatively quickly (less than an hour). You can take it with or without food, and if the former, it would be held in your stomach longer than an hour, so it could potentially be exposed to stomach acid even if it were not crushed. Hence, that is not a reason you would need to take it whole. Here again, there is no reason to think the crushing will prevent the drug from having its proper effect.

The one difference it is likely to make is that if you take whole without food, it would normally move through your stomach quickly and be released in the small intestine. If you take it crushed, your stomach would be exposed to the full concentration of it without any food. This could potentially cause some stomach irritation. As nausea and stomach pain are known (though not common) side effects of the drug, the main purpose of the coating is to prevent them in cases where people choose to take it without food.

In my somewhat-educated opinion, you are good to go - but I'd recommend taking it with food and plenty of liquid.

[1stimebare]

Have you considered apretude, the injectable prep?  Tho I understand in some countries its not available.  I am on it and I am told I am the first and at this time still the only patient on it at my Dr's. office.  Had to go with the injectable cause the kidney Dr said no to the pills due to potential damage to my kidneys.

[Guest]

5 minutes ago, 1stimebare said:

Have you considered apretude, the injectable prep?  Tho I understand in some countries its not available.  I am on it and I am told I am the first and at this time still the only patient on it at my Dr's. office.  Had to go with the injectable cause the kidney Dr said no to the pills due to potential damage to my kidneys.

I am sorry to hear that. I am not able to get it as far as I know it is not in my country but when I get my PrEP appointment it is the first thing I plan to ask.