On-demand PrEP: stomach issues

[tonio]

Hello,

I recently tried PrEP for the first time, on an on-demand basis (2-1-1 dosage).

And it was just awful.

It felt like I had the stomach of a 80-year-old.

I couldn't drink, even one beer. And even if I took the pills with a meal, I experienced pretty nasty stomach discomfort.

What's the point of being immune to HIV if you can't even enjoy to party and play?

So I stopped the medication, and quickly recovered (about 2 days after stopping medication).

Now I am talking about alternative options with my physician (maybe going for a 1-1-1-1-1 dosage to decrease side effects).

Anyone else experienced stomach issues linked to on-demand PrEP?

[Spunkinmyarse]

When I first went on daily Prep, years ago, it was awful. I had the worst diarrhea of my life. I very nearly gave up, but I’d been warned that this was a possible side effect- particularly for guys in middle age- and was told it would probably just be temporary, so stuck with it. And after about 3 weeks, it just stopped- and has never come back.

But I do remember thinking at the time, the reason Prep must be so effective is that with diarrhea like that, there’s no way guys could have anal sex at all when on it 🤣

 

[blackrobe]

I started PrEP and had no side effects. Except I got to take a lot of bare dick and seed without fretting about HIV at all. 

I'd consider trying the daily dosing to see if ii's a matter of your body being able to adjust/adapt.

[BootmanLA]

Lots of side effects of medication are temporary. I'd give it additional time, if I were you - but if the 1-1-1-1 you're proposing seems to work, I'd strongly urge you to shift to daily use instead. Having a regular dose in your system is likely less impactful on your digestive system AND is documented to work. And it's likely, although not guaranteed, that if you keep taking the medication, your system will adjust to be able to handle it without disrupting your digestion & excretion functions.

I don't know of any studies that have tested a 1-1-1-1 on-demand routine, but I suspect that the reason the 2-1-1 dosing was chosen as effective is that big influx of anti-retroviral medication hitting your system and being available at the point when you might get infected. The general recommendation is to take the double-dose before sex as close to, but at least 2 hours before, actually having sex, precisely because the drug will be most heavily concentrated in your system, providing the most protection. A single dose, especially one taken several hours before sex, may just not have sufficient "ooomph" by the time you might get infected.

[Memphian]

I use on demand dosing, and have never had any stomach issues

[tonio]

Okay so here is my current on-demand PrEP regimen as discussed and modified with my physician.

My main problem seemed to be that the initial doses (especially the first double dose) were too much for my stomach.

So instead of the 2-1-1 standard on-demand regimen, I was allowed to use an alternative 0.5-0.5-0.5-0.5-1-1-1 regimen.

That is:

- Four daily 0.5 doses on the four days preceding the sexually active day (to get the drug progressively into my system without hurting my stomach too much)

- One full dose on the sexually active day

- One full dose on the next day

- One final full dose on the following day

Doing this (and always crushing the pill with my teeth before I swallowed it) seemed to reduce my gastrointestinal issues to almost nil while maintaining a good level of protection.

I post this for information only, always do things with the permission of your physician.

Edited November 9 by tonio

[tonio]

The reason my physician allowed me to go on this regimen is because I am a circumcised total top. In his view, in my situation, even a low level of PrEP in my system would be sufficient to prevent a potential infection, provided I took care of other STDs and cuts/abrasions. The initial double dose is particularly efficient for bottoms though, he said.

So I guess I will just stick with this modified on-demand regimen + DoxyPEP if needed

Edited November 9 by tonio

[1Exhibitionist]

10 hours ago, tonio said:

The reason my physician allowed me to go on this regimen is because I am a circumcised total top. In his view, in my situation, even a low level of PrEP in my system would be sufficient to prevent a potential infection, provided I took care of other STDs and cuts/abrasions. The initial double dose is particularly efficient for bottoms though, he said.

So I guess I will just stick with this modified on-demand regimen + DoxyPEP if needed

Does taking the dose with food alleviate or worsen your stomach issues?

I’m on a daily regimen and notice less stomach rumble when I’ve eaten something a few hours before my dose vs taking on an empty stomach.

[tonio]

3 hours ago, 1Exhibitionist said:

Does taking the dose with food alleviate or worsen your stomach issues?

I’m on a daily regimen and notice less stomach rumble when I’ve eaten something a few hours before my dose vs taking on an empty stomach.

Yes. Starting four days before with a reduced dose, taking the pill with food and crushing the pill with my teeth before swallowing it seemed to help. I think it's a combination of all these three factors because food or not, the initial double dose seemed to be overwhelming for my stomach.

 

Edited November 10 by tonio

[BootmanLA]

On 11/9/2024 at 12:12 PM, tonio said:

So instead of the 2-1-1 standard on-demand regimen, I was allowed to use an alternative 0.5-0.5-0.5-0.5-1-1-1 regimen.

As you noted, as a top-only guy, this may be enough to protect you. But it does require a great deal of planning ahead, knowing which days you plan to have sex. If you don't have at least four or five days' notice, it's impossible for this scenario to play out. If you're that sure that far ahead, more power to you.

[tonio]

12 hours ago, BootmanLA said:

As you noted, as a top-only guy, this may be enough to protect you. But it does require a great deal of planning ahead, knowing which days you plan to have sex. If you don't have at least four or five days' notice, it's impossible for this scenario to play out. If you're that sure that far ahead, more power to you.

I pretty much agree.

FWIW, I'm on Truvada, not Descovy (because Descovy is not covered by insurance where I live). But it's not really a problem as I almost don't experience sides with my modified Truvada on-demand regimen.

I have heard that Descovy was better tolerated than Truvada in most people.

 

Edited November 11 by tonio

[verslut]

I tried on demand PrEP with Descovy for the first time recently. I've taken Descovy for daily PrEP and Truvada for PEP before with no stomach side effects. I didn't eat anything that would upset my stomach on the double-dose day, but my stomach was upset the next morning. I took some bismuth subsalicylate and felt fine the rest of the day.

[BootmanLA]

I'm also going to just point out the old bromide that "correlation is not causation".

A person can have an upset stomach issue after taking PrEP while PrEP is actually not the cause in the least. That's not to say it CAN'T cause gastric distress, but just because one happens after the other doesn't mean they're connected.