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Late drug doses
   Last updated: 21.12.05
 
For combinations of anti-HIV drugs (often called highly active antiretroviral therapy, or HAART for short), to work properly it is necessary to take them at the right time, in the right way, following any restrictions on food. Many people find this very demanding and sometimes miss doses, or take a dose late.

Taking your medication late can be as bad as not taking it at all, allowing HIV to become resistant to some or all of the drugs you are taking.

The safest approach is to aim to take all your doses at the right time and in the right way, though most people will probably take their medicines late at some time. If this happens very occasionally it may make no difference to the success of your medication. However, if you regularly take your medication late, then it could allow HIV to become resistant to your treatment, meaning that your viral load may rise, your CD4 count fall and as a result you could face a greater risk of becoming sick.

Some anti-HIV drugs, particularly protease inhibitors, are processed more quickly by the body than others. This means that it is very important to take them at the correct time as the amount of drug in your body will not be sufficient to suppress HIV if dosed late.

For some other drugs, such as 3TC (Epivir), efavirenz (Sustiva), nevirapine (Viramune), and tenofovir (Viread), it may be possible to take your drugs an hour or two late (or early) and for it to have minimal risk for the success of your medication. This is because these drugs pass through the body slowly.

For other drugs it is very important to stick as closely as possible to exact prescribing times. The drugs which are most likely to require strict dosing times are protease inhibitors, particularly indinavir (Crixivan), saquinavir (Fortovase) and nelfinavir (Viracept) which are not boosted by the addition of small doses of ritonavir (Norvir).

Do not assume that because somebody else is able to take their medication late, even if they are taking the same drugs as you, that you will be able to do the same, as the speed and effectiveness with which people process medicines can vary considerably. Remember also that regardless of which drugs you are taking, the safest approach is always to take all of your medication on time.

If the way you lead your life means that you find it difficult to stick to very strict dosing schedules then talk to your doctor about the possibility of switching to a combination that requires less rigorous timing.

If you forget to take your medicine at the time you were told to, then take it as soon as you remember, then carry on with your normal dosing schedule. Do not take a double dose if you forget to take your medication completely.

Planning ahead
Going out, traveling, or doing anything which interrupts your normal routine may cause you to have difficulty taking your medication at the correct time. If you know that your normal dosing routine may be interrupted, then try and make a plan that ensures that you take your medication as close as possible to the correct time. For example, taking your pills with you, having a bottle of water to hand, and if you need to take your medicine with food, a bar of chocolate or some other easily carried food, may mean that you are able to take your medicines without disrupting either what you are doing or your medication routine.

Asking people to remind you to take your medication, if you are socialising and the people you are with know you have to take doses of drugs, may also prove useful. Also, keeping spare doses of medicine in places where you may be when you have to take your medicines, such as work, at friends or relatives homes, or in your bag may also prove useful. Always store medicines out of the reach of children.

Alarmed watches are useful tools if you find that you are regularly forgetting to take your medication on schedule.

More information
An easy-to-read booklet on Adherence is available from NAM and can be found online at aidsmap.com