Question

What are alternative third drugs to rilpivirine?

17 February 2013. Related: All topics, Changing treatment.

Hi,

I am currently on efavirenz and Kivexa (abacavir+3TC) combination therapy.

Although this treatment is successful, I am wishing to switch treatment. The main reason for wanting to switch is due to suffering with chronic fatigue, poor concentration, tiredness and lethargy, which I’m sure is due to efavirenz.

Can I ask – is efavirenz known to cause debilitating tiredness and fatigue? My consultant has recommended a switch to rilpivirine (Edurant) as stated that this drug is in the NNRTI family.

Having read about rilpivirine, I do not consider this an option as apparently it needs to be taken WITH food everyday which is not suitable to my lifestyle with meal times etc.

Can I ask – which drug could I switch to instead of efavirenz which will consist of 1) Once daily dosage with Kivexa and 2) Can be taken with or without food. Many thanks.

Answer

Answer: Rebecca McDowall

Hi,

Thanks for your email. I’m sorry to hear about the side effects. This is not unusual with efavirenz and if they have not improved it is very good that you are going to try a different combination.

Food recommendations are important and rilpivirine does need to be taken with a meal of at least 500 calories. If this doesn’t fit into your lifestyle then talk to your doctor about these options.

There are several different options for a third drug to be taken with Kivexa (abacavir + 3TC). These may all be possibilities for you, but there may be limitations if you have any underlying health conditions or drug resistance. I have outlined the alternatives below, along with information about dosage and food requirements. If you click on the links you will be able to read more information about each drug.

Nevirapine probably best matches what you are looking for in terms of food requirements and dosage but you will need to speak to your doctor about whether this is suitable for you.

The BHIVA guidelines for preferred third drugs are as follows:

atazanavir/ritonavir (ATV/r) – this is 2 pills, once daily but needs to be taken with food. The type of food is not important though, and calorie count is not specified.

darunavir/ritonavir (DRV/r) – again 2 pills, once daily, but with food. The type of food is not important though, and calorie count is not specified.

efavirenz (EFR) – this is the drug you are already on, and mustn;t be taken with a high fat meal.

raltegravir (RAL) – twice daily, with or without food, but may not be available due to high pricing.

The guidelines also include alternative options that are not so strongly recommended, but which are still useful in many situations:

nevirapine (NVP) – can be dosed once-daily, after a lead in period of two weeks. With or without food.

lopinavir/ritonavir (LPV/r) – twice daily, with or without food

fosamprenavir/ritonavir (FPV/r) – twice daily, with or without food

rilpivirine (RPV) – once daily, with a 500 calorie meal.

etraviriine (ETR) – this is a twice-daily NNRTI that needs to be taken with food. Some clinics use this once-daily.