Question
How do I time my meds when travelling?
19 December 2009. Related: Adherence, All topics, Resistance, Side effects, Travel.
I am currently on Atripla (since Feb 08) and remain undectable.
Next week I am taking a vacation and we are going from the UK to the US. There is a 6hr time difference with the US being behind 6hrs. I usually take my Atripla around 11pm at night. I am really frightened and concerned and dont know what to do?
If I don’t adjust the times then i will be taking my meds at 5pm US time which will mean I could be wiped out from the side effects for the rest of the evening? However, I dont want to risk taking them at 11pm US time, as it will mean that I am 6hrs late taking my Atripla, which could lead to resistance. What should i do?
Thanking you in advance and i would really appreciate if someone was able to give me advice as we travel in a few days.
Answer
Thanks for your question.
For someone who is using Atripla (efavirenz+tenofovir+FTC) and has had an undetectable viral load for many months (or years) it is probably easiest to just switch to US time on your first night.
Although this risks low drug levels for up to 6 hours, this is just like forgetting one days meds, which even someone with the best adherence is likely to do at least once or twice. Although this isn’t the best scientific answer, in practice, missing one dose for a few hours is unlikely to do any harm – see this previous question on this.
This approach is also supported by a study called FOTO (Five On Two Off) where people with undetectable viral load on Atripla, were randomised to either continue on 7-day dosing or change to taking meds for 5 days a week and not for 2 days at weekends. After one year, the people on the 5-day strategy all still had undetectable viral load.
While I think that the FOTO study is too small a study to support people switching routinely to the 5 days on/2 days off strategy, I think it provides interesting evidence to support the general safety from extending, or missing, one dose of Atripla.
Scientifically, and for people using other combinations, the main options when travelling to different time zones is either to stay on UK times (ie taking them at different local times – 5pm rather than 11pm UK time n your example) or to switch to the same time of day in the new time zone. For anything other than a very short trip, it is usually easier to change to the new time zone – ie so if you take meds at 11pm in the UK to take them at 11pm on your holiday time zone.
When changing the schedule the main principal is that it is easier and safer to bring forward your dose time then is is to extend it. For a twice-daily drug you don’t want to leave it longer than 12 hours, but it is fine to bring one dose forward, even by 6 hours, if that gets you on the same local time at your destination. With a once-daily drug, you don’t want to go past 24 hours, but could bring it forward by 6, 8 or even 12 hours.
Although bringing froward a dose will give you slightly higher levels of each drug, this is very safe for such a short period.
When returning to the UK, bringing the dose forward to get you on UK time with your first dose is fine for the same reasons.
Reference: Cohen C et al. The FOTO study: The 48 week extension to assess durability of the strategy of taking efavirenz, tenofovir and emtricitabine Five days On, Two days Off (FOTO) each week in virologically suppressed patients. 5th IAS Conference, 2009. Abstract MOPEB063.
http://library.iasociety.org/AbstractView.aspx?confID=2009&abstractId=3046
Hi Lao, you can switch the time of the meds and it will not cause any harm. It is more important that you take the meds at a suitable time for you, rather than struggle with a difficult time that could cause you to miss your meds.
Thank you for this one Josh.
Im taking my meds usually at 8pm PH time, for me it’s actually quite early. Since my dinner is around 5:30-6:00pm coz Im not allowed to eat for 2 hours.
Is changing my drinking time wont affect any harm? Im planning to take my ART 10pm?
And I will stick with your advise of taking my meds Berlin Time. Once I will go for work in Europe.
Thank you very much
Hi Lao, yes your doctor is right. You are taking your medication well and as long as you are careful there is no reason for you not to travel.
A lay-over in Istanbul will not cause you any problems.
It is good to hear that you have been doing well on treatment and currently you only have this one side effect. What time are you taking your treatment? Hopefully this effect will wear off as your body adjusts to the treatment.
I hope you have a wonderful day ahead. I feel relieved knowing that there’s an organization that extends their help for HIV people globally, reading some concerns from people also boosts my chances to live longer and like normal as long as we will take the ARVs religiously.
I use the name “Lao” for my identity, and I also wrote a question and posted it on the page. I was the one who asked about traveling in different time zones from the Philippines to Berlin. In regard to how to work on my medicines because the Philippines is ahead of 7 hours which was already answered.
I started my treatment last January 8, 2024 with CD4 of 49. So far I don’t have any side effects on the medicines that I’m taking except that I’m drowsy a bit and I take it every 8pm Philippine Time. Im also taking cotrimoxazole daily and azemax twice a week. My Doctor allows me to travel as long as I’ll be extra careful not to get any infections or viruses. I also want to seek your opinion about it.
About it my new concern is we will be having a connecting flight and will be in Istanbul for lay-over, would that be okay?
And what will be your guidelines for my upcoming trip?
I also had some questions submitted to the page but I can’t see the answers, for maybe it is mixed up with and hard to find.
Please help me.
Hi Lao, yes it is alright that you will be there for 2.5 weeks.
No you do not need to change your bottles. There are no restrictions for entering Germany as a person living with HIV. As with all medication it is advised to carry a prescription/doctors note detailing that the medication is for personal use.
Thank you for this answers. I will follow what you said and will take my ART and other meds Berlin time onceI reach there. I will be there for 2.5 weeks so it’s okay right?
And one question, do I need to change my ART bottles with vitamin bottles? Im afraid customs will question me bringing such medicines. Please help me with this.
Thank you.
Hi Lao, yes this is okay. Because it can be difficult to gradually switch times/keep up with your regular time in other time zones, it is safe to do a big switch in one go.
This switch will help you maintain your adherence and this is more important than a 7 hour delay in treatment. You can then switch back to your normal time when you return.
This will not cause any harm and is safe for you to do. It is more important that you stay taking your treatment daily while on holiday instead of figuring out how to take it using your at home time.
I appreciate this, so its okay to take it in Berlin time? which is 7 hours late than Philippines time? And will revert if once I’m back in the Philippines right?
it wont affect any harm? in my case starting my medications Jan 8,2024 I’m afraid the are wont take effect if I drink it late than my usual drinking time.
Please enlighten me.
thank you
Hi Nik, the easiest way to do this is to switch to the time you are travelling to.
E.g., take your treatment as normal and while you go travelling, have the next dose have the treatment at 8pm when you get to Berlin and do the same for your Tb treatment.
This will lead to one day your dose being 7 hours early and on return (or vice versa) your treatment being late. Doing this on one occasion is not going to risk it not working and it is easier than trying to adjust incrementally for the duration of your travels.
Hello.
I am going to travel to Berlin, and I am bringing my HIV meds with me, my concern is I usually take them at 8 pm Philippine time and the Philippines is 7 hours in advance to Berlin What is the solution for this one?
And Im aslo taking anti tb meds every before breakfast?
What are the best solution so that I cant skip my meds?
Thank you