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    HIV Medications [Question]
    GuzV64 posted:
    I've been living HIV + for the past 13 years and since my diagnosis in 1999 I've always been a great "medication taker". But recently I became overwhelmed by another condition which required over 26 pills per day instead and in addition to my regular 13 year regimen of 4 to 5 pills a day. I suppose it has to be mental, but it has now become extremely difficult to take the pills provided, even being back to a simple 8 pill daily regimen. From being a person who never missed a single dose -EVER- in 13 years, I now find myself missing too many doses for my liking and health. I am extremely concerned, as I should be, knowing a lot of what needs to be known as far as resistance consequences, etc. My phobia" overcomes logic in this ocassion and I wish to chage it. My question: Would I be able to crush my meds and add them to food or drink in order to ease the ingestion? one [intellence> is already disolveable, so there's probably no issue with it, but I'd like to get an opinion preferrably from an expert or someone who is knowledgeable with HIV meds. I am not too concerned about side effects regarding upset stomach or other similar issues, since I simply wish to return to a daily routine and regain my confidence. Thanks for any answer, suggestion, tip...
    georgiagail responded:
    You haven't described what medications you are on but there would be a problem with crushing any that are "sustained release". These are developed to be digested and absorbed slowly over an extended period of time and crushing them would result in a larger dose being absorbed into the bloodstream at one time.

    David J Malebranche, MD, MPH responded:

    Sorry to hear you are having this trouble... and you're right, it does seem to be psychological, and is very common among folks taking HIV medications, but also among alot of people having to take lots of meds. "HIV fatigue" is what many call it, because the burden of taking the extra pills is a bit much.

    Many of the medications formulated cannot be crushed and put in liquid and be just as effective, but some can. Let us know which ones, including the Intelence, you are on, and we can check for you..

    GuzV64 replied to David J Malebranche, MD, MPH's response:
    Truvada [Emtricitabine - Tenofovir 300 MG> once per day
    Norvir [Ritonavir 100 MG> twice per day
    Isentress [Raltegravir 400 MG> twice per day
    Intellence [Etravirine 100 MG> twice per day
    Prezista [Darunavir Ethalonate 600 MG> twice per day

    Current CD4 - 274
    Viral Load - 3 Mil

    I may've mentioned this before, but the Intellence is already disolveable and I simply add 1 to 2 oz of juice or water for ingestion. I'm concerned about the others although I have to certainly ingest on a full stomach, as reconnebded by previous doctors. Your present and continued assistance is greatly/immensely appreciated. I hope I can overcome this mental phobia or inability to consume the huge pills I am given. Thank you so much...
    GuzV64 replied to georgiagail's response:
    Thank you for the assistance. I responded to Dr, Malebreanch with the exact meds. as you might be able to see, Sustained release suggests periodical or throughout the day. These are some of the newest in the market and many of them are indeed not sustained release. HIV meds normally work if they do their job at once, not 1 pill now and release of another's 2 hrs later. Sustained release medications are normally for pain or other conditions which require a slow release into the body. I've done a bit of research and these are not sustained release. One of them is actually dissolveable as many others in the long list of HIV meds. Concern with crushing is more about the interaction with ingredients in food or drinks I may mix them with. But I suppose if you have to drink anything on a full stomach anyhow. I'm simply seeking assurance that these will not, I guess, although nothing is assured. I would certainly and unequivocably accept and appreciate suggestions and assistance received. Thank you and keep all replies regarding coming...
    David J Malebranche, MD, MPH replied to GuzV64's response:

    so I found a summary of medications noted on a list made by a PharmD (Pharmacist with a PhD in Pharmacology) - and from the list, Intelence and Norvir look like when they are crushed, it reduces the bioavailability of the medication, or how well it is absorbed into the bloodstream and achieves good levels in the blood to treat HIV. The others are not on the list, and may be fine. So the question you must ask yourself is if you want to take this risk of crushing some and swallowing others whole... and there still might be an issue if the other meds will work as well if you crush them.

    There is something about the pill or capsule releasing the contents in the stomach, and crushing before may reduce how effective your regimen will work. And if your viral load is 3 million, you want to give yourself the best chance you can. You could also look into seeing a counselor or a therapist to discuss anxiety and mental blocks with this, or even ask your doctor if you can speak to one of their pharmacists to get specific advice on how to better take the pills if the size of them is causing you some anxiety.

    Hope that helps.... here's the link for the list:

    GuzV64 replied to David J Malebranche, MD, MPH's response:
    This has been extremely helpful. I realize the risks involved and would probably not be the best route to crush the medications. I will consult with therapists as well as immediately begin the regimen. I think I can possibly take the intellence and norvir whole and "re-train" myself to take the others as well, by slowly either crushing the larger pills or sectioning them into manageable pieces. I wish to return to a normal routine as soon as possible, since the present alternative of not taking them at all is much more detrimental to my health than difficult swallowing of the medication, especially since I believe now I have a throat or chest infection which makes it even more difficult to swallow anything. Again, thank you so much for your so needed assistance and I hope to keep you updated as to my progress. Thank you...

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