Is there a preferred time to take my etravirine?

Preferred Time to Take Etravirine

Etravirine should always be taken twice daily following a meal to ensure optimal absorption and effectiveness. 1

Dosing Schedule and Food Requirements

The FDA-approved labeling for etravirine clearly specifies that the medication must be taken with food:

• Adult dosage: 200 mg (one 200 mg tablet or two 100 mg tablets) twice daily following a meal 1
• The type of food does not affect the exposure to etravirine, so the specific meal content is not critical 1

Impact of Food on Absorption

Taking etravirine in a fasted state significantly reduces its bioavailability:

• Administration in a fasted state results in 51% lower mean exposure compared to taking it after a meal 2
• This reduction in absorption could potentially lead to suboptimal drug levels and reduced antiviral efficacy

Meal Options and Flexibility

Research has shown that while food is necessary, the specific type of meal is less important:

• Standard breakfast, high-fat breakfast, enhanced-fiber breakfast, or even a light breakfast (like a croissant) all provide adequate absorption 2
• The differences in exposure between these meal types are not considered clinically relevant 2

Administration Considerations

If you have difficulty swallowing the tablets whole:

1. Place the tablet(s) in 5 mL (1 teaspoon) of water
2. Stir well until the water looks milky
3. Add approximately 15 mL (1 tablespoon) of liquid (water, orange juice, or milk)
4. Drink immediately
5. Rinse the glass several times and swallow the rinse to ensure the entire dose is taken 1

Drug Interactions to Consider

Etravirine interacts with several medications through its effects on cytochrome P450 enzymes:

• It is a substrate for and weak inducer of CYP3A4
• It is a substrate and weak inhibitor of CYP2C9 and CYP2C19
• It is a weak inhibitor of P-glycoprotein 3

Important Interactions to Monitor

• Avoid co-administration with drugs that strongly induce CYP3A4 and P-gp (such as carbamazepine, rifampicin, St. John's wort) 4
• Dose adjustments may be needed when taken with certain antiretrovirals 4
• Etravirine should not be given with rilpivirine 4

Key Points to Remember

• Always take etravirine twice daily with food
• Consistency in timing relative to meals is more important than the specific time of day
• The type of food does not significantly impact absorption, so choose what works best for your schedule
• Never take etravirine on an empty stomach as this significantly reduces its effectiveness

By following these guidelines, you can maximize the effectiveness of etravirine while minimizing potential side effects and treatment failure.