How to take PrEP Effectively?
If you’re at high risk of getting HIV, taking PrEP might be something you’ll want to do. PrEP treatment is more flexible than ever these days. You can decide to take PrEP in a way that works for you. Although flexible dosing is possible with PrEP, many people opt for daily PrEP dosing.
In general, PrEP works best when you take it every day, 7 days a week. You should aim to take it at the same time every day for maximum effectiveness. In addition, you can take it with or without food, although you should follow the directions from your doctor for best results.
Continue reading to learn more details on how to take PrEP, if you’ve decided that PrEP may be right for you.
How to take PrEP
Take PrEP daily
PrEP is considered a daily HIV prevention pill. The available PrEP medications are Truvada and Descovy. Truvada contains tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) while Descovy contains tenofovir alafenamide (TAF) and emtricitabine (FTC). Both medications are approved as PrEP treatments, with Descovy being a newer drug with slightly better effectiveness. However, both drugs are similarly effective and may be available in generic versions.
Who should take PrEP?
PrEP may be right for you if you are HIV negative and any of the following apply to you:
- You have anal or vaginal sex with a partner who has HIV
- You regularly have anal or vaginal sex without a condom
- You have had an STD in the past 6 months
- You inject drugs or have a sexual partner who is an injection drug user with HIV
- You share syringes, needles, or other injectable drug equipment with others
- You have been prescribed PEP (post-exposure prophylaxis) multiple times in the past
- You continue to engage in risky behaviors after finishing a course of PEP
- You are pregnant with a partner who has HIV
Who should not take PrEP?
You should not take PrEP if any of the following apply to you:
- You have tested positive for HIV
- You have certain kidney problems
- You’re not ready to commit to taking medication consistently every day
You should take PrEP at the same time everyday with or without food. One of the best ways to take your PrEP at the same time every day is to use an alarm or pillbox, which can also help you keep track of your doses and avoid missing or skipping a dose. Taking PrEP daily is one of the most effective ways to get maximum protection.
Alcohol and PrEP
Alcohol does not directly interact with PrEP medication. The danger with drinking alcohol while on PrEP is that alcohol might make it more likely for you to forget your medicine. Missing doses can increase the risk of getting HIV. For that reason, it’s not recommended to drink excessively while on PrEP treatment. Moderate alcohol consumption should be fine though.
PrEP and other medications
It’s important to tell your doctor about other medications you may be taking including prescription drugs, over-the-counter medications, and herbal supplements. PrEP may interact with certain drugs like nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, naproxen, and ibuprofen. Taking these drugs together may increase the risk of kidney problems while on PrEP. You may want to contact your doctor or pharmacist for other possible drug interactions.
PrEP after exposure
PrEP should be taken if you expect to be at high risk of getting HIV. It is a preventative means of treatment to avoid getting infected with HIV. It is different from PEP, which is taken after a potential exposure to HIV. PEP is most effective when started within 72 hours of exposure. If you’ve been exposed to HIV, you may be recommended certain antiviral drugs for 28 days. You can switch to PrEP after finishing PEP treatment if you think you’ll be at high risk of getting HIV after completing a course of PEP.
Daily PrEP dosage vs taking it every other day
Studies have shown that men who take at least four daily doses of PrEP every week may be well-protected from getting HIV. Blood levels of PrEP have been found to be high enough to be protective when PrEP is taken every other day, or at least four days, of the week. However, these studies only looked at men having sex with men. Taking PrEP four days a week or every other day might not be as effective in women and transgender men. It is advised to go for daily PrEP dosage to ensure the best protection.
When should I take PrEP: morning or night?
PrEP can be taken in the morning or evening. There is no set rule for the best time to take it. You can set it around your schedule as long as you take it at the same time every day. You might choose to take it before breakfast or before going to bed to make it part of your daily routine.
How to take PrEP on demand?
On demand PrEP, also called event-based PrEP, is another way to stay protected from HIV. As you might expect, event-based PrEP is taken when you know when you’ll be having sex. You can use this type of PrEP dosage if you have sex less than a couple times per week or you’re able to predict when you will have sex. It’s a convenient way to be on PrEP without having to take it daily. You can also save on the costs of PrEP since you only need enough to take for the period of time you’re having sex.
Take PrEP on demand
It’s important to take event-based PrEP as directed without missing a dose. At this time, this type of PrEP dosage plan is only recommended for cisgender men who have sex with other men. It is not typically recommended for women or transgender people.
The event-based PrEP dosage is as follows:
- Take an initial loading dose of two pills (at the same time) between 2 and 24 hours before sex
- Take a single dose of one pill 24 hours after the loading dose
- Take another dose 24 hours after the last dose
Event-based PrEP is also known as the 2-1-1 method.
If you’ll continue to have sex for multiple days after the initial loading dose, you can take one pill for every day you have sex after the first time. Just remember to take a single dose for two days after you stop having sex.
Other ways to take PrEP pills
Periodic PrEP dosage
Going away for a long weekend or a weeklong adventure? Or maybe you have a bunch of parties lined up for the spring or summer? No worries. You can take PrEP for an extended period of time. Similar to PrEP on demand, you can be on PrEP if you want to protect yourself for a certain period of time. You might be concerned about the cost and side effects associated with long-term PrEP use. Fortunately, periodic PrEP is a good way to ease into daily PrEP dosage if needed.
Guidelines for periodic PrEP dosage
Here’s a guideline on periodic PrEP. For cisgender men who have sex with men:
- Take an initial loading dose of two pills (at the same time) between 2 and 24 hours before sex
- Take a single dose of one pill 24 hours after the loading dose and then 24 hours every day while you have sex
- After the last time you have sex, take a single dose every day for 2 days
For other people, including transgender people who have sex with other men:
- Take a single dose of one pill for 7 days before having sex
- After the last time you have sex, take a single dose every day for 28 days
Depending on your situation, you’ll want to make sure you have enough PrEP medication on hand to cover all the days you’ll be having sex. You don’t want to mess up your planning by not having enough PrEP to protect you.
What if I missed a dose of PrEP?
If you’ve been consuming PrEP daily on a consistent basis, missing one dose is not usually a huge concern. Just remember to take a dose as soon as you remember. Don’t take two pills at the same time to make up for a missed dose.
Men who have sex with men can miss up to three doses per week; in other words, these men can still be protected when consuming PrEP for 4 days per week. Women shouldn’t miss more than one dose per week. PrEP is most effective in women when taken for 6 to 7 days per week.
How long does it take for PrEP to take effect?
It can take 7 days for PrEP to be fully effective in people who have anal sex. For people who have vaginal sex or those who inject drugs, PrEP is not fully effective until 21 days after starting treatment. PrEP can take longer to be available and absorbed into the vaginal tissue versus the anal tissue. You should use condoms until you are fully protected with PrEP after the allotted time period.
How long do you need to take PrEP?
You should be on PrEP for as long as you’ll be potentially exposed to HIV. If you’re having sex with other men as a man, you’re not using condoms, or you or your partner is using injectable drugs regularly, you should keep taking PrEP daily.
You can choose to take a break from PrEP at any time, depending on your life situation. For example, you can stop PrEP dosage if you believe you’ll no longer engage in activities that increase your risk for getting HIV. However, if you think you’ll be exposed to HIV again, you should use condoms if you’re having high-risk anal or vaginal sex. Or, you should consider restarting PrEP. Just keep in mind that PrEP is not effective in anal tissue until 7 days after restarting treatment or in vaginal tissue until 21 days after restarting treatment.
Switching between PrEP dosages
PrEP is a flexible treatment that can be taken in different ways. You can switch between PrEP dosing strategies as often as you need to based on your HIV risk. If you’ve taken a course of PEP, you can be on PrEP if you’ll be exposed to HIV regularly. You can also start PrEP dosage after trying event-based or periodic PrEP dosing strategies if you think you might be exposed to HIV often. You can also talk to a healthcare provider to determine the best strategy for you.
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Learn more about how to buy PrEP online.
