Learn what PrEP on-demand is, who it's for, and how it's different from daily PrEP.
PrEP on-demand can be an effective HIV prevention option for those with infrequent, planned sexual habits.
PrEP on-demand (PrOD), like daily PrEP, requires a prescription from a healthcare provider in Canada. Itâs less frequently prescribed because PrOD requires more planning than daily PrEP.
Patients must start the PrEP on-demand regimen 2-24 hours before a planned sexual encounter.
PrEP on-demand can be an effective HIV prevention option for those with infrequent, planned sexual habits.
PrEP on-demand (PrOD), like daily PrEP, requires a prescription from an approved PrEP provider in Canada. Itâs less frequently prescribed because PrOD requires more planning than daily PrEP.
If taken correctly, PrEP on-demand can offer up to 99% protection against HIV during anal sex.
Patients must start the PrEP on-demand regimen 2-24 hours before a planned sexual encounter.
Only Truvada and its generic form can be used for PrEP on-demand. Descovy cannot be prescribed as PrEP on-demand.
PrEP is an acronym for Pre-Exposure Prophylaxis, a daily regimen that helps prevent people from contracting HIV when taken correctly.
There are two ways PrEP can be prescribed to be taken:
The daily regimen is the most common approach to PrEP.
This strategy involves a once-daily routine to help optimize its potential benefits, and it is generally recommended that the regimen be utilized at the same time each day for consistency.
Many healthcare providers in Canada typically recommend the daily approach, as evidence suggests individuals may find it easier
to maintain consistent adherence compared to on-demand strategies.
PrEP on-demand is less commonly prescribed because it requires careful planning and tracking of sexual activity - and we know sex isnât always planned. Studies show that PrEP on-demand is effective at preventing HIV, but there is a higher chance of missed doses or low drug levels that might make it less effective than daily PrEP. But if you and your prescriber think itâs right for you, it is a great way to prevent HIV.
PrEP on-demand does not require daily intake. This is ideal for someone who canât access a sufficient supply of PrEP due to cost or if they have predictable and fluctuating sexual behaviour.
Nicknames for PrEP on-demand include:
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Intermittent PrEP
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Non-daily PrEP
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Event-driven PrEP
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Off-label PrEP
Clinical guidelines currently support the on-demand strategy primarily for individuals seeking to reduce the risk of HIV transmission through anal sex. Because of how the active compounds distribute in different body tissues, this method is not currently recommended for vaginal/frontal exposures. Additionally, this approach has not been established for reducing transmission risk associated with injection drug use.
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All PrEP strategies are intended for individuals who are confirmed to be HIV-negative and require oversight by a healthcare provider. While many clinicians typically recommend the daily strategy to help optimize overall risk reduction,
the on-demand approach may still play an effective role in HIV prevention and might be considered for individuals who
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Face financial barriers to maintaining a daily regimen
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Have limited access to housing or secure storage for treatments
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Find it challenging to maintain a daily routine
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Have infrequent, predictable sexual encounters that can be planned in advance
Book a phone appointmentLESS THAN 10% OF PATIENTS EXPERIENCE SIDE EFFECTS FROM PrEP ON DEMAND.
The most common side effects are nausea and diarrhea. These symptoms might be mild or severe. Other possible side effects include headaches, dizziness, and abdominal pain or cramps (in the stomach).
Although these are experienced more frequently among PrEP on demand than daily PrEP medicine users, the amount of patients that experience side effects is still generally low.
Whether you choose to take PrEP on-demand or daily is your choice. Itâs important to understand that most providers in Canada will prescribe daily PrEP when possible, as itâs more effective in preventing HIV and more regulated.
However, if you are considering on-demand PrEP and think it would better suit your current situation, feel free to chat with your PrEP provider. They should be able to advise you on the best dosing schedule and how to best continue preventing HIV in a way that works for you.
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Reviewed by:
Dr. Caley Shukalek
Caley is passionate about evidence-based patient-centred care, including telemedicine that can provide high quality care from wherever a patient may choose.
He helped create Albertaâs PrEP guidelines and works as a specialist in General Internal Medicine with additional training in sexual health, including HIV and sexually transmitted infections.
He holds a Masters of Public Health from Johns Hopkins University, an MD from the University of Calgary and an MSc from the University of Alberta.
