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Common Name:
emtricitabine and tenofovir DF
Brand Name:
Truvada |
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Class: fixed dose combination—nucleoside/nucleotide analogs (also called nucleoside or nucleotide reverse transcriptase inhibitors, NRTIs or nukes)
Standard dose: One tablet (300 mg Viread and 200 mg Emtriva) once a day, no food restrictions (may be taken with or without food). Dosing frequency needs to be adjusted for people with decreased kidney function. Take missed dose as soon as possible, but do not double up on your next dose.
AWP: $934.50 / month
Manufacturer contact:Gilead Sciences,
www.gilead.com, 1 (800) GILEAD5 (445–3235)
AIDSInfo:
1 (800) HIV–0440 (448–0440), www.aidsinfo.nih.gov
Potential side effects and toxicity: See the drugs contained in Truvada: Viread and Emtriva. Overall, fairly well tolerated, however, individuals may experience the following: nausea, headache, dizziness, diarrhea, rash, vomiting, abdominal distension/pain and gas.
Potential drug interactions: See the drugs contained in Truvada (Viread and Emtriva). Do not take with Emtriva, Viread, Atripla, Epivir, Combivir, Epzicom, or Trizivir, since all or part of these medications are already in Truvada or have equivalent medications. The levels of Videx EC and Videx (ddI) are increased by 44–60% when given at the same time as Viread. Therefore, a dose reduction to 250 mg for Videx is recommended for people who weigh more than 60 kg (132 pounds) and to 200 mg for those who weigh less than this. See Tips. Viread decreases the concentration levels of Reyataz. In addition, Reyataz (and Kaletra) increases Viread concentrations. The reasons for these interactions are not fully understood. Higher Viread concentrations could increase the risk of Viread-associated adverse events, including kidney disorders. The FDA suggests that patients receiving Reyataz and Viread should be monitored for Viread-associated adverse events. When taken with Viread, it is recommended that Reyataz 300 mg is given with Norvir 100 mg (all as a single daily dose with food). Reyataz without Norvir should not be taken with Viread.
Tips: Remember, Truvada is two drugs in one pill, so see the pages for those drugs, Emtriva and Viread. Currently, U.S. HIV treatment guidelines recommend Truvada over Epzicom as a preferred agent for the NRTI component of an HIV regimen. The combination of Viread with either Epivir or Emtriva has shown potent virologic suppression with Sustiva and was not worse than Combivir. The kidney toxicity must be monitored before and during treatment with Truvada. And Truvada may not be a good option for patients with underlying kidney problems. Please see package insert for more complete potential side effects and interactions.
Truvada is a safe, effective, and well tolerated nuke backbone, for the reasons discussed under “tenofovir” and “emtricitabine.” Truvada would generally be combined with PIs; if you’re taking this backbone with efavirenz, you’d use Atripla. The only real downside is the potential for kidney toxicity, though this is quite uncommon in people with normal kidney function (see “Viread”).—Joel Gallant, M.D.
Truvada was the first fixed dose combination from Gilead Sciences. It combined two of the company’s highly successful products, Viread/tenofovir and Emtriva/FTC. It has quickly become a mainstay of treatment. Viread appears to be the most potent and perhaps the least toxic of the nucleoside/nucleotide drugs, and Emtriva is believed to be slightly superior to Epivir. Thus, Truvada has quickly overcome the market lead once enjoyed by Combivir. Truvada in turn has been combined in a single pill with a third drug, Sustiva, to create a highly potent complete combination that requires only one pill once a day. Though there are lingering concerns about potential kidney toxicity and possible bone toxicity from the Viread/tenofovir component of Truvada, it hasn’t shown up to a significant degree in any clinical studies. Individual physicians have reported cases but not enough yet to warrant any major concerns. Overall, Truvada is widely used and highly regarded by patients and physicians alike.—Martin Delaney
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