Odefsey and Complera

Moderate to severe side effects are uncommon; insomnia, headache, nausea, and depressive disorders (depression, negative thoughts, suicidal thoughts or actions) were observed. Cases of rash, angioedema (swelling), urticaria (itchy rash), and increased liver enzymes have also been reported with regimens containing rilpivirine. TAF has been associated with potential weight gain. There may be a small increase in serum creatinine (SCr) and decrease in estimated creatinine clearance (CrCl) associated with rilpivirine. Prior to initiation, people should be tested for hepatitis B virus (HBV) infection. Severe exacerbations of HBV have been reported in people co-infected with HBV who have discontinued Odefsey or Complera (due to elimination of the emtricitabine, TAF, and TDF components, which also treat hepatitis B). Monitor liver enzymes closely in co-infection. Initiation of HBV therapy may be warranted upon discontinuation. Call your health care provider right away if you develop any of the following signs or symptoms of hepatitis: yellowing of the skin or whites of the eyes; dark or tea-colored urine; pale-colored bowel movements; nausea or vomiting; loss of appetite; or pain, aching, or tenderness on the right side below the ribs. SEE Descovy and Truvada pages for more possible effects on kidney function. Increased monitoring for adverse events is recommended for people with ESRD who are taking Odefsey.

Proton pump inhibitors (PPIs, heartburn or stomach acid drugs such as Aciphex, Dexilant, Nexium, Prevacid, Prilosec, Protonix, etc.) cannot be taken. Antacids containing aluminum, magnesium hydroxide, or calcium carbonate can be taken two hours before or four hours after Odefsey or Complera. Stomach acid-reducing drugs such as Pepcid, Tagamet, and Zantac can be taken 12 hours before or four hours after a dose of Odefsey or Complera. Do not take with carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, rifapentine, or the herb St. John’s wort. Do not take with more than one dose of the injectable steroid dexamethasone (sometimes given in the ER or hospital). Use caution if taken with fluconazole, itraconazole, ketoconazole, posaconazole, or voriconazole. Use azithromycin when possible, instead of the antibiotics clarithromycin, erythromycin, or telithromycin, because these drugs increase rilpivirine levels, which can increase the risk of side effects. Reduced methadone levels can occur; while dose adjustments are not necessary, it is recommended to monitor for withdrawal symptoms. Taking Odefsey with rifabutin is not recommended. Co-administration of rifabutin with Complera requires an extra Edurant 25 mg tablet in addition to Complera. Odefsey should not be taken with other medications that prolong QTc interval (these abnormal heart rhythms can make the heart stop) or medications with a known risk for torsades de pointes. Odefsey may be taken with Harvoni and Zepatier, but Complera cannot. Odefsey can be taken with Epclusa, but monitor for tenofovir toxicity with Complera. Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not, as there are other drug interactions which are not listed here.

Odefsey is an option for people with impaired kidney function. For individuals with HIV-2, more commonly found outside the U.S., an NNRTI would not be recommended as HIV-2 is inherently resistant to NNRTIs. Odefsey is one of the smallest STRs, which may be advantageous to individuals who have difficulty swallowing. Pregnant individuals virologically suppressed on Odefsey or Complera may continue taking it. Lower exposures of rilpivirine were observed during pregnancy, therefore viral load should be monitored closely. Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; GO TO apregistry.com.

Dr. Melanie Thompson:

These single-tablet regimens both contain rilpivirine, a nonnucleoside reverse transcriptase inhibitor (NNRTI), and differ only in the use of TAF (Odefsey) or TDF (Complera). Neither is recommended as initial therapy in most people, largely because of potency and drug interactions associated with rilpivirine. Studies showed worse response when used as initial treatment in persons with viral loads of 100,000 copies/mL or more and CD4 counts of 200 cells/L or less, so they are not recommended in this population; they certainly are not to be used for rapid start of HIV treatment. They have fewer CNS side effects than Atripla but still can be associated with depression or exacerbation of pre-existing depression in some people. Elevation in lipids is less than with efavirenz and rash is infrequent but can also occur, along with a severe hypersensitivity reaction. The choice between the drugs should be made based on the side effects of TAF and TDF, although there is little reason to initiate either of these drugs in 2024. Odefsey is the only NNRTI option containing TAF, while Complera is similar to Delstrigo (doravirine/TDF/3TC) but Delstrigo has fewer drug-drug interactions and no restrictions on viral load or CD4. SEE Descovy and Truvada for more information.

Activist Joey Wynn:

Although lighter on the side effects, this combo still has lots of drug-drug interactions based on people’s feedback to me a few years back. Having to time it based on food intake makes this a less than stellar option for you in 2024. This is a hard pass in favor of several better options with little to no interactions or food requirements.