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Truvada

General Information This drug is actually a combination of two antiviral drugs in one pill - tenofovir and emtricitabine.  It may be used as one component of a multiple drug combination.
Specifics Truvada is a new combination drug approved in August 2004 for the treatment of HIV infection 

Truvada works by inhibiting the formation of HIV's genetic material.  Truvada's two components are called nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs) or nukes.

Dosing Generally Truvada is taken as 1 pill once a day.  The dosing may be changed if your kidneys are weak.
Adherence
(this refers to your willingness, ability, and actual performance in taking your medications)

For further information and tips on adherence, go to the Adherence section of this site.

As with any antiviral drug or antibiotic, try not to ever miss a dose.  If you miss a dose and notice that you have done so within a few hours of its scheduled time, you may take the dose as usual and take the next dose at its regular time.

Do not change the dose or timing of Truvada without speaking to your healthcare provider.

Because Truvada contains abacavir, it is recommended that you do NOT stop this medication without consulting with your healthcare provider or someone experienced with the use of abacavir.

If you miss more than one dose, look at the reasons why you missed them and come up with a plan to avoid it in the future.  For example, if you fell asleep too early, take the medicine earlier in the evening, with your later meal, set an alarm, or have someone appointed to wake you up for your medicine.  

It is strongly recommended that you consider using weekly pill boxes and arrange all of your doses a week in advance.  Buy a small pill box so that you can carry a dose or two of your medicines with you in case you are away from home.

Possible Side Effects
The package insert for most drugs including Truvada is often overwhelming and scary with perhaps an overemphasis on side effects.  We have summarized the important and more common problems here.

Most people take Truvada without many side effects.

Possible side effects include nausea (which usually gets better over time,) headache, muscle aches, kidney problems, liver problems, allergy or skin discoloration.  Usually you will have blood tests done in the first month to look for the beneficial effects of zidovudine and any side effects. 

Many minor side effects will either stay constant or get better with time.  It is mainly the side effects that are severe or get worse that may cause significant health risks for you.

All drugs of this type can cause or contribute to abnormal fat redistribution characterized by thinning of the face, arms, or legs.  In most cases this would be also accompanied by elevated cholesterol levels, elevated triglyceride levels, and perhaps a tendency to develop diabetes.  Truvada may be better than other nukes in this respect.

Rarely, a build-up of (lactic) acid may occur due to taking medications of this type.  Persons taking multiple nukes (NRTIs), those taking d4T (stavudine, Zerit), those on the combination of d4T (stavudine, Zerit) and ddI (didanosine, Videx), and those persons with hepatitis C are the most likely to encounter this rare, but potentially fatal problem.  Pregnancy may also raise the risk of this problem.  The symptoms are vague but troublesome including nausea, vomiting, muscle aches, weakness, turning yellow with jaundice, and just feeling plain bad.  Truvada has very little tendency to cause lactic acidosis.

If you have hepatitis B and you stop Truvada suddenly, your liver may be damaged.

Interactions
This refers to the way that Truvada affects other medications
Do not take Truvada with tenofovir (Viread) or emtricitabine (Emtriva) pills so that you do not get too much of those drugs.  Lamivudine (Epivir) is useless when taken with Truvada.

Truvada should not be taken with didanosine (Videx EC) unless you reduce the dose of didanosine.

When Truvada is taken with atazanavir (Reyataz), the dose of atazanavir should be changed in most cases to two of the 150 mg atazanavir capsules and ritonavir (Norvir) boosting with 100 mg per day should be used.

Report to you healthcare provider or go to an Emergency Room if you have severe side effects, increasing side effects, shortness of breath, uncontrollable diarrhea, fever, weakness, jaundice (eyes and skin turn yellow,) muscle pain, nausea and vomiting so that you cannot hold down your food and liquids.
You can download this handout in PDF format by clicking HERE.

8-7-2004