POSITIVELY AWARE MARCH/APRIL 2011
brand name: Atripla
common name: efavirenz, emtricitabine, and tenofovir disoproxil fumarate
class: Nucleoside/nucleotide analog reverse transcriptase inhibitor
(nucleoside/nucleotide analog, NRTI, or nuke)
and non-nucleoside reverse transcriptase inhibitor
(non-nucleoside, NNRTI, or non-nuke)—fixed dose regimen
manufacturers: Bristol-Myers Squibb | www.bms.com, (800) 321–1335, and
Gilead Sciences | www.gilead.com, (800) GILEAD5 (445–3235), www.atripla.com
Standard dose: One tablet (Sustiva [600 mg] and Truvada [200 mg Emtriva and 300 mg Viread]), once a day, preferrably at bedtime, on an empty stomach or with a light, low-fat snack. Take missed dose as soon as possible, unless it is almost time for your next dose. Do not double up on your next dose.
AWP: $1,858.15 / month
Potential side effects and toxicity
See the drugs contained in Atripla—Sustiva, Emtriva, and Viread. Atripla is well tolerated in most, but not all, individuals. Use with caution in individuals with depression or other psychiatric issues. Diarrhea, nausea, fatigue, headache, dizziness, depression, insomnia, abnormal dreams, and rash. Women taking Atripla should not become pregnant or breast-feed because of the risk of birth defects. Dose cannot be adjusted for people with kidney problems. Immune Reconstitution Inflammatory Syndrome (IRIS) may occur as the immune system regains strength; signs and symptoms of inflammation from previous infections may occur soon after anti-HIV treatment is initiated. Report symptoms of illness, such as shingles and TB, to a health care provider.
Potential drug interactions
See the drugs contained in Atripla: Sustiva, Emtriva, and Viread. Do not take Atripla with Combivir, Emtriva, Epivir, Epivir-HBV, Epzicom, rilpivirine/Truvada, Sustiva, Trizivir, Truvada, or Viread, since these medications are already in Atripla or have equivalent medications.
More information
Atripla is the first complete HIV treatment regimen in one pill, taken once daily. It’s a first in HIV. It is on the current list of preferred regimens for treatment-naïve patients in the U.S. DHHS HIV treatment guidelines (see Sustiva). Atripla is one of the most commonly prescribed medications for those taking HIV medicine for the first time due to the ease of taking one pill, once a day. Another benefit: the single tablet cuts the number of insurance co-pays. Despite that, a new three-in-one HIV regimen coming down the pike (see rilpivirine/Truvada) will make Atripla’s difficulties harder to overlook; there is also a quad tablet being studied (see “Coming into View”). Most treatment-experienced people (those who’ve already been on HIV therapy) may not be able to use Atripla due to their having developed drug resistance (when medications may no longer work against the virus). Drug resistance most commonly occurs when people don’t take their HIV medicine as prescribed, but you may also be infected with a drug-resistant virus against which some of the medications in Atripla will not work. Because it is one dose once a day, it is important not to miss a dose. Be careful when stopping Atripla, so that you avoid the rapid development of HIV resistance to it—check with your doctor or pharmacist first. Remember, Atripla is a combination of three drugs, so see the pages for its components: Sustiva, Emtriva, and Viread. Sustiva cannot be taken during pregnancy, and use of Viread must be monitored in people with underlying kidney problems. In this combination product, the Viread dose cannot be adjusted. Therefore, Atripla should not be used in people with severe kidney problems. The Sustiva in Atripla can cause a false positive for marijuana on certain drug tests. A more specific confirmatory test can be done. Atripla should not be used in patients under 18 years of age. Gilead and BMS are forever to be commended for collaborating to bring Atripla to market. See package insert for more complete information on potential side effects and interactions.
Doctor’s comments
Atripla is the first and only single-tablet, once-daily regimen, although there are others in development. It’s a preferred regimen in all treatment guidelines based on its outstanding efficacy, safety, tolerability and convenience. The main disadvantages include the potential for kidney toxicity with tenofovir (see Viread) and the early side effects of efavirenz (see Sustiva). While Atripla is by far the most convenient regimen for initial therapy, it’s not a good choice for people who aren’t fully committed to staying on therapy without interruption. The long half-lives of the three drugs mean that an occasional missed dose or two won’t matter, but interrupting therapy altogether can cause drug resistance, especially to efavirenz. —Joel Gallant, MD, MPH
Activist’s comments
The drug that started the current one pill/once-a-day craze, Atripla still remains the sum of its parts. The Sustiva component especially can cause sleep disturbances, lipid and bone density problems, and taking it with a high fat meal can make these side effects worse. Fortunately, it’s paved the way for other one-pill/once-a-day combos in the pipeline, so patients will soon have other options with the same convenience and a single co-pay. —Jeff Taylor
