Treating HIV With Atripla (Tenofovir, Emtricitabine and Efavirenz)

Combination HIV Pill Among Most Prescribed Worldwide

Atripla is a single-pill, fixed-dose combination (FDC) drug comprised of three antiretroviral agents: tenofovir, emtricitabine, and efavirenz.

Tenofovir and emtricitabine are both classified as nucleotide reverse transcriptase inhibitors and are independently marketed as Viread (tenofovir), Emtriva (emtricitabine, FTC), and the co-formulated FDC Truvada (tenofovir + emtricitabine). Efavirenz is, by contrast, is a non-nucleoside reverse transcriptase inhibitor and is commercially marketed as Sustiva (efavirenz).

Atripla was licensed by the U.S. Food and Drug Administration (FDA) on June 12, 2012, and was the first once-daily, three-in-one drug approved for use in the treatment of HIV for adults and children ages 12 years and older.

Until 2015, Atripla was positioned as a preferred, first-line HIV treatment in the U.S, with nearly one-third of all patients prescribed the drug. Newer next-generation drugs (which boasted fewer side effects and better durability) eventually moved Atripla from the "recommended" drug list to its current "alternative" first-line status.

There is currently no generic alternative for Atripla in the U.S.

Atripla pills spilling out of a pill bottle

NIAID / Flickr / CC BY 2.0


Atripla is a co-formulated tablet comprised of 300mg tenofovir disoproxil fumarate, 200mg emtricitabine, and 600mg of efavirenz. The pink, oblong tablet is film-coated and embossed on one side with the number "123."


For adults and children 12 years or older who weigh at least 87 lbs (40kg): one tablet taken orally on an empty stomach, ideally at bedtime (due to the dizziness that may arise as a result of the efavirenz component). 

For patients taking rifampin (used frequently in the treatment of tuberculosis coinfection) who weigh at least 110 lbs (50kg): one Atripla tablet and one tablet of Sustiva (efavirenz) taken orally, again on an empty stomach and ideally at bedtime.

Side Effects

The most common side effects associated with Atripla use (occurring in at least 5% of cases) include:

  • Nausea
  • Diarrhea
  • Fatigue
  • Sinusitis
  • Headache
  • Dizziness
  • Depression
  • Insomnia
  • Abnormal dreams
  • Rash

Most of the symptoms are generally short-lasting, often resolving themselves within a week or two. Some of the central nervous system disturbances, like dizziness, may sometimes take longer to resolve, although taking the pills at night, just before bedtime, tends to alleviate the symptoms significantly.


  • Antifungal medication: Vrend (voriconazole)
  • Hepatitis B medication: Hepsera (adefovir)
  • Ergot derivatives (including Wigraine and Cafergot)
  • Calcium channel blockers: Vascor (bedripil), Propulsid (cisapride), Orap (pimozide)
  • St. John's Wort

Treatment Considerations

Patients who have had experienced previous, strong hypersensitivity reactions to Sustiva (including severe or eruptive rash) should not be prescribed Atripla.

Atripla should be used with care in patients with a history of renal (kidney) impairment. Always assess estimated creatinine clearance before initiating treatment. In patients with a risk of renal dysfunction, include estimated creatinine clearance, serum phosphorus, urine glucose, and urine protein when monitoring. Atripla should not be used in patients with an estimated creatinine clearance below 50mL/minute.

Monitor liver function tests in hepatic patients with underlying liver disease, including hepatitis B and hepatitis C. Atripla is not recommended in patients with moderate to severe liver impairment. Use with caution in patients with mild liver impairment.

The efavirenz component in Atripla has been associated with fetal abnormalities in a number of animal studies. While there is still contention as to whether efavirenz poses any real risk in humans, it is recommended Atripla be avoided during pregnancy), particularly during the first trimester. Mothers are also advised not to breastfeed while taking Atripla.

Atripla should be prescribed with caution in people who have seizures, as well as those with schizophrenia, clinical depression, or other mental disorders. The efavirenz component is known to affect the central nervous system, resulting in dizziness, vivid dreams, unsteadiness, and disorientation in some people.

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  • Bristol Myers Squibb. Highlights of Prescribing Information - ATRIPLA. 2006.

  • U.S. Food and Drug Administration (FDA). FDA Approves the First Once-a-Day, Three Drug Combination for Treatment of HIV-1. Silver Spring, Maryland; press release issued August 2, 2004.