Truvada (Emtricitabine/Tenofovir Disoproxil Fumarate) - Oral

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What Is Truvada?

Truvada (emtricitabine and tenofovir disoproxil fumarate) is a two-in-one antiretroviral drug used to both treat and prevent HIV. Truvada belongs to a class of drugs called nucleoside reverse transcriptase inhibitors (NRTIs).

When used for the treatment of HIV, Truvada is prescribed in combination with at least one other antiretroviral drug. The combination of drugs works by blocking enzymes that the virus needs to replicate. By doing so, the virus is unable to make copies of itself and infect other cells.

People who do not have HIV can also use Truvada to prevent infection. When taken as prescribed, Truvada is extremely effective in preventing infection should an accidental exposure occur.

Truvada is available in tablet form. In 2020, the Food and Drug Administration (FDA) approved the first generic versions of Truvada, marketed under the name emtricitabine/tenofovir disoproxil fumarate.

This medication carries a boxed warning, the FDA's highest level of warning, for the risk of severe flare-ups in people with hepatitis B after stopping treatment.

Drug Facts

  • Generic Name: Emtricitabine and tenofovir disoproxil fumarate
  • Brand Name(s): Truvada
  • Administration Route(s): Oral
  • Drug Availability: Prescription
  • Therapeutic Classification: Antiretroviral agent
  • Available Generically: Yes
  • Controlled Substance: N/A
  • Active Ingredient: Emtricitabine and tenofovir disoproxil fumarate
  • Dosage Form(s): Tablet

What Is Truvada Used For?

Truvada is composed of two drugs, emtricitabine and tenofovir disoproxil fumarate (TDF). TDF dramatically slows the progression of the disease by blocking an enzyme called reverse transcriptase which the virus needs to make copies of itself. The same action can also prevent the virus from establishing an infection in people without HIV.

Truvada is currently licensed in the United States for the following uses:

Truvada does not cure HIV. If taken as prescribed for HIV, Truvada can help suppress the virus to undetectable levels, which not only increases the chance of a normal, healthy life but also reduces the risk of infecting others to zero.

If taken as prescribed in people without HIV, Truvada as PrEP can reduce the risk of getting HIV by up to 99%.

When used for PrEP, Truvada is indicated for adults and adolescents who have a higher chance of getting HIV.

According to the Centers for Disease Control and Prevention (CDC), people who are more likely to become exposed to HIV include:

Limitations

As effective as Truvada is, it is not a one-size-fits-all solution. Because the virus is prone to mutation and wide genetic variation, the choice of drugs is largely directed by genetic resistance testing. This is a simple blood test that helps healthcare providers determine which drugs “your” virus is most sensitive to.

How to Take Truvada

Truvada is a fixed-dose combination (FDC) oral tablet consisting of 200 milligrams (mg) of emtricitabine and 300 mg of tenofovir disoproxil fumarate. Because the dose is fixed and cannot be adjusted, it is only used in people who weigh at least 37 pounds. People who weigh less are at an increased risk of kidney side effects due to their smaller body size.

Truvada is taken by mouth once daily with or without food. By taking the pill every day—ideally at the same time—the drug is better able to remain at the optimal concentration in the blood.

Make sure to swallow Truvada tablets whole. Do not crush, chew, or split the tablets as this can affect drug absorption.

Truvada is never used on its own to treat HIV.

Storage

Truvada tablets can be safely stored at room temperature (around 77 F). It is OK to expose the drugs to temperatures between 59 F and 86 F, but avoid storing the pills on a sunny windowsill or in a glove compartment where temperatures can be excessive. Do not store it in the bathroom.

Keep the tablets tightly sealed in their original light-resistant container. Discard any drugs that have expired. Properly discard this medication when it is expired or no longer needed. Do not flush medications down the toilet or pour them into a drain unless instructed to do so.

Off-Label Uses

Healthcare providers sometimes prescribe Truvada off-label for a preventive strategy known as HIV post-exposure prophylaxis (PEP). The aim of PEP is to prevent an infection if someone has been accidentally exposed to HIV, either through unprotected sex, shared needles, or healthcare exposure (such as a needlestick injury).

PEP must be started within 72 hours of exposure—ideally less—and taken for 28 consecutive days to have any benefit.

According to the Public Health Service, Truvada in combination with the HIV drug Isentress (raltegravir) is the preferred option for PEP in cases of occupational exposure.

How Long Does Truvada Take to Work?

Truvada can take up to three weeks for the drug to reach its maximum protective concentration.

What Are the Side Effects of Truvada?

This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.

As with all drugs, Truvada may cause side effects. Most tend to be mild and temporary, usually resolving within several days or weeks as your body adapts to treatment. However, in some, Truvada has been known to trigger severe side effects, typically in people with underlying kidney disease or those who are co-infected with hepatitis B.

Common Side Effects

Truvada may not cause any side effects at all. If side effects do occur, they most commonly involve (by order of frequency):

The side effects tend to be low grade and resolve relatively quickly. Call your healthcare provider if side effects persist, worsen, or seem unusual.

Severe Side Effects

People with hepatitis B and kidney disease are at an increased risk of potentially severe side effects from Truvada. In some cases, Truvada may need to be avoided or the dosage adjusted.

Hepatitis B

Truvada carries a black box warning advising users about the risk of severe flare-ups in people with hepatitis B once the treatment is stopped. Stopping Truvada can cause the hepatitis B virus to rebound, and, in people with advanced liver disease, potentially lead to liver failure.

The FDA strongly recommends hepatitis B testing before treatment is started. People with hepatitis B who stop taking Truvada may need close monitoring and anti-hepatitis B drugs to reduce the risk of a severe flare-up.

Kidney Dysfunction

Truvada also poses risk to people with underlying kidney dysfunction due to TDF, which has been known to cause acute kidney failure.

Although older people with chronic kidney disease or diabetes are at greatest risk, people with no history of kidney disease have been known to experience acute failure (most often reversible once the treatment is stopped).

To avoid this, healthcare providers should test a person’s kidney function—most specifically the creatinine clearance (CrCl)—before treatment is started and routinely thereafter. Truvada should not be used in people whose CrCl is below 30 (an indication of severe kidney impairment).

Contact your healthcare provider right away if you have serious side effects after using Truvada. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

These include symptoms of acute kidney failure, including:

Long-Term Side Effects

Although concerning, TDF-associated kidney failure remains a relatively uncommon occurrence due to the routine monitoring of kidney function and the management of drug-drug interactions. Even so, because Truvada is intended for long-term use, there are concerns as to whether ongoing exposure can lead to kidney problems down the road.

Report Side Effects

Truvada may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting Program or by phone (1-800-332-1088).

Dosage: How Much Truvada Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (tablets):

For treatment of shingles:

  • Adults—500 milligrams (mg) every eight hours for seven days.
  • Children—Use and dose must be determined by your doctor.

For suppression of recurrent genital herpes:

  • Adults—250 milligrams (mg) two times a day for up to one year.
  • Children—Use and dose must be determined by your doctor.

For treatment of recurrent genital herpes:

  • Adults—1000 milligrams (mg) two times a day for one day.
  • Children—Use and dose must be determined by your doctor.

For treatment of recurrent herpes labialis (cold sores):

  • Adults—1500 milligrams (mg) as a single dose.
  • Children—Use and dose must be determined by your doctor.

For treatment of recurrent herpes infections in HIV-infected patients:

  • Adults—500 milligrams (mg) two times a day for seven days.
  • Children—Use and dose must be determined by your doctor.

Modifications

To reduce the risk of kidney injury, the Truvada dose should be reduced to one tablet every 48 hours in people with moderate kidney impairment (defined as a CrCl between 30 and 49).

People with a CrCl below 30 or who are on dialysis should not use Truvada.

Missed Dose

If you miss a dose of Truvada, take it as soon as you remember. If it is almost time for your next dose, skip the original dose and continue as normal. Never double up doses. This applies to whether you are taking Truvada for HIV therapy or for PrEP.

Overdose: What Happens If I Take Too Much Truvada?

Because of its effect on the kidneys, a Truvada overdose may cause irreversible kidney injury.

A 2017 study showed that overdose of Atripla (efavirenz/emtricitabine/tenofovir disoproxil fumarate) caused irreversible kidney damage, which the researchers attributed to TDF.

A Truvada overdose requires immediate emergency care. Healthcare providers treating the overdose would first perform tests to determine the concentration of TDF and emtricitabine in the bloodstream. If needed, hemodialysis would help clear the drugs. Supportive care would also be provided to treat nausea, vomiting, and other symptoms.

What Happens If I Overdose On Truvada?

If you think you or someone else may have overdosed on Truvada, call a healthcare provider or the Poison Control Center (1-800-222-1222).

If someone collapses or isn't breathing after taking Truvada, call 911 immediately.

Precautions

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It is very important that your doctor check your or your child's progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects. You should remain under the care of a doctor while using this medicine.

Two rare but serious reactions to this medicine are lactic acidosis (too much acid in the blood) and liver toxicity, which includes an enlarged liver. These are more common if you are female, very overweight (obese), or have been taking anti-HIV medicines for a long time. Check with your doctor right away if you or your child have stomach discomfort, decreased appetite, diarrhea, fast, shallow breathing, general feeling of discomfort, muscle pain or cramping, nausea, sleepiness, unusual tiredness or weakness, or yellow eyes or skin.

This medicine may cause rare, but serious, liver problems. This is more common in patients with a history of hepatitis B infection or those who already have liver disease. Check with your doctor right away if you have clay-colored stools, dark urine, a decreased appetite, a fever, a headache, itching, nausea and vomiting, a skin rash, stomach pain or tenderness, swelling of the feet or lower legs, unusual tiredness or weakness, or yellow eyes or skin.

This medicine is not for the treatment of hepatitis B virus infection. Patients infected with both HBV and HIV who take emtricitabine and tenofovir combination need close medical follow-up for several months after stopping treatment to make sure their hepatitis B infection does not get worse. You should also be tested for hepatitis B before starting treatment with this medicine.

This medicine may cause kidney problems. Avoid using other medicines that may injure the kidneys, including multiple or high-dose NSAID pain medications or certain other antiviral medications.

This medicine may also increase your risk of developing fractures (broken bones). Ask your doctor about this if you or your child have any concerns.

Your immune system may get stronger when you start using HIV medicines. Tell your doctor right away if you or your child notice any changes in your health. Sometimes the immune system will start to fight infections that were hidden in your body, such as pneumonia, herpes, or tuberculosis. Autoimmune disorders (including Graves disease, polymyositis, and Guillain-Barré syndrome) may also occur.

If you are using this medicine for Pre-exposure prophylaxis:

  • You should be confirmed that you are HIV-negative before you start using this medicine and you must stay HIV-negative to keep taking this medicine.
  • You and your partner should be tested regularly (for at least once every 3 months) for HIV-1. You should also be tested regularly for other sexually transmitted infections, including syphilis or gonorrhea.
  • Check with your doctor right away if you have a fever, headache, joint or muscle pain, a rash, night sweats, or swollen lymph nodes.

This medicine does not decrease the risk of transmitting the HIV infection to others through sexual contact or by contaminated blood. Make sure you understand and practice safe sex, even if your partner also has HIV. Avoid sharing needles with anyone. If you have any questions about this, check with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Truvada?

People whose HIV status is unknown should never use PrEP. A person should be confirmed HIV negative and retested every three months thereafter in order to use Truvada.

What Other Medications Interact With Truvada?

There are certain drugs you may need to avoid while taking Truvada. When taken with Truvada, nephrotoxic drugs (medications that can damage the kidneys) may “compete” for clearance in the kidneys, leading to increased TDF and emtricitabine levels and an increased risk of kidney-related side effects.

Nephrotoxic drugs that may interact with Truvada include:

Certain HIV and hepatitis C drugs can also affect drug concentration, including:

To avoid interactions, always advise your healthcare provider about any drugs you take, whether they are prescription, over-the-counter, herbal, nutritional, or recreational.

What Medications Are Similar?

Truvada belongs to a class of drugs called NRTIs. They were the first class of drugs used to treat HIV and continue to be among the most effective and durable antiretroviral agents.

There are five single-agent NRTIs currently licensed for use in treating HIV:

  • Emtriva (emtricitabine)
  • Epivir (lamivudine)
  • Retrovir (zidovudine)
  • Viread (tenofovir disoproxil fumarate)
  • Ziagen (abacavir)

These agents are found in other fixed-dose combination drugs, including Combivir (lamivudine/zidovudine), Epzicom (abacavir/lamivudine), and Trizivir (abacavir/lamivudine/zidovudine).

The “New” Tenofovir

In 2015, the FDA approved the first in a line of antiretroviral drugs made with an “improved” version of tenofovir called tenofovir alafenamide (TAF). This new drug agent is a pro-drug, meaning that it is an inactive compound converted by the body into an active drug. Because of this, TAF requires a far lower dose and is less likely to cause kidney-related side effects.

Descovy (emtricitabine/tenofovir alafenamide fumarate), the improved version of Truvada, was one of the first TAF-containing drugs approved by the FDA. Like Truvada, it is approved for the treatment of HIV and is the only other drug licensed for use as PrEP.

Frequently Asked Questions

  • What is Truvada used for?

    Truvada (emtricitabine/tenofovir disoproxil fumarate) is a combination antiretroviral drug used for both the treatment of HIV and the prevention of HIV (also known as pre-exposure prophylaxis or PrEP).

  • How does Truvada work?

    Truvada works by blocking an enzyme called reverse transcriptase, which the virus uses to make copies of itself. By blocking this action, the virus population is reduced to undetectable levels where it can do the body little harm.

  • Can Truvada cure HIV?

    No. There is no cure for HIV. Truvada and all other antiretroviral drugs only suppress the virus and slow disease progression. With that said, if treatment is started early and the viral suppression is maintained, a person living with HIV can enjoy a near-normal to normal life expectancy.

  • Is Descovy more effective than Truvada?

    Truvada (which contains tenofovir disoproxil fumarate) and Descovy (which contains tenofovir alafenamide) are equally effective in treating and preventing HIV. Of the two, Descovy is less likely to cause kidney problems because it contains only 25 milligrams (mg) of tenofovir (compared to 300 mg for Truvada). Lower tenofovir doses place less stress on the kidneys.

  • Is Truvada less safe than Descovy?

    For the most part, no. According to a 2018 study, there are no major differences in the safety of Truvada versus Descovy. It is only when Truvada is paired with an antiretroviral “booster”—such as Tybost (cobicistat) or Norvir (ritonavir)—that it is more likely to harm the kidneys.

  • How long does it take for HIV PrEP to work?

    When used for PrEP, Truvada can take up to three weeks for the drug to reach its maximum protective concentration. This is especially true for injecting drug users and people who engage in vaginal sex. The protective benefit may be reached sooner in people who engage in anal sex.

  • How safe is Truvada in pregnancy?

    Observation studies on the use of Truvada in pregnancy have shown no evidence of fetal harm. When comparing the rate of birth defects in the general population, the risk with birth defects emtricitabine and tenofovir disoproxil fumarate is more or less the same.

How Can I Stay Healthy While Taking Truvada?

Antiretroviral drugs like Truvada have transformed the treatment of HIV and created new avenues for HIV prevention. But the drugs only work if you take them.

Failure to stay on top of daily pill-taking can undermine the benefits of PrEP. Research has shown that the real-world effectiveness of PrEP decreases if Truvada doses are consistently missed or the treatment is interrupted.

If you have trouble taking your current Truvada-based therapy, speak with your healthcare provider about newer all-in-one pill options that may help you stay on track with your regimen.

Medical Disclaimer

Verywell Health's drug information is meant for education purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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