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All about: Efavirenz/Emtricitabine/Tenofovir

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Generic Name: Efavirenz/Emtricitabine/Tenofovir (eh-FAV-er-enz/EM-trye-SYE-ta-been/ten-OH-foe-vir)
Brand Name: Atripla

Severe and sometimes fatal lactic acidosis (a buildup of lactic acid in the blood) has occurred in patients taking this type of medicine. The risk my be greater in women, patients who are very overweight, or patients who have been taking nucleoside medicines (eg, emtricitabine, tenofovir) for a long time. Contact your doctor at once if you develop extreme weakness or tiredness; unusual muscle pain; trouble breathing; stomach pain with nausea or vomiting; cold feeling, especially in the arms and legs; severe or persistent dizziness or lightheadedness; or fast or irregular heartbeat.

Severe and sometimes fatal liver problems have occurred in patients taking this type of medicine. Contact you doctor at once if you if you develop yellowing of the skin or eyes, dark urine, pale stools, loss of appetite, severe or persistent nausea, or stomach pain.

Efavirenz/Emtricitabine/Tenofovir is not approved to treat hepatitis B infection. Safety and effectiveness have not been confirmed in patients who have both HIV and hepatitis B. Some patients with hepatitis B who were treated with similar medicines have had severe worsening of liver problems after they stopped treatment. Patients with both HIV and hepatitis B who take Efavirenz/Emtricitabine/Tenofovir should have medical exams and liver function tests performed for at least several months after they stop taking Efavirenz/Emtricitabine/Tenofovir .


Efavirenz/Emtricitabine/Tenofovir is used for:

Treating HIV infection alone or along with other medicines.

Efavirenz/Emtricitabine/Tenofovir is an antiviral combination of 3 reverse transcriptase inhibitors. It works by slowing the growth of HIV, the virus that causes AIDS. Efavirenz/Emtricitabine/Tenofovir is not a cure for HIV or AIDS.

Do NOT use Efavirenz/Emtricitabine/Tenofovir if:

  • you are allergic to any ingredient in Efavirenz/Emtricitabine/Tenofovir
  • you have moderate to severe kidney problems
  • you have a history of abnormal liver function tests, severe liver problems (eg, enlarged or fatty liver), or lactic acidosis
  • you are taking carbamazepine, cisapride, an ergot derivative (eg, ergotamine), an H1 antagonist (eg, astemizole, terfenadine), midazolam, St. John's wort, triazolam, or voriconazole
  • you are taking a medicine that contains lamivudine, or another medicine that contains efavirenz, emtricitabine, or tenofovir

Contact your doctor or health care provider right away if any of these apply to you.

Before using Efavirenz/Emtricitabine/Tenofovir :

Some medical conditions may interact with Efavirenz/Emtricitabine/Tenofovir . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have a history of bone problems (eg, osteoporosis, fracture), seizures, diabetes, kidney problems (including dialysis treatment), or liver problems (eg, hepatis B infection)
  • if you have a history of mental or mood problems, suicidal thoughts or actions, or alcohol or other substance abuse or dependence
  • if you are very overweight

Some MEDICINES MAY INTERACT with Efavirenz/Emtricitabine/Tenofovir . Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Astemizole, cisapride, ergot derivatives (eg, ergotamine), midazolam, terfenadine, or triazolam because the risk of irregular heartbeat, severe drowsiness, or breathing problems may be increased
  • Acyclovir, adefovir, cidofovir, ganciclovir, other medicines that may harm the kidney, valacyclovir, or valganciclovir because they may increase the risk of Efavirenz/Emtricitabine/Tenofovir 's side effects. Ask your doctor or pharmacist if you are not sure if any of your medicines may harm the kidney
  • Lamivudine or medicines that contain efavirenz, emtricitabine, or tenofovir because they may increase the risk of Efavirenz/Emtricitabine/Tenofovir 's side effects
  • HIV protease inhibitors (eg, atazanavir, lopinavir, ritonavir) because they may decrease Efavirenz/Emtricitabine/Tenofovir 's effectiveness or increase the risk of Efavirenz/Emtricitabine/Tenofovir 's side effects
  • Rifabutin, rifampin, or St. John's wort because they may decrease Efavirenz/Emtricitabine/Tenofovir 's effectiveness
  • Didanosine because the risk of its side effects may be increased by Efavirenz/Emtricitabine/Tenofovir
  • Warfarin because its effectiveness may be decreased or the risk of its side effects may be increased by Efavirenz/Emtricitabine/Tenofovir
  • Azole antifungals (eg, ketoconazole), carbamazepine, clarithromycin, HMG-CoA reductase inhibitors (eg, atorvastatin), methadone, phenobarbital, phenytoin, sertraline, or voriconazole because their effectiveness may be decreased by Efavirenz/Emtricitabine/Tenofovir

This may not be a complete list of all interactions that may occur. Ask your health care provider if Efavirenz/Emtricitabine/Tenofovir may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Efavirenz/Emtricitabine/Tenofovir :

Use Efavirenz/Emtricitabine/Tenofovir as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • An extra patient leaflet is available with Efavirenz/Emtricitabine/Tenofovir . Talk to your pharmacist if you have questions about this information.
  • Take Efavirenz/Emtricitabine/Tenofovir by mouth on an empty stomach at least 1 hour before or 2 hours after eating.
  • Take Efavirenz/Emtricitabine/Tenofovir with a full glass of water (8 oz/240 mL).
  • Do not take Efavirenz/Emtricitabine/Tenofovir if the seal over the bottle opening is broken or missing.
  • Continue to take Efavirenz/Emtricitabine/Tenofovir even if you feel well. Do not miss any doses.
  • Taking Efavirenz/Emtricitabine/Tenofovir at the same time each day will help you remember to take it.
  • Do not suddenly stop taking Efavirenz/Emtricitabine/Tenofovir without checking with your doctor. This may cause the virus to become less sensitive to this or other medicines. Also, some conditions (eg, hepatitis B) could become worse if you suddenly stop taking Efavirenz/Emtricitabine/Tenofovir .
  • If you miss a dose of Efavirenz/Emtricitabine/Tenofovir , take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Efavirenz/Emtricitabine/Tenofovir .

Important safety information:

  • Efavirenz/Emtricitabine/Tenofovir may cause drowsiness, dizziness, or trouble concentrating. These effects may be worse if you take it with alcohol or certain medicines. Use Efavirenz/Emtricitabine/Tenofovir with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
  • Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Efavirenz/Emtricitabine/Tenofovir ; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
  • Dizziness, drowsiness, trouble sleeping, trouble concentrating, and strange dreams are common side effects during the first few weeks of therapy with Efavirenz/Emtricitabine/Tenofovir . If any of these occur, check with your doctor about whether you should take your medicine at bedtime. This may help make these effects more tolerable.
  • Keep a list of all the medicines that you take. Make a new list each time medicines are added or stopped. Find out about medicines that should not be taken while you are using Efavirenz/Emtricitabine/Tenofovir . Be sure that each of your health care providers knows all the medicines that you are taking.
  • Efavirenz/Emtricitabine/Tenofovir is not a cure for HIV infection. Patients may still get illnesses and infections associated with HIV. Remain under the care of your doctor.
  • Efavirenz/Emtricitabine/Tenofovir does not stop the spread of HIV to others through blood or sexual contact. Use barrier methods of birth control (eg, condoms) if you have HIV infection. Do not share needles, injection supplies, or items like toothbrushes or razors.
  • When your medicine supply is low, get more from your doctor or pharmacist as soon as you can. Do not stop taking Efavirenz/Emtricitabine/Tenofovir , even for a short period of time. If you do, the virus may grow resistant to the medicine and become harder to treat.
  • Changes in body fat (eg, an increased amount of fat in the upper back, neck, breast, and trunk, and loss of fat from the legs, arms, and face) may occur in some patients taking Efavirenz/Emtricitabine/Tenofovir . The cause and long-term effects of these changes are unknown. Discuss any concerns with your doctor.
  • Efavirenz/Emtricitabine/Tenofovir may improve immune system function. This may reveal hidden infections in some patients. Tell your doctor right away if you notice symptoms of infection (eg, fever, sore throat, weakness, cough, shortness of breath) after you start Efavirenz/Emtricitabine/Tenofovir .
  • Check with your doctor to see if you should take a calcium and vitamin D supplement while you are taking Efavirenz/Emtricitabine/Tenofovir .
  • Diabetes patients - Efavirenz/Emtricitabine/Tenofovir may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.
  • Women who may become pregnant should have a negative pregnancy test before they start to take Efavirenz/Emtricitabine/Tenofovir . Discuss any questions or concerns with your doctor.
  • If you may become pregnant, you must use effective birth control while you take Efavirenz/Emtricitabine/Tenofovir . It is unknown how Efavirenz/Emtricitabine/Tenofovir effects birth control (eg, birth control pills). You should always use a barrier form of birth control (eg, condoms) even if you already use a hormonal birth control method. If you have questions about effective birth control, talk with your doctor.
  • Efavirenz/Emtricitabine/Tenofovir may affect certain lab tests, including drug tests. Be sure your doctor and lab personnel know you are taking Efavirenz/Emtricitabine/Tenofovir .
  • Lab tests, including liver and kidney function, may be performed while you use Efavirenz/Emtricitabine/Tenofovir . These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
  • Efavirenz/Emtricitabine/Tenofovir should not be used in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed.
  • PREGNANCY and BREAST-FEEDING: Efavirenz/Emtricitabine/Tenofovir may cause harm to the fetus. Do not become pregnant while you are using it. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Efavirenz/Emtricitabine/Tenofovir while you are pregnant. It is not known if Efavirenz/Emtricitabine/Tenofovir is found in breast milk. Do not breast-feed while taking this medicine. Mothers infected with HIV should not breast-feed. There is a risk of passing the HIV infection or Efavirenz/Emtricitabine/Tenofovir to the baby.

Possible side effects of Efavirenz/Emtricitabine/Tenofovir :

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Back pain; cough; darkened skin color on the palms of hands or soles of feet; diarrhea; dizziness; drowsiness; gas; headache; loss of appetite; muscle or joint aches; nausea; skin discoloration (small spots or freckles); stomach upset; strange dreams; stuffy nose; tiredness; trouble concentrating; trouble sleeping; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; confusion; decreased urination; delusions; fever, chills, or sore throat; hallucinations; lactic acidosis (eg, cold feeling, especially in the arms and legs; severe or persistent dizziness or lightheadedness; extreme weakness or tiredness; fast or irregular heartbeat; stomach pain with nausea or vomiting; trouble breathing; unusual muscle pain); liver problems (eg, dark urine, pale stools, yellowing of the skin or eyes); memory loss; mental, mood, or behavior changes (eg, depression); numbness, burning, pain, or tingling of the hands, feet, or skin; red, swollen, blistered, or peeling skin; seizures; stomach pain; suicidal thoughts or actions.

This is not a complete list of all side effects that may occur. If you have questions or need medical advice about side effects, contact your doctor or health care provider. You may report side effects to the FDA at 1-800-FDA-1088 (1-800-332-1088) or at http://www.fda.gov/medwatch.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org/findyour.htm), or emergency room immediately. Symptoms may include muscle twitching or severe dizziness, drowsiness, or coordination problems.

Proper storage of Efavirenz/Emtricitabine/Tenofovir :

Store Efavirenz/Emtricitabine/Tenofovir at 77 degrees F (25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Do not use Efavirenz/Emtricitabine/Tenofovir if is past the expiration date on the bottle. Keep Efavirenz/Emtricitabine/Tenofovir out of the reach of children and away from pets.

General information:

  • If you have any questions about Efavirenz/Emtricitabine/Tenofovir , please talk with your doctor, pharmacist, or other health care provider.
  • Efavirenz/Emtricitabine/Tenofovir is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Efavirenz/Emtricitabine/Tenofovir . If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: September 5, 2007
Database Edition 07.3.1.003
Copyright © 2007 Wolters Kluwer Health, Inc.

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