Atripla (efavirenz/emtricitabine/tenofovir disoproxil fumarate)

What is Atripla?

Atripla is a brand-name medication that’s used to treat HIV in adults and children. It’s prescribed for people who weigh at least 88 pounds (40 kilograms).

Atripla can be used alone as a complete treatment regimen (plan). It can also be used in combination with other drugs. It comes as a single tablet that contains three drugs:

• efavirenz (600 mg), which is a non-nucleoside reverse transcriptase inhibitor (NNRTI)
• tenofovir disoproxil fumarate (300 mg), which is a nucleoside analog reverse transcriptase inhibitor (NRTI)
• emtricitabine (200 mg), which is also a nucleoside analog reverse transcriptase inhibitor (NRTI)

Current guidelines do not recommend Atripla as a first-choice treatment for most people with HIV. This is because there are newer therapies that may be safer or more effective for most people. However, Atripla may be appropriate for some people. Your doctor will decide the best treatment for you.

It’s important to note that Atripla is not approved to prevent HIV.

Atripla generic

Atripla is available only as a brand-name medication. It’s not currently available in generic form.

Atripla contains three active drug ingredients: efavirenz, emtricitabine, and tenofovir disoproxil fumarate. Each of these drugs is available individually in generic forms. There may also be other combinations of these drugs that are available as generics.

Atripla side effects

Atripla can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Atripla. This list does not include all possible side effects.

For more information on the possible side effects of Atripla, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common side effects of Atripla can include:

• diarrhea
• nausea
• headache
• low energy
• abnormal dreams
• trouble concentrating
• dizziness
• trouble sleeping
• depression
• rash or itchy skin
• increased cholesterol

Most of the side effects in this list are mild effects in nature. If they’re more severe or make it hard to keep taking your medication, talk to your doctor or pharmacist.

Serious side effects

Serious side effects from Atripla aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

• Severe worsening of hepatitis B (HBV). Symptoms can include:
  • fatigue
  • dark-colored urine
  • body pain and weakness
  • yellowing of your skin and the whites of your eyes
• Rash. This side effect usually occurs within 2 weeks of starting Atripla and goes away by itself within a month. Symptoms can include:
  • red, itchy skin
  • bumps in the skin
• Liver damage. Symptoms can include:
  • yellowing of your skin and the whites of your eyes
  • pain in the upper right area of your abdomen (stomach area)
  • nausea and vomiting
• Mood changes. Symptoms can include:
  • depression
  • suicidal thoughts
  • aggressive behavior
  • paranoid reactions
• Nervous system problems. Symptoms can include:
  • hallucinations
• Kidney damage. Symptoms can include:
  • bone pain
  • pain in your arms or legs
  • bone fractures
  • muscle pain or weakness
• Bone loss. Symptoms can include:
  • bone pain
  • pain in your arms or legs
  • bone fractures
• Convulsions. Symptoms can include:
  • loss of consciousness
  • muscle spasms
  • clenched teeth
• Buildup of lactic acid and liver damage. Symptoms can include:
  • fatigue
  • muscle pain and weakness
  • pain or discomfort in your abdomen (belly)
• Immune reconstitution syndrome (when the immune system improves quickly and starts to “overwork”). Symptoms can include:
  • fever
  • fatigue
  • infection
  • swollen lymph nodes
  • rash or skin wound
  • trouble breathing
  • swelling around your eyes
• Changes in fat placement and body shape. Symptoms can include:
  • increased fat around your middle (torso)
  • development of a fatty lump on the back of your shoulders
  • enlarged breasts (in both males and females)
  • loss of weight in your face, arms, and legs

Weight gain

Weight gain was not a side effect that occurred in clinical studies of Atripla. However, HIV treatment in general may cause weight gain. This is because HIV may cause weight loss, so treating the condition may cause a return of some of the weight that had been lost.

People who take Atripla may notice that their body fat has shifted to different areas of their body. This is called lipodystrophy. Body fat may gather toward the center of your body, such as in your waist, breasts, and neck. It may also shift away from your arms and legs.

It’s not known if these effects go away over time, or if they disappear after you stop using Atripla. If you experience these effects, tell your doctor. They may switch you to a different medication.

Pancreatitis

It’s rare, but pancreatitis (inflamed pancreas) has been seen in people taking drugs that contain efavirenz. Efavirenz is one of the three drugs contained in Atripla.

Increased levels of pancreatic enzymes have been seen in some people taking efavirenz, but it isn’t known if this was connected to pancreatitis.

Tell your doctor if you’re experiencing possible symptoms of pancreatitis. These include pain in your torso, nausea or vomiting, a fast heartbeat, and a tender or swollen stomach. Your doctor may switch you to a different medication.

Note: Pancreatitis has been noted more often with use of other HIV drugs such as didanosine.

Side effects in children

In clinical studies of Atripla, most side effects in children were similar to those in adults. Rash was one of the side effects that occurred more often in children.

A rash occurred in 32% of children, while only 26% of adults got a rash. The rash in children most often appeared around 28 days after starting treatment with Atripla. To prevent a rash in your child, their doctor may suggest using allergy medication such as antihistamines before starting Atripla treatment.

Other common side effects seen in children but not adults include changes in skin color, such as freckles or darkened skin. This typically occurs on the palms of the hands or soles of the feet. Side effects also include anemia, with symptoms such as low energy levels, a fast heartbeat, and cold hands and feet.

Rash

Rash is a very common side effect of Atripla treatment.

In clinical trials, rash occurred in 26% of adults who received efavirenz, one of the drugs in Atripla. There have been reports of very serious rashes with use of efavirenz, but they only occurred in 0.1% of people studied. Rashes that caused blisters or open wounds occurred in about 0.9% of people.

The majority of rashes seen with efavirenz were mild to moderate, with red and patchy areas and some bumps in the skin. This type of rash is called a maculopapular rash. These rashes typically appeared within 2 weeks of the start of efavirenz treatment and went away within a month of their appearance.

Tell your doctor if you develop a rash while taking Atripla. If you develop blisters or a fever, stop taking Atripla and call your doctor right away. Your doctor may give you drugs to treat the reaction. If the rash is severe, they may change you to a different medication.

Note: When a person first contracts HIV, rash may be an initial symptom. This rash typically lasts for 2 to 4 weeks. But if you’ve had HIV for a while and just started treatment with Atripla, a new rash would most likely be due to Atripla.

Depression

Depression was a common side effect in clinical trials of Atripla. It occurred in 9% of the people taking the drug.

Tell your doctor right away if you have symptoms of depression. These can include feelings of sadness, hopelessness, and loss of interest in daily activities. Your doctor may change you to a different HIV medication. They may also recommend treatment for your depression symptoms.

Atripla cost

As with all medications, the cost of Atripla can vary.

Your actual cost will depend on your insurance coverage.

Financial and insurance assistance

If you need financial support to pay for Atripla, or if you need help understanding your insurance coverage, help is available.

Gilead Sciences, Inc., the manufacturer of Atripla, offers a program called Advancing Access. For more information and to find out if you’re eligible for support, call 800-226-2056 or visit the program website.

Atripla uses

The Food and Drug Administration (FDA) approves prescription drugs such as Atripla to treat certain conditions. Atripla has only been approved to treat HIV.

Atripla for HIV

Atripla is approved to treat HIV in adults and children who weigh at least 88 pounds (40 kilograms). Atripla is used either by itself or in combination with other HIV drugs.

Most newer HIV drugs are approved for people who have never taken HIV drugs or are stable on another HIV treatment. Atripla doesn’t have that specific approved use.

Uses that are not approved

Atripla isn’t approved for any other uses. It should only be used to treat HIV.

Atripla for hepatitis B

Atripla isn’t approved for hepatitis B and shouldn’t be used to treat it. However, one of the drugs in Atripla (tenofovir disoproxil fumarate) is used to treat chronic hepatitis B.

Atripla for PEP

Atripla isn’t approved and shouldn’t be used for post-exposure prophylaxis (PEP). PEP refers to the use of HIV medications after possible exposure to HIV to prevent infection.

In addition, Atripla isn’t approved and shouldn’t be used for pre-exposure prophylaxis (PrEP). PrEP refers to the use of HIV medications before possible exposure to HIV to prevent infection.

The only FDA-approved drug for PrEP is Truvada, which contains emtricitabine and tenofovir disoproxil fumarate. While Atripla contains both of these drugs, it hasn’t been studied as a preventive therapy for HIV.

Atripla for children

Atripla can be used to treat HIV in people of any age as long as they weigh at least 88 pounds (40 kilograms). This includes children.

Atripla dosage

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you.

Drug forms and strengths

Atripla comes as an oral tablet. Each tablet contains three drugs:

• 600 mg of efavirenz
• 300 mg of tenofovir disoproxil fumarate
• 200 mg of emtricitabine

Dosage for HIV

One Atripla tablet should be taken once daily on an empty stomach (without food). In most cases, it should be taken at bedtime.

Pediatric dosage

The Atripla dosage for children is the same as the dosage for adults. The dosage doesn’t change based on age.

What if I miss a dose?

If you’re taking Atripla and miss a dose, take the next dose as soon as you remember. If it’s almost time for your next dose, just take that next dose. You should not double your dose to make up for the missed dose.

Will I need to use this drug long-term?

If you and your doctor decide that Atripla is a good treatment for you, you will likely need to take it long-term.

Once you’ve started treatment, do not stop taking Atripla without talking to your doctor first.

Sticking to your Atripla treatment plan

Taking Atripla tablets exactly as your doctor tells you to is very important. Taking Atripla regularly will increase your chance of treatment success.

Missing doses can affect how well Atripla works to treat HIV. If you miss doses, you may develop resistance to Atripla. This means the drug may no longer work to treat your HIV.

If you have hepatitis B as well as HIV, you have an additional risk. Missing doses of Atripla may cause your hepatitis B to worsen.

Be sure to follow your doctor’s instructions and take Atripla once a day, every day, unless your doctor tells you otherwise. Using a reminder tool can be helpful in making sure you take Atripla each day.

If you have any questions or concerns about your Atripla treatment, talk with your doctor. They can help resolve any issues you may have and help make sure Atripla is working well for you.

Alternatives to Atripla

In addition to Atripla, there are many other drugs available that can treat HIV. Some may be better suited for you than others. If you’re interested in finding an alternative to Atripla, talk with your doctor to learn more about other medications that may work well for you.

Other combination medications

All people who have HIV generally need to take more than one drug. For this reason, there are many combination HIV medications available. These medications contain more than one drug. Atripla is a combination medication that contains three drugs: emtricitabine, tenofovir disoproxil fumarate, and efavirenz.

Examples of other combination drugs available for treating HIV include:

• Biktarvy (bictegravir, emtricitabine, and tenofovir alafenamide)
• Complera (emtricitabine, rilpivirine, and tenofovir disoproxil fumarate)
• Descovy (emtricitabine and tenofovir alafenamide)
• Genvoya (elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide)
• Juluca (dolutegravir and rilpivirine)
• Odefsey (emtricitabine, rilpivirine, and tenofovir alafenamide)
• Stribild (elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate)
• Symtuza (darunavir, cobicistat, emtricitabine, and tenofovir alafenamide)
• Triumeq (abacavir, dolutegravir, and lamivudine)
• Truvada (emtricitabine and tenofovir disoproxil fumarate)

Individual medications

For each person with HIV, their doctor will design a treatment plan specially for them. This may be a combination drug, or it may be separate individual drugs.

Many of the drugs found in combination HIV drugs are available on their own. Your doctor can tell you more about the drugs that might work best for you.

Atripla vs. Genvoya

You may wonder how Atripla compares with other medications that are prescribed for similar uses. Here, we look at how Atripla and Genvoya are alike and different.

Uses

Both Atripla and Genvoya are approved to treat HIV. Genvoya is approved for use in people of any age as long as they weigh at least 55 pounds (25 kilograms). Atripla, on the other hand, is approved for use in people of any age as long as they weigh at least 88 pounds (40 kilograms).

Drug forms and administration

Both Atripla and Genvoya come as oral tablets that are taken once daily. Genvoya should be taken with food, while Atripla should be taken on an empty stomach. And while Genvoya can be taken at any point during the day, it’s recommended that you take Atripla at bedtime to help prevent certain side effects.

Each Atripla tablet contains the drugs emtricitabine, efavirenz, and tenofovir disoproxil fumarate. Each Genvoya tablet contains the drugs emtricitabine, elvitegravir, cobicistat, and tenofovir alafenamide.

Side effects and risks

Atripla and Genvoya have similar effects in the body and therefore cause very similar side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Atripla, with Genvoya, or with both drugs (when taken individually).

• Can occur with Atripla:
  • depression
  • upper respiratory tract infections
  • anxiety
  • sore throat
  • vomiting
  • dizziness
  • rash
  • trouble sleeping
• Can occur with Genvoya:
  • increased levels of LDL cholesterol
• Can occur with both Atripla and Genvoya:
  • diarrhea
  • nausea
  • headache
  • fatigue
  • increased total cholesterol levels

Serious side effects

These lists contain examples of serious side effects that can occur with Atripla, with Genvoya, or with both drugs (when taken individually).

• Can occur with Atripla:
  • mental health changes, such as severe depression or aggressive behavior
  • convulsions
  • changes in fat location throughout the body
• Can occur with Genvoya:
  • few unique serious side effects
• Can occur with both Atripla and Genvoya:
  • bone loss
  • severe worsening of hepatitis B* (if you already have the virus)
  • immune reconstitution syndrome (when the immune system improves quickly and starts to “overwork”)
  • kidney damage**
  • lactic acidosis (a dangerous buildup of acid in the body)
  • severe liver disease (enlarged liver with steatosis)

*Atripla and Genvoya both have a boxed warning from the FDA regarding worsening of hepatitis B. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

**Tenofovir, one of the drugs in both Genvoya and Atripla, has been linked to kidney damage. However, the type of tenofovir in Genvoya (tenofovir alafenamide) has less risk of kidney damage than the type that’s in Atripla (tenofovir disoproxil fumarate).

Effectiveness

These drugs haven’t been directly compared in clinical studies, but studies have found both Atripla and Genvoya to be effective for treating HIV.

However, neither drug is recommended as a first-choice for treatment for most people with HIV. This is because Atripla and Genvoya are both older HIV drugs, and there are newer drugs available that are often better options. The newer HIV drugs are often more effective and have fewer side effects than older drugs.

Atripla and Genvoya may be appropriate for some people, but in general, they’re not the first choice that doctors would recommend for most people.

Costs

Atripla and Genvoya are both brand-name medications. They’re not available in generic forms, which are usually cheaper than brand-name drugs.

Atripla may cost slightly less than Genvoya. The actual price you would pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Atripla vs. other drugs

In addition to Genvoya (above), other medications are prescribed to treat HIV. Below are comparisons between Atripla and some other HIV medications.

Atripla vs. Truvada

Atripla is a combination medication that contains the drugs emtricitabine, tenofovir disoproxil fumarate, and efavirenz. Truvada is also a combination medication, and it contains two of the same drugs that are in Atripla: emtricitabine and tenofovir disoproxil fumarate.

Uses

Both Atripla and Truvada are approved for treatment of HIV. Atripla is approved for use on its own, but Truvada is only approved for use with dolutegravir (Tivicay) or other HIV drugs.

Atripla is approved for use in people of any age as long as they weigh at least 88 pounds (40 kilograms). Truvada is approved to treat HIV in people of any age as long as they weigh at least 37 pounds (17 kilograms).

Truvada is also approved for the prevention of HIV. Atripla is only approved to treat HIV.

Drug forms and administration

Both Atripla and Truvada come as oral tablets that are taken once daily. Truvada can be taken with or without food, while Atripla should be taken on an empty stomach. And while Truvada can be taken at any time during the day, it’s recommended that you take Atripla at bedtime to help prevent certain side effects.

Side effects and risks

Atripla contains the same drugs as Truvada, plus efavirenz. Therefore, they have similar side effects.

More common side effects

These lists contain examples of more common side effects that can occur with both Atripla and Truvada (when taken individually). Note: The side effects for Truvada listed here are from a clinical trial in which Truvada was taken with efavirenz.

• Can occur with both Atripla and Truvada:
  • diarrhea
  • nausea and vomiting
  • dizziness
  • headache
  • fatigue
  • trouble sleeping
  • sore throat
  • respiratory infections
  • abnormal dreams
  • rash
  • increased total cholesterol levels

Serious side effects

These lists contain examples of serious side effects that can occur with Atripla or with both drugs (when taken individually). Note: The side effects for Truvada listed here are from a clinical trial in which Truvada was taken with efavirenz.

• Can occur with Atripla:
  • convulsions
  • changes in fat location throughout the body
• Can occur with both Atripla and Truvada:
  • mental health changes, such as severe depression or aggressive behavior
  • severe worsening of hepatitis B* (if you already have the virus)
  • immune reconstitution syndrome (when the immune system improves quickly and starts to “overwork”)
  • bone loss
  • kidney damage**
  • lactic acidosis (a dangerous buildup of acid in the body)
  • severe liver disease (enlarged liver with steatosis)

*Atripla and Truvada both have a boxed warning from the FDA regarding worsening of hepatitis B. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

**Tenofovir, one of the drugs in both Truvada and Atripla, has been linked to kidney damage.

Effectiveness

These drugs haven’t been directly compared in clinical studies, but studies have found both Atripla and Truvada to be effective for treating HIV.

Although Atripla can be effective in treating HIV, it’s not recommended as a first-choice treatment for HIV. This is because newer drugs can also treat HIV but may have fewer side effects than Atripla.

Truvada used in combination with dolutegravir (Tivicay), however, is recommended as a first-choice treatment for most people with HIV.

Costs

Atripla and Truvada are both brand-name medications. They’re not available in generic forms, which are usually less expensive than brand-name drugs.

Atripla may cost slightly more than Truvada. The actual price you would pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Atripla vs. Complera

Atripla is a combination medication that contains the drugs emtricitabine, tenofovir disoproxil fumarate, and efavirenz. Complera is also a combination medication, and it contains two of the same drugs that are in Atripla: emtricitabine and tenofovir disoproxil fumarate. Its third drug ingredient is rilpivirine.

Uses

Both Atripla and Complera are approved for treatment of HIV.

Atripla is approved for use in people of any age as long as they weigh at least 88 pounds (40 kilograms). Complera, on the other hand, is approved for use in people of any age as long as they weigh at least 77 pounds (35 kilograms).

Complera is typically only used in people who have a low viral load before starting treatment. Atripla doesn’t have this restriction.

Drug forms and administration

Both Atripla and Complera come as oral tablets that are taken once daily. Complera should be taken with food, while Atripla should be taken on an empty stomach. And while Complera can be taken at any time during the day, it’s recommended that you take Atripla at bedtime to help prevent certain side effects.

Side effects and risks

Atripla and Complera contain similar drugs. Therefore, they have similar side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Atripla, with Complera, or with both drugs (when taken individually).

• Can occur with Atripla:
  • few unique common side effects
• Can occur with Complera:
  • few unique common side effects
• Can occur with both Atripla and Complera:
  • diarrhea
  • nausea and vomiting
  • dizziness
  • headache
  • fatigue
  • trouble sleeping
  • sore throat
  • upper respiratory tract infections
  • abnormal dreams
  • rash
  • depression
  • anxiety
  • increased total cholesterol levels

Serious side effects

These lists contain examples of serious side effects that can occur with Atripla, with Complera, or with both drugs (when taken individually).

• Can occur with Atripla:
  • convulsions
  • changes in fat location throughout the body
• Can occur with Complera:
  • swelling in your gallbladder
  • gallstones
• Can occur with both Atripla and Complera:
  • mental health changes, such as severe depression or aggressive behavior
  • severe worsening of hepatitis B* (if you already have the virus)
  • immune reconstitution syndrome (when the immune system improves quickly and starts to “overwork”)
  • bone loss
  • kidney damage**
  • lactic acidosis (a dangerous buildup of acid in the body)
  • severe liver disease (enlarged liver with steatosis)

*Atripla and Complera both have a boxed warning from the FDA regarding worsening of hepatitis B. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

**Tenofovir, one of the drugs in both Complera and Atripla, has been linked to kidney damage.

Effectiveness

The use of the drugs found in Atripla (efavirenz, emtricitabine, and tenofovir disoproxil fumarate) has been directly compared with the use of Complera in a clinical study. The two treatments were found to be equally effective for HIV treatment.

In people who had never been treated for HIV before, both Complera and the Atripla drug combination had treatment success of 77% at week 96. Treatment was considered successful if the person’s viral load was less than 50 at the end of the study.

However, 8% of people who took the Atripla drug combination did not have benefit, while 14% of people who took Complera did not have benefit. This suggests that Complera may have more treatment failure than the Atripla drug combination.

Neither Atripla nor Complera is recommended as a first-choice treatment for most people with HIV. These drugs may be appropriate for some people, but in general, newer drugs are recommended more often. This is because the newer drugs, such as Biktarvy or Triumeq, might work better and have fewer side effects.

Costs

Atripla and Complera are both brand-name drugs. There are currently no generic forms available for either drug. Brand-name medications usually cost more than generics.

Atripla and Complera generally cost about the same. The actual price you would pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

How to take Atripla

You should take Atripla according to your doctor or healthcare provider’s instructions.

Timing

You should take Atripla at the same time every day, preferably at bedtime. Taking it at bedtime may help ease some of the side effects, such as trouble concentrating and dizziness.

Taking Atripla on an empty stomach

You should take Atripla on an empty stomach (without food). Taking Atripla with food may increase the effects of the medication. Having too much medication in your system can lead to serious side effects.

Can Atripla be crushed?

In general, it’s not recommended to split, crush, or chew Atripla tablets. They should be swallowed whole.

If you have trouble swallowing the tablets whole, talk with your doctor about other medications that might work better for you.

Atripla and alcohol

It’s best to avoid drinking alcohol while taking Atripla. This is because combining alcohol and Atripla may lead to more side effects from the drug. These can include:

• dizziness
• sleep problems
• confusion
• hallucinations
• trouble concentrating

If you have trouble avoiding alcohol, let your doctor know before you start treatment with Atripla. They may suggest a different medication.

Atripla interactions

Atripla can interact with many different medications as well as certain supplements and foods.

Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Atripla and other medications

Below is a list of medications that can interact with Atripla. This list does not contain all drugs that may interact with Atripla. There are many other drugs that can interact with Atripla.

Before taking Atripla, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also, tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Certain HIV drugs

Atripla interacts with many other HIV drugs. Do not start taking multiple drugs for HIV unless instructed to do so by your doctor. Taking Atripla with certain other HIV drugs may decrease the effects of these drugs or increase your risk of side effects.

Examples of these HIV drugs include:

• protease inhibitors, such as:
  • atazanavir
  • fosamprenavir calcium
  • indinavir
  • darunavir/ritonavir
  • lopinavir/ritonavir
  • ritonavir
  • saquinavir
• non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as:
  • rilpivirine
  • etravirine
  • doravirine
• maraviroc, which is a CCR5 antagonist
• didanosine, which is a nucleoside reverse transcriptase inhibitor (NRTI)
• raltegravir, which is an integrase inhibitor

Certain hepatitis C drugs

Taking Atripla with certain hepatitis C drugs could make those drugs less effective. It could also make your body become resistant to the hepatitis C drugs. With resistance, the drugs might not work at all for you. For other hepatitis C drugs, taking Atripla with them could increase the side effects of Atripla.

Examples of hepatitis C medications that should not be taken with Atripla include:

• Epclusa (sofosbuvir/velpatasvir)
• Harvoni (ledipasvir/sofosbuvir)
• Mavyret (glecaprevir/pibrentasvir)
• Olysio (simeprevir)
• Victrelis (boceprevir)
• Vosevi (sofosbuvir/velpatasvir/voxilaprevir)
• Zepatier (elbasvir/grazoprevir)

Antifungal drugs

Taking Atripla with certain antifungal medications could make those drugs less effective. It could also increase certain side effects. Examples of these antifungal medications include:

• itraconazole
• ketoconazole
• posaconazole
• voriconazole

Drugs that can affect kidney function

Taking Atripla with certain drugs that affect the way your kidneys work can increase the effects of Atripla. This could lead to increased side effects. Examples of these drugs include:

• certain antiviral drugs, such as:
  • acyclovir
  • adefovir dipivoxil
  • cidofovir
  • ganciclovir
  • valacyclovir
  • valganciclovir
• aminoglycosides, such as gentamicin
• nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, piroxicam, or ketorolac, when they’re used together or in high doses

Drugs whose effects can be reduced

There are many drugs whose effects could be reduced when taken with Atripla. Examples of these drugs include:

• certain anticonvulsants, such as:
  • carbamazepine
  • phenytoin
  • phenobarbital
• certain antidepressants, such as:
  • bupropion
  • sertraline
• calcium channel blockers, such as:
  • diltiazem
  • felodipine
  • nicardipine
  • nifedipine
  • verapamil
• certain statins (cholesterol medications), such as:
  • atorvastatin
  • pravastatin
  • simvastatin
• certain drugs that decrease the function of your immune system, such as:
  • cyclosporine
  • tacrolimus
  • sirolimus
• certain birth control pills, such as ethinyl estradiol/norgestimate
• certain drugs used in implantable birth control devices, such as etonogestrel
• clarithromycin
• rifabutin
• certain drugs that treat malaria, such as:
  • artemether/lumefantrine
  • atovaquone/proguanil
  • methadone

Warfarin

Taking Atripla with warfarin (Coumadin, Jantoven) could make warfarin more or less effective. If you take warfarin, talk with your doctor about the possible effects of taking these drugs together.

Rifampin

Taking Atripla with rifampin could make Atripla less effective. That’s because it can reduce the amount of efavirenz in your body. Efavirenz is one of the drugs found in Atripla.

If your doctor decides that you need to take Atripla with rifampin, they may recommend taking an extra 200 mg per day of efavirenz.

Atripla and Viagra

Atripla can increase how fast sildenafil (Viagra) passes through your body. This can make Viagra less effective.

If you would like to take Viagra during your treatment with Atripla, talk with your doctor first. They can advise you about whether Viagra is the best option for you, or if there’s another drug that might work better.

Atripla and herbs and supplements

Taking St. John’s wort with Atripla may make Atripla less effective. If you would like to take these products together, talk with your doctor first about whether it’s safe.

And be sure to let your doctor and pharmacist know of any natural products you take, even if you think they’re natural and safe. This includes teas, such as green tea, and traditional medicines, such as ma-huang.

Atripla and foods

Eating grapefruit while you take Atripla may increase the levels of the drug in your body. This could increase your side effects from Atripla, such as nausea and vomiting. Avoid consuming grapefruit or grapefruit juice during your treatment with Atripla.

How Atripla works

HIV is a virus that damages the immune system, which is the body’s defense against disease. When HIV goes untreated, it takes over immune system cells called CD4 cells. HIV uses these cells to replicate (make copies of itself) and spread throughout the body.

Without treatment, HIV can develop into AIDS. With AIDS, the immune system becomes so weak that a person can develop other conditions, such as pneumonia or lymphoma. Eventually, AIDS can shorten a person’s life span.

Atripla is a combination drug that contains three antiretroviral medications. These medications are:

• efavirenz, which is a non-nucleoside reverse transcriptase inhibitor (NNRTI)
• emtricitabine, which is a nucleoside analog reverse transcriptase inhibitors (NRTI)
• tenofovir disoproxil fumarate, which is also an NRTI

All three of these drugs work by stopping HIV from replicating. This slowly decreases a person’s viral load, which is the amount of HIV in the body. When this level is so low that HIV is no longer present in HIV test results, it’s called undetectable. An undetectable viral load is the goal of HIV treatment.

How long does it take to work?

For any HIV treatment, including Atripla, it generally takes 8–24 weeks to reach an undetectable HIV viral load. This means that a person will still have HIV, but it’s at such a low level that it’s not detected by testing.

Will I need to take this drug long-term?

There’s currently no cure for HIV. Therefore, to keep HIV viral load under control, most people will always need to take some kind of HIV medication.

If you and your doctor decide that Atripla is working well for you, you’ll likely need to take it long-term.

Atripla and pregnancy

Pregnancy should be avoided during treatment with Atripla, and for at least 12 weeks after treatment ends. This is because Atripla can harm your pregnancy.

If you’re pregnant or planning to become pregnant, talk with your doctor. They may suggest a different treatment for your HIV. And if you become pregnant while taking Atripla, call your doctor right away.

If you do take Atripla while pregnant, you may consider joining the Antiretroviral Pregnancy Registry. This registry tracks the health and pregnancy of people who take antiretroviral medications while pregnant. Your doctor can tell you more.

Atripla and breastfeeding

The drugs in Atripla pass into breast milk. People who are taking Atripla should not breastfeed, because their child would take the drug in through the breast milk. If this occurs, the child may have side effects from the drug, such as diarrhea.

Another consideration is that HIV may pass to a child through breast milk. In the United States, the Centers for Disease Control and Prevention (CDC) recommends that people with HIV avoid breastfeeding.

However, the World Health Organization (WHO) still encourages breastfeeding for people with HIV in many other countries.

Common questions about Atripla

Here are answers to some frequently asked questions about Atripla.

Can Atripla cause depression?

Yes, Atripla can cause depression. In clinical studies, 9% of people taking the drug developed depression.

If you notice any changes in your mood while you’re taking Atripla, talk with your doctor right away. They may change your HIV treatment, and they can provide other treatment recommendations that can help relieve your depression.

Does Atripla cure HIV?

No, there’s currently no cure for HIV. But effective treatment should make the virus undetectable. This means that a person will still have HIV, but it’s at such a low level that it’s not detected by testing. The FDA currently considers a non-detectable level to be treatment success.

Can Atripla prevent HIV?

No, Atripla isn’t approved for HIV prevention. The only medication approved to prevent HIV is Truvada, which is used for pre-exposure prophylaxis (PrEP). With PrEP, medication is taken before potential exposure to HIV to help prevent the spread of the virus.

Atripla hasn’t been studied for this use, even though it contains both of the drugs found in Truvada (emtricitabine and tenofovir disoproxil fumarate). Therefore, Atripla shouldn’t be used for this purpose.

A person who doesn’t have HIV but has a chance of contracting it should talk with their doctor. They can recommend preventive options such as PrEP or post-exposure prophylaxis (PEP). They can also suggest other preventive measures, such as always using a condom during vaginal or anal sex.

What happens if I miss several doses of Atripla?

If you miss several doses of Atripla, don’t take multiple doses to make up for the ones you missed. Instead, talk with your doctor as soon as possible. They’ll let you know what next steps you should take.

It’s important to take Atripla every day. This is because if you miss doses, your body could develop a resistance to Atripla. With drug resistance, a drug no longer works to treat a certain condition.

But if you just miss one dose, in general, you should take that dose as soon as you remember.

Atripla warnings

This drug comes with several warnings.

FDA warning: Worsening of hepatitis B (HBV)

This drug has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

• For people taking Atripla and who have HIV and HBV, stopping Atripla may lead to worsening HBV. This can lead to problems such as liver damage.
• All patients should be tested for HBV before starting treatment with Atripla. Also, you should not stop taking Atripla unless your doctor tells you to.
• If you have both HIV and HBV and stop taking Atripla, your doctor should monitor your liver function closely for several months. If your HBV worsens, your doctor may start you on HBV treatment.

Other warnings

Before taking Atripla, talk with your doctor about your health history. Atripla may not be right for you if you have certain medical conditions. These include:

• Hypersensitivity to Atripla or its ingredients. If you’ve had a serious allergic reaction to Atripla or any of the drugs it contains, you should avoid taking Atripla. If your doctor prescribes Atripla for you, be sure to tell them about your previous reaction before you start taking the drug.

Note: For more information about the potential negative effects of Atripla, see the “Side effects” section above.

Atripla overdose

Taking too much of this medication can increase your risk of serious side effects.

Overdose symptoms

Clinical studies of Atripla didn’t state what could happen if too much of the drug is taken. But other studies have shown that taking too much efavirenz, a drug found in Atripla, can increase certain side effects of the drug. These include:

• dizziness
• trouble sleeping
• confusion
• hallucinations
• muscle twitching

What to do in case of overdose

If you take more than one Atripla tablet in a day, tell your doctor. And be sure to tell them about any changes in your side effects or in how you feel in general.

If you think you’ve taken too much Atripla, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

Atripla expiration

When Atripla is dispensed from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date the medication was dispensed.

The purpose of such expiration dates is to guarantee the effectiveness of the medication during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications.

How long a medication remains good can depend on many factors, including how and where the medication is stored. Atripla pills should be stored at room temperature, around 77°F (25°C). They should also be kept in their original container, with the lid tightly closed.

If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.