Truvada interactions: Alcohol, medications, and other factors

Some factors or conditions could prevent your doctor from prescribing Truvada due to the risk of harm. These are known as contraindications. The contraindications of Truvada include:

Having an unknown or positive HIV status if you’re taking Truvada to prevent HIV

Truvada can treat or help prevent HIV. Measures used for HIV prevention are known as preexposure prophylaxis (PrEP). If you’re taking Truvada for PrEP, your doctor will test your blood for HIV before you start treatment. You’ll also have HIV tests every 3 months while you take the medication.

The testing is necessary because if you have HIV, taking Truvada for PrEP may increase the risk of drug resistance. In fact, the drug has a boxed warning regarding this risk. For details, see “Boxed warnings” at the top of this article.

Drug resistance occurs when a drug no longer works to treat a condition. In this situation, the antiviral drug Truvada could stop being effective for HIV. Doctors usually won’t prescribe Truvada for PrEP if you have HIV or don’t know whether you have it.

Note: Before you start treatment with Truvada, it’s important to tell your doctor if this contraindication applies to you. They can determine whether to prescribe Truvada.

There aren’t any known interactions between Truvada and alcohol. However, it’s possible that drinking alcohol may increase your risk of certain side effects of Truvada.* For example, both Truvada and alcohol can cause:

• nausea
• vomiting
• headache
• dizziness
• liver problems, such as liver damage

If you consume alcohol during Truvada treatment, these side effects may be more likely to occur.

If you’d like to drink alcohol while taking Truvada, talk with your doctor. They can recommend how much alcohol, if any, may be safe for you.

* For details about Truvada’s side effects, see this article.

Before you start treatment with Truvada, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Truvada interacts with supplements, herbs, or vitamins, see the “Truvada and other interactions” section below.)

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

Here’s a table of drugs that can interact with Truvada. Keep in mind that this table doesn’t include all drugs that may interact with Truvada. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For details about Truvada’s side effects, see this article.

Here’s a closer look at certain drug interactions of Truvada.

Certain other HIV medications

Like Truvada, other HIV medications are used to treat or help prevent HIV.

Interaction result: Taking Truvada in combination with certain other HIV drugs can increase your risk of side effects from Truvada and the HIV medications.

Interaction explained: Truvada contains the active drugs emtricitabine and tenofovir disoproxil. Taking Truvada with certain other HIV drugs may raise the level of tenofovir in your body. This can increase your risk of side effects from Truvada* and the HIV medications.

In addition, taking Truvada with emtricitabine/tenofovir alafenamide (Descovy) can raise the levels of emtricitabine and tenofovir in your system. This can increase your risk of side effects from both Truvada and Descovy.†

Examples of other HIV drugs: Here are some other HIV drugs that may interact with Truvada:

• lopinavir/ritonavir (Kaletra)
• lamivudine (Epivir)

Steps you or your doctor may take: Before you start Truvada treatment, tell your doctor about any other HIV medications you take. They can help determine which HIV drugs are safe to take with Truvada. If your doctor prescribes an HIV drug and Truvada, they’ll closely monitor you.

* For details about Truvada’s side effects, see this article.
† To learn about Descovy’s side effects, refer to this article.

Certain antiviral medications

Antiviral drugs can be used to treat viral infections, such as herpes or shingles.

Interaction result: Taking Truvada in combination with certain antiviral drugs may increase the risk of side effects from both Truvada* and the antiviral drugs.

Interaction explained: Truvada and certain antiviral medications can cause kidney problems, such as kidney damage. Taking Truvada and one of these antiviral drugs can increase your risk of kidney problems. In some cases, the problems may be severe.

Examples of antiviral drugs: Here are some antiviral drugs that may interact with Truvada:

• ganciclovir (Zirgan)
• acyclovir (Zovirax)
• valacyclovir (Valtrex)
• valganciclovir (Valcyte)
• cidofovir

Steps you or your doctor may take: If your doctor prescribes Truvada and an antiviral drug, they’ll monitor you for side effects. They’ll also check your blood levels to see whether the medications are affecting your kidneys. In some cases, your doctor may recommend different treatment options for you.

* For details about Truvada’s side effects, see this article.

Orlistat

Orlistat (Xenical, Alli) is a drug that’s used to help manage weight.

Interaction result: Orlistat may decrease the effectiveness of Truvada.

Interaction explained: It’s unknown why orlistat may cause Truvada to be less effective than usual. The reason could be that orlistat stops your body from absorbing Truvada. And this makes Truvada less effective in treating or helping prevent HIV. In some situations, this interaction may cause HIV to worsen.

Steps you or your doctor may take: Before taking Truvada, tell your doctor if you’re taking orlistat. If you are, they may monitor your blood frequently during Truvada treatment. This helps them see how well Truvada is working for you. If your HIV worsens while you’re taking orlistat, your doctor will likely recommend you stop taking the drug.

Truvada may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Truvada.

Truvada interactions with supplements

Before you start treatment with Truvada, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

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

Truvada interactions with herbs

It’s possible for Truvada to interact with an herb called echinacea. Some people take this herb to boost their immune system. If you take echinacea during Truvada treatment, it may decrease the effectiveness of Truvada.

Due to this risk, your doctor may recommend that you not take echinacea while also taking Truvada. If your doctor does advise you to take echinacea, they may monitor your blood to see whether Truvada is working for you.

Truvada and vitamins

There are no specific reports of vitamins interacting with Truvada. However, that does not mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Truvada.

Truvada interactions with food

Grapefruit and grapefruit juice can interact with Truvada. Specifically, grapefruit products can stop your body from breaking down tenofovir, one of the active ingredients in Truvada. This raises the level of tenofovir in your body, which increases your risk of side effects from Truvada.* Due to this risk, your doctor may recommend not consuming grapefruit and grapefruit juice while taking the drug.

It’s also important to note that Truvada may interact with echinacea. This herb is available as a tea. For more information about the interaction between Truvada and echinacea, see “Truvada interactions with herbs” above.

* For details about Truvada’s side effects, see this article.

Truvada and vaccines

There aren’t any known interactions between Truvada and vaccines. To find out if you’re up to date on your vaccines, talk with your doctor or pharmacist.

Truvada and lab tests

Truvada isn’t known to interact with any lab tests. If you have questions about certain lab tests that your doctor recommends, talk with your doctor.

TRUVADA INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Truvada. Specifically, cannabis may raise the level of tenofovir in your system. (Tenofovir is one of the active drugs in Truvada.) This may increase your risk of side effects from Truvada. For details about Truvada’s side effects, see this article.

Before you start treatment with Truvada, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many U.S. states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Truvada. Before you take this drug, be sure to talk with your doctor about your health history. Truvada may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Truvada include the following.

HIV: Doctors typically do not prescribe Truvada to help prevent HIV if you have HIV or if you don’t know whether you have it. This is because drug resistance may occur.*

Hepatitis B: If you have hepatitis B, tell your doctor before you start taking Truvada. Stopping treatment with the drug may cause hepatitis B to worsen and become severe.*

Liver problems: If you have a liver problem, such as liver failure, tell your doctor before starting Truvada treatment. This medication may increase your risk of liver damage. And, if you already have a liver problem, taking Truvada may worsen it. Your doctor can help determine whether Truvada is safe for you.

Kidney problems: If you have a kidney problem, such as chronic kidney disease, tell your doctor before taking Truvada. You should also tell them if you’re receiving dialysis. Truvada can worsen kidney problems. So, if you have a kidney problem, your doctor may lower your dose of the drug. In some cases, such as with severe kidney disease, they may recommend a different treatment option for you.

Bone problems: It’s possible for Truvada to cause bone loss. If you have a bone condition, such as osteoporosis, taking the drug may weaken your bones even more. In this case, your doctor can determine whether Truvada is safe for you.

Pregnancy: It’s unknown whether it’s safe to take Truvada during pregnancy. However, information suggests that Truvada does not increase the risk of congenital anomalies during the first trimester of pregnancy.† (These anomalies are commonly known as birth defects.) There’s limited information available about the effects of Truvada during the second and third trimesters.†

If you’re pregnant or planning to become pregnant, talk with your doctor before starting Truvada treatment.

Breastfeeding: It’s not recommended that you breastfeed while you’re taking Truvada. It’s also not advised to breastfeed if you have HIV. To learn more, see the breastfeeding section of this article.

Allergic reaction: If you’ve had an allergic reaction to Truvada or any of its ingredients, your doctor will likely not prescribe the drug. Taking Truvada could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

* Truvada has a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see “Boxed warnings” at the top of this article.
† The first trimester is weeks 1 to 12 of pregnancy. The second trimester is weeks 13 to 28. The third trimester is weeks 29 to 40.

You can take certain steps to help prevent interactions with Truvada. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Truvada label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions. (If Truvada doesn’t come with paperwork, you can ask your pharmacist to print a copy.) If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Truvada by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Truvada. These resources might help:

• Overview of Truvada: For a general overview of Truvada, you can see this article.
• Side effects: If you’re interested in the side effects of Truvada, refer to this article. Another option is to look at the Truvada prescribing information.
• Drug comparison: Find information about how Truvada compares with Descovy and Biktarvy.
• Cost: You can get details about Truvada and cost here.
• Facts about your condition: To learn more about Truvada for PrEP, see this article. For information about HIV, see our related hub.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.