Truvada side effects: What you should know

Truvada can cause certain side effects, some of which are more common than others. These side effects are usually temporary, lasting a few days or weeks. If the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Some of the more common side effects of Truvada in people who took it to treat HIV include:

• depression (see “Side effect specifics” below)
• diarrhea
• headache
• rash
• fatigue
• insomnia

The more common side effects in people who took Truvada as preexposure prophylaxis (PrEP) to help prevent HIV include:

• abdominal pain
• weight loss (see “Side effect specifics” below)
• headache

It’s important to note that these lists contain only a few common side effects of Truvada reported by people who took the drug during clinical trials.

Mild side effects can occur with Truvada use. This list doesn’t include all possible mild side effects of the drug. For more information, you can refer to Truvada’s prescribing information.

Mild side effects of Truvada can include:

• unusual dreams
• abdominal pain
• diarrhea
• insomnia
• dizziness
• fatigue
• headache
• nausea or vomiting
• rash
• weight loss (see “Side effect specifics” below)

These side effects are usually temporary, lasting a few days or weeks. If the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Truvada and want to tell the FDA about it, visit MedWatch.

Truvada may cause serious side effects. The list below may not include all possible serious side effects of the drug. For more information, you can refer to Truvada’s prescribing information.

Most serious side effects from Truvada are rare. However, it’s important to point out that one serious side effect, depression, was one of the more common side effects of the drug.

If you develop serious side effects while taking Truvada, call your doctor right away. If your side effects seem life threatening or if you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects and their symptoms can include:

• Liver problems. Symptoms can include:
  • fatigue
  • nausea or vomiting
  • swelling or pain in your abdomen
  • yellowing of your skin or the whites of your eyes
  • decreased appetite
  • dark urine
  • light-colored stools
• Kidney problems. Symptoms can include:
  • fatigue
  • muscle pain or bone pain
  • nausea or vomiting
  • decreased urine output
  • weakness
• Depression (see “Side effect specifics” below).
• Immune reconstitution syndrome (changes in your immune system that can cause certain past infections to reappear). Symptoms vary depending on the type and severity of infection.
• Bone loss (see “Side effect specifics” below).
• Worsening of hepatitis B (see “Side effect specifics” below).*
• Resistance to Truvada (see “Side effect specifics” below).*
• Lactic acidosis (see “Side effect specifics” below).†
• Allergic reaction (see “Side effect specifics” below).

* Truvada has a boxed warning about this side effect. This is a serious warning from the Food and Drug Administration (FDA). For details, see “Side effect specifics” below.
† This side effect wasn’t reported in clinical trials for Truvada. But it was reported in studies of emtricitabine and tenofovir disoproxil fumarate, the two active ingredients in Truvada.

Learn more about some of the side effects Truvada may cause.

Depression

It’s possible to have depression while taking Truvada. In clinical trials, this was one of the more common side effects of Truvada in people taking the drug to treat HIV.

Symptoms of depression can include:

• feeling sad or down
• having less interest in activities you typically enjoy
• fatigue or loss of energy
• sleeping too little or too much

What you can do

If you have symptoms of depression while taking Truvada, tell your doctor. They can recommend ways to help improve your mood.

Weight loss

Weight loss has been reported in people taking Truvada. However, this side effect wasn’t common in clinical trials.

Some drugs used to treat HIV have been found to cause changes in body mass, including body fat. Some of these drugs have also been found to affect lipids (certain types of fat in your body), such as cholesterol. However, in a clinical trial of people taking Truvada to help prevent HIV, the drug did not seem to cause changes in body fat or lipids.

What you can do

If you’re concerned about weight loss while taking Truvada, talk with your doctor. They may recommend a dietitian to help you make sure you’re consuming enough food. Or your doctor may have you try a different medication for your condition.

Bone loss or slowed bone growth

Truvada may cause bone loss in adults. In children, the drug may slow bone growth.

With bone loss, your bones aren’t able to properly repair themselves and maintain their strength. Over time, this can lead to weaker bones, which may increase your risk of fractures. Symptoms of bone loss are rare. However, some people may have early symptoms, including:

• brittle, weak fingernails
• receding gums
• weakened grip strength

With slowed bone growth, bone mineral density (BMD) may be lower than usual. BMD measures how much mineral you have in your bones. Typically, BMD increases quickly in children as they grow. With less bone mineral available, your bones aren’t as strong as usual.

It’s important to note that in Truvada’s clinical trials, the height of children taking the drug didn’t appear to be affected. Possible long-term effects of decreased BMD in children taking Truvada aren’t currently known.

What you can do

While taking Truvada, your doctor may order tests to check your bone health. They may recommend that you take vitamin D and calcium supplements to help prevent bone loss. If you notice early signs of bone loss, talk with your doctor. They may recommend a different treatment for your condition.

Lactic acidosis

Lactic acidosis is a possible side effect of Truvada. With this condition, there’s a buildup of lactic acid in your body. This can be caused by your body producing too much lactic acid, not breaking down enough lactic acid, or both.

Lactic acidosis wasn’t reported in clinical trials of Truvada. Though rare, it has been reported as a side effect in people taking emtricitabine and tenofovir disoproxil fumarate, either individually or in combination with other antiretroviral drugs. (Emtricitabine and tenofovir disoproxil fumarate are the active ingredients in Truvada.)

Lactic acidosis is a medical emergency that can be life threatening if it’s not treated right away.

Symptoms of lactic acidosis include:

• decreased appetite
• trouble breathing
• dizziness
• feeling cold
• feeling extremely tired
• flushing
• lightheadedness
• muscle pain
• nausea or vomiting
• slow or fast heart rate
• weakness
• abdominal pain that occurs with any of the symptoms mentioned above

What you can do

Talk with your doctor right away if you have any of the symptoms of lactic acidosis listed above. If you have trouble breathing, call 911 or your local emergency number right away, or go to the nearest emergency room.

Worsening of hepatitis B

Truvada has a boxed warning about worsening of hepatitis B. This is a serious warning from the Food and Drug Administration (FDA).

This side effect can occur in people with hepatitis B who stop taking Truvada.

Symptoms of hepatitis B can include:

• fatigue
• nausea or vomiting
• swelling or pain in your abdomen
• yellowing of your skin and the whites of your eyes

What you can do

If you have hepatitis B, make sure your doctor is aware of it before you start taking Truvada. And do not stop taking this medication without first speaking with your doctor.

If your doctor recommends that you stop taking Truvada, they will typically have you get occasional blood tests to check your liver function and see whether your hepatitis B is worsening.

If you have additional questions about this side effect, talk with your doctor or pharmacist.

Resistance to Truvada

Truvada has a boxed warning about resistance to this drug. This is a serious warning from the FDA.

You should not take Truvada for preexposure prophylaxis (PrEP) if you already have HIV. PrEP refers to taking an HIV drug to prevent HIV.

Taking Truvada for PrEP if you already have HIV may cause the virus to become resistant to Truvada. This means the drug won’t work as well and may even stop working to treat HIV entirely.

What you can do

If you’re using Truvada for PrEP, your doctor will order blood tests to make sure you don’t have HIV. You’ll have these tests before you start taking Truvada and at least every 3 months while you’re taking the drug for HIV prevention.

While taking Truvada for PrEP, you should continue taking other precautions to reduce your risk of contracting HIV. Other precautions include:

• using condoms when having sex
• avoiding sharing needles and syringes

If you have additional questions about resistance to Truvada, talk with your doctor or pharmacist.

Allergic reaction

As with most drugs, Truvada can cause an allergic reaction in some people. Although this side effect wasn’t reported in clinical trials of Truvada, it was reported after the drug became available to prescribe.

Symptoms of an allergic reaction can be mild or serious and can include:

• rash
• itching
• flushing
• swelling under your skin, typically in your lips, eyelids, feet, or hands
• swelling of your mouth, tongue, or throat, which can make it hard to breathe

What you can do

For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking Truvada. If your symptoms are serious and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Truvada may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

How long do Truvada side effects last?

It depends. Most mild side effects usually go away on their own as you continue to take Truvada.

However, some side effects can be long term. For example, the effects of bone loss on long-term bone health currently aren’t known. Some side effects, such as liver problems or kidney problems, may be permanent. It’s important to note that these side effects of Truvada are rare.

If you have questions about side effects, or you’re concerned about how long your side effects are lasting, talk with your doctor. They can work with you to determine whether Truvada is causing your symptoms and help you find the best treatment for your condition.

Does Truvada have any drug interactions?

Yes, Truvada does have drug interactions. A drug interaction occurs when one medication affects how another medication works. Some drug interactions interfere with how well a drug works, while others can cause an increase in severity and number of side effects.

Drugs known to interact with Truvada include:

• drugs other than Truvada that are removed by the kidneys, such as nonsteroidal anti-inflammatory drugs, including:
  • aspirin
  • diclofenac (Voltaren)
  • ibuprofen (Motrin, Advil)
  • naproxen (Aleve)
• atazanavir (Reyataz)
• darunavir (Prezista)
• velpatasvir/sofosbuvir (Epclusa)
• velpatasvir/sofosbuvir/voxilaprevir (Vosevi)
• ledipasvir/sofosbuvir (Harvoni)
• lopinavir/ritonavir (Kaletra)

If you’d like to read explanations of Truvada interactions, see this article. You can also refer to Truvada’s prescribing information.

Before taking Truvada, be sure that your doctor and pharmacist are aware of all medications you take. This includes any supplements, herbs, and over-the-counter medications. This will help them determine whether Truvada is safe to use with your other medications. If it isn’t, they can discuss with you the best treatments for your condition.

Does Truvada cause diabetes?

Yes, Truvada may cause a certain type of diabetes.

Type 1 and type 2 diabetes weren’t reported as side effects in clinical trials of Truvada. However, some people have developed a condition called nephrogenic diabetes insipidus (NDI) while taking Truvada.

With NDI, your kidneys stop working correctly. This causes your body to excrete large amounts of urine, which can cause dehydration.

Symptoms of NDI can include:

• dizziness
• fatigue
• headache
• orthostatic hypotension (low blood pressure leading to dizziness when sitting or standing up)
• weight loss

If you’re concerned about NDI, or if you have symptoms of this condition, talk with your doctor. They may have you stop taking Truvada and try a different medication for your condition.

Truvada may not be right for you based on other medical conditions you may have. Below, we detail conditions that may make Truvada unsafe for you.

Boxed warnings

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

• Worsening of hepatitis B: If you have hepatitis B, your infection may get worse if you stop taking Truvada.
• Resistance to Truvada: If you already have HIV, you should not use Truvada as preexposure prophylaxis (PrEP). PrEP refers to taking an HIV drug to prevent HIV. If you already have HIV, taking Truvada can cause your HIV to become resistant to the drug. This means that your HIV can no longer be treated with Truvada.

See the “Side effect specifics” section above for more information.

Other precautions

Be sure to talk with your doctor about your health history before you take Truvada. This drug may not be the right treatment option for you if you have certain medical conditions or other factors that affect your health. The conditions and factors to consider include:

Bone disease: Truvada may cause bone loss. If you have bone disease, such as osteoporosis, you may be at higher risk of fractures while taking Truvada. Talk with your doctor about ways to decrease this risk before you start taking Truvada.

Kidney disease: If you have kidney disease, Truvada may worsen your kidney function. For this reason, your doctor may have you take Truvada every other day instead of every day for the treatment of HIV. However, if you have severe kidney disease, you may not be able to safely take Truvada. Talk with your doctor to learn more.

Liver disease: Truvada can cause liver damage. If you have liver disease, taking Truvada may make your condition worse. If you have liver disease, talk with your doctor to see whether Truvada is right for you.

Allergic reaction: You should not take Truvada if you’ve ever had an allergic reaction to Truvada or any of its ingredients. Talk with your doctor about what other treatments are better choices for you.

Alcohol and Truvada

Drinking alcohol while you’re taking Truvada can increase your risk of some side effects that both Truvada and alcohol may cause. These include:

• diarrhea
• headache
• nausea or vomiting

Drinking excessive amounts of alcohol and taking Truvada could also increase your risk of kidney problems or liver problems.

If you take Truvada, talk with your doctor about whether drinking alcohol is safe for you.

Pregnancy and breastfeeding while taking Truvada

If you’re taking Truvada to treat HIV, you should not breastfeed while taking Truvada.

If you’re taking Truvada to prevent HIV and you’re considering breastfeeding, talk with your doctor about the possible risks and benefits of breastfeeding while taking Truvada. The active ingredients in Truvada (emtricitabine and tenofovir disoproxil fumarate) pass into breast milk.

Truvada appears to be safe to take during pregnancy. It isn’t known whether Truvada may increase the risk of pregnancy loss.

If you become pregnant during Truvada treatment, your doctor may suggest that you join the Antiretroviral Pregnancy Registry. This registry monitors the safety of taking medications such as Truvada during pregnancy. For more information, talk with your doctor.

If you have additional questions about taking Truvada while pregnant or breastfeeding, talk with your doctor. They can discuss the risks and benefits of the medication with you.

Side effects can occur while taking Truvada, but they’re usually mild. Most mild side effects of the drug are temporary and don’t require medical attention.

You should talk with your doctor if you experience symptoms of lactic acidosis, kidney or liver problems, bone loss, or an allergic reaction. These side effects could be serious and require medical attention.

If you have additional questions about Truvada, including concerns about side effects, talk with your doctor or pharmacist.

Besides talking with your doctor, you can do some research on your own. These articles might help:

• More information about Truvada: For details about other aspects of Truvada, refer to this article.
• Cost: If you’d like to learn about Truvada and cost, see this article.
• Drug comparison: To learn how Truvada compares with Descovy, read this article.
• Dosage: For information about the dosage of Truvada, view this article.
• Interactions: To find out about Truvada’s interactions, see this article.
• A look at HIV: For details about HIV, see our HIV and AIDS 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.