|Stribild||elvitegravir / cobicistat / emtricitabine / tenofovir DF, or EVG / COBI / FTC / TDF|
|BRAND NAME||GENERIC NAME|
STR: Single-Tablet Regimen—Boosted Integrase Inhibitor and NRTIs
|MANUFACTURER:||Gilead Sciences, Inc. | www.gilead.com | (800) GILEAD-5 (445–3235)|
$2,810.96 / month
Take missed dose as soon as possible, unless it is closer in time to your next dose. Do not double up on your next dose. Dose cannot be adjusted for people with kidney problems, therefore it should not be started in individuals with estimated creatinine clearance less than 70 mL per min. and should be discontinued if CrCl decreases to 50 or less.
See the individual drugs contained in Stribild: elvitegravir, Emtriva (emtricitabine), Viread (tenofovir DF), and cobicistat. Most common are nausea and diarrhea. Abnormal dreams, headaches, and fatigue have also been seen. Others include changes in kidney function tests (see cobicistat page for more, and reassuring, information), bone problems, and elevated liver function tests. Check for potential drug class side effects.
See package insert for the most complete list. Tell your provider or pharmacist about all medications, herbs, and supplements you are taking or thinking of taking, prescribed or not. Do not take with Atripla, cobicistat, Combivir, Complera, elvitegravir, Emtriva, Epivir, Epivir-HBV, Epzicom, Hepsera, Norvir, “572-Trii,” Trizivir, Truvada, or Viread, since these medications are already in Stribild or it has equivalent medications. Do not take at the same time with antacids. Separate by at least 2 hours from antacids and vitamins/supplements containing aluminum or magnesium. Elvitegravir induces CYP2C9 (it revs up the activity of this enzyme in the liver), which can decrease blood levels of many medications, including some for diabetes and depression. Cobicistat is a potent CYP3A4 inhibitor (it slows down the activity of this enzyme), and is expected to have many drug interactions, similar to those seen with Norvir. Do not take with Advicor, alfuzosin, Altoprev, ergotamine, Livalo, lovastatin, methylergonovine, midazolam, pimozide, Revatio, rifabutin, Rifadin, rifampin, Simcor, simvastin, triazolam, voriconazole, Vytorin, garlic supplements, or St. John’s wort. Cholesterol-lowering alternatives are atorvastatin, Crestor, fluvastatin, and pravastatin, but should be used with caution and started at the lowest dose possible; monitor closely for increased side effects from these medications. Titrate dose of antidepressants. No dose adjustments needed with proton pump inhibitors. Use with caution and therapeutic monitoring of antiarrhythmic drugs. Increases levels of fluticasone (found in Advair, Flonase, and Flovent); monitor for signs of Cushing’s syndrome (such as rounded face). A lower dose of trazodone is recommended. Methadone may need to be increased. Use caution with anti-convulsants carbamazepine, phenobarbital, and phenytoin, and calcium channel blockers. Cialis, Levitra, and Viagra levels are increased; doses should not exceed 10 mg Cialis or 2.5 mg Levitra per 72 hours, or 25 mg Viagra per 48 hours. Effectiveness of birth control pills may be decreased; consider the use of alternative or additional contraception. Clarithromycin levels can increase. Use with caution with bosentan, salmeterol, and immunosuppressants; lower colchicine dose. Incivek or Victrelis with Stribild can potentially reduce the effectiveness of both drugs—combined use is not recommended.
Stribild was approved by the FDA in August 2012 for HIV treatment-naïve people, and the guidelines quickly added it to its list of alternative regimens while citing limitations. One doctor newsletter noted the addition “reflects the value of single tablet regimens in general and increasing enthusiasm for integrase inhibitors in particular.” Not recommended for people with severe liver impairment. Stribild is available through all state ADAPs. Insurance companies may require prior authorization. See package insert for more complete details about potential side effects and drug interactions.