Emtriva
FTC emtricitabine
Standard Dose
One 200 mg capsule once daily without regard to food for adults and children regardless of age. According to the label, dosing needs to be adjusted for adults who have decreased kidney function (creatinine clearance less than 50 mL/ min). This medication, however, is often used off-label in reduced renal function below 50 mL/min due to the relatively minimal risk of emtricitabine accumulation and side effects. See package insert for guidance on dosing in the setting of kidney impairment. Must be taken in combination with another antiretroviral(s). Emtriva is dosed based on body weight for children. See the package insert for weight-based dosing. Emtriva is also available as an oral solution (10 mg/mL) (cotton candy flavored) for children aged 0–3 months (3 mg/kg), children aged 3 months to 17 years (6 mg/kg), and adults (10 mg/kg) who are not able to swallow the capsules. Liquid dose is up to a maximum of 240 mg (24 mL) daily; the 200 mg capsule equals 240 mg solution. Emtriva oral solution should be kept in the refrigerator. If kept at room temperature, the oral solution should be used within three months. Emtriva can be substituted for Epivir.Take missed dose as soon as possible, unless it is closer to the time of your next dose. Do not double up on your next dose.
- See package insert for more complete information on potential side effects and interactions.
Manufacturer
Gilead Sciences, Inc.gilead.com
(800) GILEAD-5 (445–3235)
AWP
200 mg30 capsules: $643.82/month
generic: $579.37/month
Potential Side Effects and Toxicity
Emtriva is very well tolerated. The most common side effects (which were rarely reported) may include headache, diarrhea, and nausea. Prior to initiation, people should be tested for hepatitis B virus (HBV) infection. Severe exacerbations of hepatitis B have been reported in people co-infected with HBV who have discontinued Emtriva (because emtricitabine also treats hepatitis B). Monitor liver enzymes closely in people co-infected with HBV and, if appropriate, initiation of anti-hepatitis B therapy may be warranted upon discontinuation of Emtriva. Call your health care provider right away if you develop any of the following signs or symptoms of hepatitis: yellowing of the skin or whites of the eyes; dark or tea-colored urine; pale-colored bowel movements; nausea or vomiting; loss of appetite; or pain, aching, or tenderness on the right side below the ribs. Rare skin discoloration (darkening of the skin on the palms and the soles) can occur and was more frequent in children, but is generally mild and not medically concerning.
Potential Drug Interactions
Do not take with Cimduo or Temixys, Descovy, Epivir, Epivir-HBV, Hepsera, or Truvada, which are used for treatment of hepatitis B. No other significant drug interactions are predicted. Emtriva may be used with hepatitis C drugs such as Epclusa, Harvoni, or Zepatier, depending on the other components in the HIV regimen. Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not.
More Information
This drug is used almost exclusively as a component of combination tablets. Emtriva (emtricitabine) is similar to Epivir (lamivudine)—both treat HIV and HBV and have the same resistance profile, meaning that if your virus is resistant to one drug, it will be resistant to the other. If your HIV develops resistance to Epivir or Emtriva, it does not mean that your HBV is also resistant to them. Both Descovy and Truvada contain Emtriva, and are currently recommended by DHHS HIV treatment guidelines for first-time therapy for most people. Emtriva is also found in several single-tablet regimens (Atripla, Biktarvy, Complera, Genvoya, Odefsey, Stribild, and Symtuza). Sometimes, drug resistance that the virus develops against emtricitabine makes the virus reproduce at a slower rate. This drug resistance can also improve the antiviral activity of Retrovir (zidovudine, or AZT—very rarely taken today) and Viread or Vemlidy (tenofovir), and for that reason, some providers continue Emtriva treatment in combination with other antiretrovirals after resistance develops. The capsule is small, which is an advantage for people with difficulty swallowing. Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; go to apregistry.com.
Doctor Comments
Dr. Melanie Thompson:
Emtricitabine, also called FTC, is generally coformulated with TDF or TAF as a dual nuke regimen, and as part of many STRs. It has the same resistance profile as 3TC and is regarded as interchangeable with 3TC by guidelines panels. An unusual side effect, hyperpigmentation of palms and soles, was noted in some early clinical trials, yet we never hear about this one any more.
There is no food requirement with FTC, but dosage requires adjustment according to kidney function.
Activist Comments
Activist Michael Broder:
Emtriva (emtricitabine, approved in 2003) is an NRTI. It is included in the fixed-dose combinations (FDCs) Truvada and Descovy, and in the single-tablet regimens (STRs) Atripla, Biktarvy, Complera, Genvoya, Odefsey, Stribild, and Symtuza, and in its generic form in the STRs Symfi and Symfi Lo. Emtriva is among the safest, most tolerable, and most convenient HIV drugs available. The only side effect that was more common among people taking Emtriva than other HIV drugs in clinical trials was skin discoloration on the palms or soles of the feet. This side effect, occurring mostly in non-White people, was mild and did not result in treatment discontinuation. Its mechanism and clinical significance remain unknown. Emtriva is a close chemical relative of Epivir (lamivudine). In 2003, Gilead Sciences purchased Triangle Pharmaceuticals with the express intention of combining Triangle’s Emtriva with Gilead’s Viread to make Truvada, which proved to be a very savvy business move.