Emtriva and Epivir
emtricitabine FTC (NRTI) and lamivudine 3TC (NRTI)
Standard DoseOne Emtriva capsule once daily, with or without food, for adults and children regardless of age. One 300 mg Epivir tablet once daily (or one 150 mg tablet twice daily), with or without food. Emtriva and Epivir for children is dosed based on body weight; see the package insert. Epivir can be used by children at least 3 months of age. Emtriva is also available as an oral solution (10 mg/mL) (cotton candy flavored) for children and adults who cannot swallow the capsules. The dosing for the oral solution is as follows: 3 mg/kg for children 0–3 months, 6 mg/kg for children aged 3 months to 17 years, and 10 mg/kg for adults 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. See package inserts for guidance on dosing in the setting of kidney impairment. Emtriva and Epivir must be taken in combination with another antiretroviral(s) from a different drug class.
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.
- Generic is available.
ManufacturerGilead Sciences, Inc.
(800) GILEAD-5 (445–3235)
200 mg, 30 capsules:
150 mg, 60 tablets:
generic lamivudine 150 mg, 60 tablets:
Epivir 300 mg, 30 tablets:
generic lamivudine 300 mg, 30 tablets:
Potential Side Effects and Toxicity
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 FTC or 3TC, because they also treat 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. 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 with Emtriva and was more frequent in children, but is generally mild and not medically concerning.
Potential Drug Interactions
May may be used with hepatitis C drugs such as Epclusa, Harvoni or Zepatier, depending on the other components in the HIV regimen. Avoid using sorbitol-containing medicines with lamivudine; there are many, such as acetaminophen liquid (Tylenol liquid and others). Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not.
These drugs are used almost exclusively as a component of combination tablets. They are similar to each other, and both treat HIV and HBV and have the same resistance profile. This means 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). Lamivudine is also available in several combination products: Cimduo and Temixys (with tenofovir DF), Combivir (with zidovudine), Epzicom (with abacavir), Trizivir (with zidovudine and abacavir), Symfi and Symfi Lo (with tenofovir DF and efavirenz), Delstrigo (with tenofovir DF and doravirine), Dovato (with dolutegravir), and Triumeq (with dolutegravir and abacavir). Epzicom is recommended as a preferred initial regimen in pregnancy. Epivir as part of the combination tablet Combivir is recommended as an alternative NRTI combination component of an HIV treatment regimen during pregnancy. Epivir is available as generic lamivudine, which should be as effective and well tolerated as the brand name drug Epivir. Sometimes, drug resistance that the virus develops against FTC or 3TC 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 FTC or 3TC treatment in combination with other antiretrovirals after resistance develops. Some insurers may require people to take regimens containing generics rather than brand name drugs, including simpler co-formulated products. The availability of generics might also limit choices of therapy. For example, newer brand name drugs and co-formulations, such as Biktarvy, might be restricted to people who can’t physically tolerate generic regimens. The Emtriva 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.
Dr. Melanie Thompson:
Emtricitabine, also called FTC, is similar to Epivir, also called lamivudine or 3TC, including in their resistance profiles. Their signature mutation, M184V, causes loss of antiviral activity but also increases the activity of tenofovir or AZT. They are considered interchangeable by guidelines panels for treatment, but not for prevention. FTC is generally coformulated with TDF or TAF as a dual nuke regimen, or as part of many STRs, while 3TC is coformulated with abacavir or generic TDF; with dolutegravir as the STR Dovato; and with doravirine and TDF as the STR Delstrigo. An unusual side effect, hyperpigmentation of palms and soles, was noted with FTC in some early clinical trials, yet rarely occurs “in real life.” Both drugs require dosage adjustment according to kidney function. Both have some activity against hepatitis B but should not be used alone for hepatitis B treatment.
The monthly wholesale acquisition costs are as follows: Emtriva $537; Epivir $416; generic 3TC $75 to $343.
Activist Joey Wynn:
Emtriva is one of the most convenient HIV drugs available; very small so it is easy to take, few to no side effects so it is not hard to keep up without problems, and mutations make the virus less “fit” to replicate. Consider it a first cousin to Epivir. Epivir is still one of my favorite medications, due to lack of side effects, tiny size, and beneficial mutations (makes the virus less able to reproduce as quickly as the wild type virus). Epivir has been around since about 1995; one of the first medications available and the only one still in use from the OG.