Delstrigo
Take missed dose as soon as possible, as long as it is at least 12 hours before your next dose. Do not double up on your next dose. Dose cannot be adjusted for people with kidney problems; Delstrigo is not recommended for people with estimated creatinine clearance less than 50 mL/min. Should not be used by people with moderate or severe kidney impairment or severe liver impairment.
- See the individual drugs contained in Delstrigo: Pifeltro, Epivir and Viread.
- See package insert for more complete information on potential side effects and interactions.
delstrigo.com
(800) 672-6372
JO-ANN JOSE, MD, MPH:
Delstrigo does not contain any integrase inhibitors, so for that reason, it is not commonly prescribed in the United States. In clinical trials, Delstrigo was shown to cause fewer side effects such as diarrhea and nausea. Delstrigo contains tenofovir disoproxil fumarate, which is associated with both kidney and bone density side effects. Delstrigo does have fewer drug interactions than most medications, but there are still some important ones to be aware of. Talk with your doctor about any interaction potential with other medications you are currently taking. Delstrigo is also expensive, so that’s another point of consideration.
Do not take with Cimduo, Descovy, Emtriva, Epivir-HBV, Hepsera, Truvada, Vemlidy or Viread, all used for hepatitis B. When using with the antibiotic drug rifabutin (used for TB and to prevent MAC in people with AIDS), increase the doravirine dose by taking Pifeltro 100 mg tablet approximately 12 hours after Delstrigo. Avoid taking Delstrigo with drugs that negatively affect the kidneys, including chronic use or high doses of anti-inflammatory drugs for pain such as Advil or Motrin (ibuprofen) and Aleve (naproxen). The following medications may lower the blood levels of doravirine, and therefore may decrease its effectiveness, and should not be used with Delstrigo: the anticonvulsants carbamazepine, oxcarbazepine, phenobarbital and phenytoin; the androgen receptor inhibitor enzalutamide; the antimycobacterials rifampin and rifapentine; the cytotoxic agent (a cancer drug) mitotane and the herbal St. John’s wort. Avoid using sorbitol-containing medicines with lamivudine; there are many, such as acetaminophen liquid (Tylenol liquid and others). Epclusa and Harvoni each increase the concentration of TDF; monitor for adverse reactions. Not intended to be taken with other HIV medications, unless prescribed that way. Tell your provider or pharmacist about all medications, herbals and supplements you are taking or thinking of taking, prescribed or not, as there are other drug interactions that are not listed here.
The most common adverse reactions observed with Delstrigo in clinical trials were dizziness (7%), nausea (5%), abnormal dreams (5%) and headache (4%). Neuropsychiatric events—such as depression, sleep disturbances, dizziness, etc.—are another common side effect of the NNRTI drug class. The proportion of people who reported one or more neuropsychiatric adverse events overall was 24% for the Delstrigo group compared to 57% for the Atripla group in the DRIVE-AHEAD study. Neuropsychiatric adverse events associated with depression and suicide/self-injury were reported in 4% of the Delstrigo group compared to 7% of the Atripla group. Overall, sleep disturbances (abnormal dreams, insomnia, nightmares, etc.) were associated with 12% of people in the Delstrigo group compared to 26% in the Atripla group. Dizziness was experienced by 9% of the Delstrigo group compared to 37% of the Atripla group. Altered sensorium (lethargy, drowsiness, etc.) was associated with 4% in the Delstrigo group compared to 8% of those on Atripla. The doravirine component of Delstrigo did not appear to negatively affect cholesterol in studied populations. Decreases in bone mineral density (BMD) have been observed in people on TDF-containing regimens. BMD monitoring should be considered for people who have a history of bone fracture due to bone disease or are at risk for osteopenia or osteoporosis. TDF may cause kidney toxicities. Creatinine clearance (CrCl) should be assessed before initiating treatment. In addition to CrCl, glucose and protein in the urine and serum phosphorus should be monitored more often in people at risk for kidney problems. Tell your provider about any pain in extremities, persistent or worsening bone pain and fractures, with or without muscular pain or weakness, as well as any concerning changes in urinary habits, as these could be signs of kidney problems. 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 Delstrigo (due to elimination of the lamivudine and TDF components, which also treat HBV). Monitor liver enzymes closely in people co-infected with HBV and, if appropriate, initiation of anti-hepatitis B therapy may be warranted upon Delstrigo 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.
SEE Pifeltro for recent big news about doravirine. Standalone versions of doravirine (Pifeltro) and lamivudine/tenofovir DF (Cimduo) are also approved; see those pages. Delstrigo contains an older prodrug of tenofovir, TDF. A safer version, TAF, is available and used in some STRs. However, as TAF and INSTIs may have some association with weight gain, Delstrigo may become a more popular option. According to HHS guidelines, “In a cross-trial analysis, DOR was not associated with weight gain compared with [efavirenz] 600 mg or boosted [darunavir].” TDF is still an effective and quite tolerable medication, but TAF has potentially less long-term renal and bone toxicity. European guidelines recommend Delstrigo for first-time therapy. In the DRIVE-FORWARD study comparing doravirine to darunavir, at 96 weeks, 72% of treatment-naïve individuals in the doravirine group attained undetectable status (a viral load of less than 50 copies/mL), compared to 65% for the darunavir group. For individuals with HIV-2, primarily found in West Africa but also present in other countries, an NNRTI would not be recommended as HIV-2 is inherently resistant to NNRTIs. There are no data on the safe use of Delstrigo during pregnancy. Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; GO TO apregistry.com.
JUAN MICHAEL PORTER II:
Some people call Delstrigo “Atripla except with doravirine instead of efavirenz.” Despite its age, Delstrigo is still considered a first-line treatment in most international guidelines, except for people who don’t tolerate integrase inhibitors. It doesn’t have to be taken with food, which makes it attractive for some people, especially because it doesn’t raise “bad cholesterol.” However, some of my friends who’ve switched to it struggled with headaches and nausea.