Emtriva and Epivir
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.
- EMTRIVA: Generic and brand available for 200 mg oral tablets. Brand name only available for 10 mg/mL oral solution.
- EPIVIR: Generic is available.
- See package insert for more complete information on potential side effects and interactions.
gilead.com
(800) GILEAD-5 (445–3235)
ViiV Healthcare
viivhealthcare.com
(877) 844-8872
200 mg Emtriva, 30 capsules: $643.82/month
generic: $579.37/month
(Epivir)
Epivir 150 mg, 60 tablets: $498.89/month
generic lamivudine 150 mg, 60 tablets: $429.66/month
Epivir 300 mg, 30 tablets: $498.89/month
generic lamivudine 300 mg, 30 tablets: $429.66/month
JO-ANN JOSE, MD, MPH:
You can usually overcome the effect of the M184V drug resistance by switching to a regimen that contains tenofovir. Emtriva and Epivir aren’t used much these days unless it’s in a single-tablet regimen (STR). While both Emtriva and Epivir work to some degree against hepatitis B, they should not be used alone for hepatitis B treatment due to risk of resistance development in the HBV.
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.
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). Emtriva and Epivir have anti-HBV efficacy but must be taken with an additional HBV medication. Severe exacerbations of hepatitis B have been reported in people co-infected with HIV 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.
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 drug 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 HHS 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 (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). Recommended as part of a preferred initial regimen in pregnancy (Tivicay + Descovy or Epzicom or Truvada; Triumeq is also a preferred initial regimen). 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, the M184V 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.
JUAN MICHAEL PORTER II:
Emitriva is an easy-to-use HIV medication with few side effects. Paul Sax, MD, calls Epivir (lamivudine, 3TC) a magic drug. It was discovered in the mid ’90s and has been found to work well in two- and three-drug combinations. It is well tolerated, and is super effective—for example, in combination with tenofovir against hepatitis B. Given its low cost and acceptability, I’ve marked it as a drug that could be taken if I ever lost access to my insurance and ADAP.