Truvada / Cimduo / Viread
Recommended as a component of initial regimen for most people
In children weighing 37–76 pounds (17–34 kg), Truvada dose is based on body weight (see package insert for weight-based dosing). Pediatric Truvada tablets are available in the following FTC/TDF dosages: 100/150 mg, 133/200 mg and 167/250 mg. In children, Viread dose is based on body weight (SEE package insert). Viread tablets are available in the following dosages: 150 mg, 200 mg, 250 mg and 300 mg tablets and oral powder (40 mg/g in 60 g packets). Truvada and Viread tablets can be dissolved in water, grape juice or orange juice with minor stirring and pressure from a spoon.
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. Dosing frequency needs to be adjusted for people who have decreased kidney function. The dose of Truvada and Viread should be adjusted if CrCl is less than 50 mL/min; Truvada should not be used if CrCl is less than 30 mL/min or if you are on dialysis. Truvada is not recommended for HIV-negative individuals if CrCl is below 60 mL/min (SEE Truvada for PrEP). Cimduo should not be used if CrCl is less than 50 mL/min or if you are on dialysis.
Truvada
- 200 mg emtricitabine, 300 mg tenofovir DF
- FTC and TDF (two NRTIs)
Cimduo
- 300 mg lamivudine, 300 mg tenofovir DF
- 3TC and TDF (two NRTIs)
- Fixed-dose combinations of two nucleoside reverse transcriptase inhibitors (nucleosides, or “nukes”)
- Truvada and Cimduo are each HHS recommended as a component of an initial regimen for most people when combined with Tivicay; recommended as a component of an initial regimen in certain clinical situations when used in other combinations
Viread
- 300 mg tenofovir DF
- TDF (NRTI)
- Nucleoside reverse transcriptase inhibitor (nucleoside, or “nuke”)
- TRUVADA: Generic is available.
- VIREAD: Generic and brand name available for 300 mg oral tablets.
- Brand name available only for oral powder 40 mg/GM and 150 mg, 200 mg, and 250 mg oral tablets.
- All three recommended as a component of rapid ART for someone newly diagnosed or entering care with no or minimal labs available.
- See the individual drugs contained in Truvada: Viread and Emtriva.
- See package insert for more complete information on potential side effects and interactions.
gilead.com; truvada.com; viread.com
(800) GILEAD-5 (445-3235)
Mylan Specialty L.P.
mylan.com; cimduo.com
(877) 446-3679
Celltrion, Inc.
celltrion.com
contact@celltrion.com
Truvada: $2,210.74/month
generic: $2,100.20/month
Viread: $1,504.20/month
generic: $1,215.94/month
Average Wholesale Price
Cimduo: $1,354.28/month
JO-ANN JOSE, MD, MPH:
All three of these drugs contain tenofovir DF, which has a high genetic barrier to resistance and works very well for hepatitis B and HIV in combination with other drugs as a treatment regimen. However, tenofovir DF also has a higher potential for kidney and bone side effects over time than the newer tenofovir AF. TDF also has a weight suppressant effect. If you’re switching from one of these drugs to a formulation that contains TDF, you will have a better side effect profile from a kidney and bone side effect perspective. However, it is possible that you may see some weight gain; that’s not necessarily because TAF is necessarily making you gain weight, it’s because TDF is suppressing weight gain. TDF is thought to lower both HDL and LDL cholesterol. All of which is to say you might want to have a nuanced conversation with your care provider.
Reyataz/Norvir and Prezista/Norvir increase TDF concentrations, so monitoring is recommended for TDF-associated adverse events, particularly decreases in kidney function. Avoid taking TDF with drugs that negatively affect the kidneys, including chronic use or high doses of anti-inflammatory drugs for pain such as aspirin, Advil or Motrin (ibuprofen) and Aleve (naproxen). TDF may be used with hepatitis C drugs Harvoni or Zepatier, depending on the third drug in the HIV regimen; monitor for TDF toxicities if used with Epclusa. Do not take TDF with adefovir or unboosted atazanavir. For Cimduo, avoid using sorbitol-containing medicines because of 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, as there are other drug interactions not listed here.
Overall, well tolerated; some people may experience headache or gastrointestinal distress. Rash and depression may occur with Cimduo. Rare skin discoloration on palms and soles may occur with Truvada. TDF is associated with long-term decreases in bone mineral density (BMD). TDF can cause kidney toxicities. Tell your provider about any pain in extremities, persistent or worsening bone pain, as well as any concerning changes in urinary habits. Routine monitoring of estimated creatinine clearance, serum phosphorus, urine glucose and urine protein should be performed in individuals with mild kidney impairment. Prior to initiation, individuals should be tested for hepatitis B virus (HBV). Severe exacerbation of hepatitis B has been reported in people co-infected with HBV who have discontinued these medications. Monitor liver enzymes closely in people co-infected with HBV and, if appropriate, initiation of anti-hepatitis B therapy may be warranted upon drug discontinuation. Call your health care provider right away if you develop any signs of hepatitis. Truvada contains lactose, which can cause some abdominal discomfort.
TDF has a high genetic barrier to drug resistance. It has strong effectiveness against hepatitis B. Truvada is also used for HIV prevention; see Truvada for PrEP page. Recommended as part of a preferred initial regimen in pregnancy (Tivicay + Descovy or Truvada). Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; GO TO apregistry.com.
JUAN MICHAEL PORTER II:
Even though we increasingly over-switch people away from Truvada (TDF) to Descovy (TAF), Truvada remains an important HIV drug. It doesn’t increase weight or cholesterol, is well tolerated and is incredibly effective. That said, some people experience toxicity with it. I don’t know anyone on Cimduo but have read it has a favorable profile. Meanwhile, one of my dearest friends was on Viread in combination with another drug for over 20 years and was entirely undetectable and in vibrant health the entire time.