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Stribild Side Effects Center
Medical Editor: John P. Cunha, DO, FACOEP
Stribild (elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate) is used to treat HIV-1 in adults who have never taken HIV-1 medications before. Side effects from the use of Stribild may include new or worsening kidney problems, including kidney failure. Stribild may also cause bone problems; changes in fat such as an increased amount of fat in the head and neck, and changes in the immune system that may result in a condition called immune reconstitution syndrome.
Stribild is available in tablets of 150 mg of elvitegravir, 150 mg of cobicistat, 200 mg of emtricitabine, and 300 mg of tenofovir disoproxil fumarate. The recommended dose for Stribild is one tablet taken once daily with or without food. Stribild may interact with other drugs. Tell your doctor all prescription and OTC medications you are taking. Stribild should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult your doctor before breastfeeding.
Our Stribild (elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What is Prescribing information?
The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.
Stribild FDA Prescribing Information: Side Effects
The following adverse drug reactions are discussed in other sections of the labeling:
- Lactic Acidosis/Severe Hepatomegaly with Steatosis [See BOXED WARNING, WARNINGS AND PRECAUTIONS].
- Severe Acute Exacerbations of Hepatitis B [See BOXED WARNING, WARNINGS AND PRECAUTIONS].
- New Onset or Worsening Renal Impairment [See WARNINGS AND PRECAUTIONS].
- Decreases in Bone Mineral Density [See WARNINGS AND PRECAUTIONS].
- Immune Reconstitution Syndrome [See WARNINGS AND PRECAUTIONS].
Adverse Reactions from Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The safety assessment of STRIBILD is based on pooled data from 1408 subjects in two comparative clinical trials, Study 102 and Study 103, in antiretroviral treatment-naive HIV-1 infected adult subjects. A total of 701 subjects received STRIBILD once daily for at least 48 weeks.
The proportion of subjects who discontinued treatment with STRIBILD, ATRIPLA (efavirenz 600 mg/emtricitabine 200 mg/tenofovir DF 300 mg) or atazanavir + ritonavir + TRUVADA (emtricitabine 200 mg/tenofovir DF 300 mg) due to adverse events, regardless of severity, was 3.7%, 5.1% and 5.1%, respectively. Table 2 displays the frequency of adverse drug reactions greater than or equal to 5%.
Table 2 : Treatment-Emergent Adverse Drug Reactionsa
(all grades) Reported in ≥ 5% of Subjects in Any Treatment Arm in Studies
102 and 103 (Week 48 analysis)
|Atazanavir + ritonavir + TRUVADA
|Ocular icterus||< 1%||0%||13%|
|GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS|
|NERVOUS SYSTEM DISORDERS|
|SKIN AND SUBCUTANEOUS TISSUE DISORDERS|
|a Frequencies of adverse reactions are based on all
treatment-emergent adverse events, attributed to study drugs.
b Rash event includes dermatitis, drug eruption, eczema, pruritus, pruritus generalized, rash, rash erythematous, rash generalized, rash macular, rash maculo-papular, rash morbilliform, rash popular, rash pruritic, and urticaria.
See WARNINGS AND PRECAUTIONS, for a discussion of renal adverse events from clinical trials experience with STRIBILD.
Emtricitabine and Tenofovir Disoproxil Fumarate
In addition to the adverse drug reactions observed with STRIBILD, the following adverse drug reactions occurred in at least 5% of treatment-experienced or treatment-naive subjects receiving emtricitabine or tenofovir DF with other antiretroviral agents in other clinical trials: depression, abdominal pain, dyspepsia, vomiting, fever, pain, nasopharyngitis, pneumonia, sinusitis, upper respiratory tract infection, arthralgia, back pain, myalgia, paresthesia, peripheral neuropathy (including peripheral neuritis and neuropathy), anxiety, increased cough, and rhinitis.
Skin discoloration has been reported with higher frequency among emtricitabine-treated subjects; it was manifested by hyperpigmentation on the palms and/or soles and was generally mild and asymptomatic. The mechanism and clinical significance are unknown.
The frequency of treatment-emergent laboratory abnormalities (Grades 3-4) occurring in at least 2% of subjects receiving STRIBILD in Studies 102 and 103 are presented in Table 3.
Table 3 : Laboratory Abnormalities (Grades 3-4) Reported
in ≥ 2% of Subjects Receiving STRIBILD in Studies 102 and 103 (Week 48
|STRIBILD||ATRIPLA||Atazanavir + ritonavir + TRUVADA|
|Laboratory Parameter Abnormality||N=701||N=352||N=355|
|AST (>5.0 x ULN)||2%||3%||4%|
|Amylasea (>2.0 x ULN)||2%||2%||4%|
|Creatine Kinase ( ≥ 10.0 x ULN)||5%||11%||7%|
|Urine RBC (Hematuria) (> 75 RBC/HPF)||3%||1%||2%|
|a For subjects with serum amylase > 1.5 x upper limit of normal, lipase test was also performed. The frequency of increased lipase (Grades 3-4) occurring in STRIBILD (N=58), ATRIPLA (N=33), and atazanavir + ritonavir + TRUVADA (N=33) was 12%, 15%, and 21%, respectively.|
Proteinuria (all grades) occurred in 39% of subjects receiving STRIBILD, 29% of subjects receiving ATRIPLA, and 24% of subjects receiving atazanavir + ritonavir + TRUVADA.
The cobicistat component of STRIBILD has been shown to increase serum creatinine and decrease estimated creatinine clearance due to inhibition of tubular secretion of creatinine without affecting renal glomerular function. In Studies 102 and 103, increases in serum creatinine and decreases in estimated creatinine clearance occurred early in treatment with STRIBILD, after which they stabilized. The mean ± SD change in serum creatinine after 48 weeks of treatment was 0.14 mg per dL ± 0.13 mg per dL for STRIBILD, 0.01 mg per dL ± 0.12 mg per dL for ATRIPLA, and 0.09 mg per dL ± 0.13 mg per dL for atazanavir + ritonavir + TRUVADA. The mean ± SD change in estimated glomerular filtration rate (eGFR) by Cockcroft-Gault method after 48 weeks of treatment was -13.9 ± 14.9 mL per min for STRIBILD, -1.6 ± 16.5 mL per min for ATRIPLA, and 9.3 ± 15.8 mL per min for atazanavir + ritonavir + TRUVADA. Elevation in serum creatinine (all grades) occurred in 7% of subjects receiving STRIBILD, 1% of subjects receiving ATRIPLA, and 4% of subjects receiving atazanavir + ritonavir + TRUVADA.
Emtricitabine or Tenofovir Disoproxil Fumarate
In addition to the laboratory abnormalities observed with STRIBILD, the following laboratory abnormalities have been previously reported in subjects treated with emtricitabine or tenofovir DF with other antiretroviral agents in other clinical trials: Grades 3 or 4 laboratory abnormalities of ALT (M: greater than 215 U per L; F: greater than 170 U per L), alkaline phosphatase (greater than 550 U per L), bilirubin (greater than 2.5 x ULN), serum glucose (less than 40 or greater than 250 mg per dL), glycosuria (greater than or equal to 3+), neutrophils (less than 750 per mm³ ), fasting cholesterol (greater than 240 mg per dL), and fasting triglycerides (greater than 750 mg per dL).
In the clinical trials of STRIBILD, a similar percentage of subjects receiving STRIBILD, ATRIPLA, and atazanavir + ritonavir + TRUVADA were on lipid lowering agents at baseline (11%, 11%, and 12%, respectively). While receiving study drug through Week 48, an additional 4% of STRIBILD subjects were started on lipid lowering agents, compared to 5% of ATRIPLA and 7% of atazanavir + ritonavir + TRUVADA subjects. During the first 48 weeks of study drug exposure, 1% or fewer subjects in any treatment arm experienced Grades 3 or 4 elevations in fasting cholesterol (greater than 300 mg per dL) or fasting triglycerides (greater than 750 mg per dL).
Changes from baseline in total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides are presented in Table 4.
Table 4: Lipid Values, Mean Change from Baseline,
Reported in Subjects Receiving STRIBILD or Comparator in Studies 102 and 103
|Atazanavir + ritonavir + TRUVADA
|Baseline mg/dL||Week 48 Changea||Baseline mg/dL||Week 48 Changea||Baseline mg/dL||Week 48 Changea|
|Total Cholesterol (fasted)||166 [N=675]||+11 [N=606]||161 [N=343]||+19 [N=298]||168 [N=337]||+9 [N=287]|
|HDL-cholesterol (fasted)||43 [N=675]||+6 [N=605]||43 [N=343]||+8 [N=298]||42 [N=335]||+5 [N=284]|
|LDL-cholesterol (fasted)||100 [N=675]||+10 [N=606]||97 [N=343]||+17 [N=298]||101 [N=337]||+11 [N=288]|
|Triglycerides (fasted)||122 [N=675]||+13 [N=606]||121 [N=343]||+13 [N=298]||132 [N=337]||+29 [N=287]|
|a The change from baseline is the mean of within-patient changes from baseline for patients with both baseline and Week 48 values.|
Because postmarketing reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. The following adverse reactions have been identified during post approval use of tenofovir DF. No additional postmarketing adverse reactions specific for emtricitabine have been identified.
Immune System Disorders
allergic reaction, including angioedema
Metabolism and Nutrition Disorders
lactic acidosis, hypokalemia, hypophosphatemia
Respiratory, Thoracic, and Mediastinal Disorders
dyspnea, gastrointestinal disorders pancreatitis, increased amylase, abdominal pain
hepatic steatosis, hepatitis, increased liver enzymes (most commonly AST, ALT gamma GT)
Skin and Subcutaneous Tissue Disorders
Musculoskeletal and Connective Tissue Disorders
rhabdomyolysis, osteomalacia (manifested as bone pain and which may contribute to fractures), muscular weakness, myopathy
Renal and Urinary Disorders
acute renal failure, renal failure, acute tubular necrosis, Fanconi syndrome, proximal renal tubulopathy, interstitial nephritis (including acute cases), nephrogenic diabetes insipidus, renal insufficiency, increased creatinine, proteinuria, polyuria
General Disorders and Administration Site Conditions
The following adverse reactions, listed under the body system headings above, may occur as a consequence of proximal renal tubulopathy: rhabdomyolysis, osteomalacia, hypokalemia, muscular weakness, myopathy, hypophosphatemia.
Read the entire FDA prescribing information for Stribild (Elvitegravir, Cobicistat, Emtricitabine, Tenofovir DF) »
Additional Stribild Information
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