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Treatment of HIV-1 Infection
TRUVADA®, a combination of EMTRIVA® and VIREAD®, is indicated in combination with other antiretroviral agents (such as non-nucleoside reverse transcriptase inhibitors or protease inhibitors) for the treatment of HIV-1 infection in adults and pediatric patients 12 years of age and older.
The following points should be considered when initiating therapy with TRUVADA for the treatment of HIV-1 infection:
- It is not recommended that TRUVADA be used as a component of a triple nucleoside regimen.
- TRUVADA should not be coadministered with ATRIPLA®, COMPLERA®, EMTRIVA, VIREAD or lamivudine-containing products [See WARNINGS AND PRECAUTIONS].
- In treatment experienced patients, the use of TRUVADA should be guided by laboratory testing and treatment history [See Microbiology].
TRUVADA is indicated in combination with safer sex practices for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 in adults at high risk. This indication is based on clinical trials in men who have sex with men (MSM) at high risk for HIV-1 infection and in heterosexual serodiscordant couples [See Clinical Studies].
When considering TRUVADA for pre-exposure prophylaxis the following factors may help to identify individuals at high risk:
- has partner(s) known to be HIV-1 infected, or
- engages in sexual activity within a high prevalence area or
social network and one or more of the following:
- inconsistent or no condom use
- diagnosis of sexually transmitted infections
- exchange of sex for commodities (such as money, food, shelter, or drugs)
- use of illicit drugs or alcohol dependence
- partner(s) of unknown HIV-1 status with any of the factors listed above
When prescribing TRUVADA for pre-exposure prophylaxis, healthcare providers must:
- prescribe TRUVADA as part of a comprehensive prevention strategy because TRUVADA is not always effective in preventing the acquisition of HIV-1 infection [See WARNINGS AND PRECAUTIONS];
- counsel all uninfected individuals to strictly adhere to the recommended TRUVADA dosing schedule because the effectiveness of TRUVADA in reducing the risk of acquiring HIV-1 was strongly correlated with adherence as demonstrated by measurable drug levels in clinical trials [See WARNINGS AND PRECAUTIONS];
- confirm a negative HIV-1 test immediately prior to initiating TRUVADA for a PrEP indication. If clinical symptoms consistent with acute viral infection are present and recent ( < 1 month) exposures are suspected, delay starting PrEP for at least one month and reconfirm HIV-1 status or use a test approved by the FDA as an aid in the diagnosis of HIV-1 infection, including acute or primary HIV-1 infection. [See WARNINGS AND PRECAUTIONS]; and
- screen for HIV-1 infection at least once every 3 months while taking TRUVADA for PrEP.
DOSAGE AND ADMINISTRATION
Recommended Dose for Treatment of HIV-1 Infection
The recommended dose of TRUVADA in adults and in pediatric patients 12 years of age and older with body weight greater than or equal to 35 kg (greater than or equal to 77 lb) is one tablet (containing 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate) once daily taken orally with or without food.
Recommended Dose for Pre-exposure Prophylaxis
The dose of TRUVADA in HIV-1 uninfected adults is one tablet (containing 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate) once daily taken orally with or without food.
Dose Adjustment for Renal Impairment
Treatment of HIV-1 infection
Significantly increased drug exposures occurred when EMTRIVA or VIREAD were administered to subjects with moderate to severe renal impairment [see EMTRIVA or VIREAD Package Insert]. Therefore, adjust the dosing interval of TRUVADA in HIV-1 infected adult patients with baseline creatinine clearance 30–49 mL/min using the recommendations in Table 1. These dosing interval recommendations are based on modeling of single-dose pharmacokinetic data in non-HIV infected subjects. The safety and effectiveness of these dosing interval adjustment recommendations have not been clinically evaluated in patients with moderate renal impairment, therefore clinical response to treatment and renal function should be closely monitored in these patients [See WARNINGS AND PRECAUTIONS].
No dose adjustment is necessary for HIV-1 infected patients with mild renal impairment (creatinine clearance 50–80 mL/min). No data are available to make dose recommendations in pediatric patients with renal impairment.
Table 1 : Dosage Adjustment for HIV-1 Infected Adult
Patients with Altered Creatinine Clearance
|Creatinine Clearance (mL/min)a|
|≥ 50||30-49||< 30 (Including Patients Requiring Hemodialysis)|
|Recommended Dosing Interval||Every 24 hours||Every 48 hours||TRUVADA should not be administered.|
|a Calculated using ideal (lean) body weight|
Routine monitoring of calculated creatinine clearance and serum phosphorus should be performed in all individuals with mild renal impairment [See WARNINGS AND PRECAUTIONS].
Do not use TRUVADA for a PrEP indication in HIV-1 uninfected individuals with creatinine clearance below 60 mL/min [See WARNINGS AND PRECAUTIONS].
Routine monitoring of calculated creatinine clearance and serum phosphorus should be performed in all individuals with mild renal impairment. If a decrease in creatinine clearance is observed in uninfected individuals while using TRUVADA for PrEP, evaluate potential causes and re-assess potential risks and benefits of continued use [See WARNINGS AND PRECAUTIONS].
Dosage Forms And Strengths
TRUVADA is available as tablets. Each tablet contains 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate (which is equivalent to 245 mg of tenofovir disoproxil). The tablets are blue, capsule-shaped, film-coated, debossed with “GILEAD” on one side and with “701” on the other side.
Storage And Handling
The blue, capsule-shaped, film-coated, tablets contain 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate (which is equivalent to 245 mg of tenofovir disoproxil), are debossed with “GILEAD” on one side and with “701” on the other side, and are available in unit of use bottles [containing a dessicant (silica gel canister or sachet) and closed with a child-resistant closure] of:
30 tablets (NDC 61958-0701-1)
Store at 25 °C (77 °F), excursions permitted to 15–30 °C (59–86 °F) (see USP Controlled Room Temperature).
- Keep container tightly closed
- Dispense only in original container
- Do not use if seal over bottle opening is broken or missing
Manufactured for and distributed by: Gilead Sciences, Inc., Foster City, CA 94404
Last reviewed on RxList: 7/24/2012
This monograph has been modified to include the generic and brand name in many instances.
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