Stribild Side Effects Center

Last updated on RxList: 11/10/2021
Stribild Side Effects Center

What Is Stribild?

Stribild (elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate) contains a combination of an HIV-1 integrase strand transfer inhibitor, a mechanism-based inhibitor of cytochrome P450 (CYP) enzymes of the CYP3A family, a synthetic nucleoside analog of cytidine, and an acyclic nucleoside phosphonate (nucleotide) analog of adenosine 5'-monophosphate used to treat HIV-1 in adults who have never taken HIV-1 medications before.

What Are Side Effects of Stribild?

Stribild can cause serious side effects, including new or worsening kidney problems, including kidney failure. Other side effects of Stribild include:

  • yellowing skin or eyes (jaundice),
  • diarrhea,
  • gas,
  • nausea,
  • fatigue,
  • drowsiness,
  • dizziness,
  • headache,
  • insomnia,
  • abnormal dreams,
  • rash,
  • bone problems,
  • changes in fat such as an increased amount of fat in the head and neck,
  • changes in the immune system that may result in a condition called immune reconstitution syndrome,
  • buildup of an acid in your blood (lactic acidosis),
  • serious liver problems, and
  • worsening hepatitis B (HBV) infection.

Dosage for Stribild

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.

What Drugs, Substances, or Supplements Interact with Stribild?

Stribild may interact with other drugs. Tell your doctor all prescription and OTC medications you are taking.

Stribild During Pregnancy and Breastfeeding

Stribild should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult your doctor before breastfeeding.

Additional Information

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.

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Stribild Consumer Information

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • kidney problems--swelling, urinating less, feeling tired or short of breath;
  • lactic acidosis--unusual muscle pain, trouble breathing, stomach pain, vomiting, irregular heart rate, dizziness, feeling cold, or feeling very weak or tired; or
  • liver problems--nausea, upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Antiviral medicine can affect your immune system (even weeks or months after you've used this medicine). Tell your doctor if you have:

  • signs of a new infection--fever, night sweats, swollen glands, cold sores, cough, wheezing, diarrhea, weight loss;
  • trouble speaking or swallowing, problems with balance or eye movement, weakness or prickly feeling; or
  • swelling in your neck or throat (enlarged thyroid), menstrual changes, impotence.

Common side effects may include:

  • nausea; or
  • diarrhea.

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.

Read the entire detailed patient monograph for Stribild (Elvitegravir, Cobicistat, Emtricitabine, Tenofovir DF)

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Stribild Professional Information

SIDE EFFECTS

The following adverse reactions are discussed in other sections of the labeling:

  • Severe Acute Exacerbations of Hepatitis B in Patients Coinfected with HIV-1 and HBV [see BOXED WARNING and WARNINGS AND PRECAUTIONS].
  • New Onset or Worsening Renal Impairment [see WARNINGS AND PRECAUTIONS].
  • Lactic Acidosis/Severe Hepatomegaly with Steatosis [see WARNINGS AND PRECAUTIONS].
  • Bone Loss and Mineralization Defects [see WARNINGS AND PRECAUTIONS].
  • Immune Reconstitution Syndrome [see WARNINGS AND PRECAUTIONS].

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.

Clinical Trials In HIV-1 Infected Adult Subjects With No Antiretroviral Treatment History

The safety assessment of STRIBILD is based on the Week-144 pooled data from 1408 subjects in two randomized, double-blind, active-controlled clinical trials, Study 102 and Study 103, in antiretroviral treatment-naive HIV-1 infected adult subjects [see Clinical Studies]. A total of 701 subjects received STRIBILD once daily in these two studies.

The proportion of subjects who discontinued treatment with STRIBILD, ATRIPLA, or ATV + RTV + TRUVADA due to adverse events, regardless of severity, was 6.0%, 7.4%, and 8.5%, respectively. Table 1 displays the frequency of adverse reactions greater than or equal to 5% of subjects in any treatment arm.

Table 1 : Adverse Reactions* (All Grades) Reported in ≥5% of Adult Subjects in Any Treatment Arm in Studies 102 and 103 (Week-144 Analysis)

STRIBILD
N=701
ATRIPLA N=352ATV + RTV + TRUVADA
N=355
EYE DISORDERS
Ocular icterus<1%0%13%
GASTROINTESTINAL DISORDERS
Diarrhea12%11%17%
Flatulence2%<1%8%
Nausea16%9%14%
GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS
Fatigue4%8%6%
HEPATOBILIARY DISORDERS
Jaundice0%<1%9%
NERVOUS SYSTEM DISORDERS
Somnolence1%7%1%
Headache7%4%6%
Dizziness3%21%5%
PSYCHIATRIC DISORDERS
Insomnia3%9%1%
Abnormal dreams9%27%4%
SKIN AND SUBCUTANEOUS
TISSUE DISORDERS
Rash†4%15%6%
*Frequencies of adverse reactions are based on all treatment-emergent adverse events attributed to study drugs.
†Rash event includes dermatitis, drug eruption, eczema, pruritus, pruritus generalized, rash, rash erythematous, rash generalized, rash macular, rash maculo-papular, rash morbilliform, rash papular, rash pruritic, and urticaria.

See WARNINGS AND PRECAUTIONS for a discussion of renal adverse reactions from clinical trials experience with STRIBILD.

Additional adverse reactions observed with STRIBILD included suicidal ideation and suicide attempt (0.3%), all in subjects with a preexisting history of depression or psychiatric illness.

Clinical Trials In Virologically Suppressed HIV-1 Infected Adult Subjects

No new adverse reactions to STRIBILD through Week 48 were identified in 584 virologically stably suppressed adult subjects switching to STRIBILD from a regimen containing a RTV-boosted protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). In a combined analysis of studies 115 and 121, the frequency of adverse reactions (all grades) was 24% in subjects switching to STRIBILD compared to 6% of subjects in either group who stayed on their baseline antiretroviral regimen, RTV-boosted PI + TRUVADA or NNRTI + TRUVADA. Common adverse reactions that occurred in greater than or equal to 2% of subjects switching to STRIBILD were nausea (4%), flatulence (2%), and headache (2%). The proportion of subjects who discontinued treatment with STRIBILD, the RTV-boosted PI, or the NNRTI due to adverse events was 2%, 3%, and 1%, respectively.

Clinical Trials Of The Components Of STRIBILD In Adult Subjects

Emtricitabine and TDF

In addition to the adverse reactions observed with STRIBILD, the following adverse reactions occurred in at least 5% of treatment-experienced or treatment-naive subjects receiving emtricitabine or TDF 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.

Laboratory Abnormalities

The frequency of laboratory abnormalities (Grades 3-4) occurring in at least 2% of subjects receiving STRIBILD in studies 102 and 103 are presented in Table 2.

Table 2 : Laboratory Abnormalities (Grades 3-4) Reported in ≥2% of Adult Subjects Receiving STRIBILD in Studies 102 and 103 (Week-144 Analysis)

Laboratory Parameter Abnormality*,†STRIBILD
N=701
ATRIPLA
N=352
ATV + RTV + TRUVADA
N=355
AST (>5.0 x ULN)3%6%6%
ALT (>3.0 x ULN)2%5%4%
Amylase* (>2.0 x ULN)3%3%5%
Creatine Kinase (≥10.0 x ULN)8%15%11%
Urine RBC (Hematuria) (>75 RBC/HPF)4%2%4%
*Frequencies are based on treatment-emergent laboratory abnormalities.
†For subjects with serum amylase >1.5 x upper limit of normal (ULN), lipase test was also performed.
The frequency of increased lipase (Grades 3-4) occurring in STRIBILD (N=69), ATRIPLA (N=40), and ATV + RTV + TRUVADA (N=38) was 17%, 15%, and 24%, respectively.

In Study 103, BMD was assessed by DEXA in a nonrandom subset of 120 subjects (STRIBILD group, N=54; ATV + RTV + TRUVADA group, N=66). Mean percentage decreases in BMD from baseline to Week 144 in the STRIBILD group were comparable to that in the ATV + RTV + TRUVADA group at the lumbar spine (-1.43% versus -3.68%, respectively) and at the hip (-2.83% versus -3.77%, respectively). In studies 102 and 103, bone fractures occurred in 27 subjects (3.9%) in the STRIBILD group, 8 subjects (2.3%) in the ATRIPLA group, and 19 subjects (5.4%) in the ATV + RTV + TRUVADA group. These findings were consistent with data from an earlier 144-week trial of treatment-naive subjects receiving TDF + lamivudine + efavirenz.

Proteinuria (all grades) occurred in 52% of subjects receiving STRIBILD, 41% of subjects receiving ATRIPLA, and 42% of subjects receiving ATV + RTV + 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 levels stabilized. Table 3 displays the mean changes in serum creatinine and eGFR levels at Week 144 and the percentage of subjects with elevations in serum creatinine (all grades).

Table 3 : Change from Baseline in Serum Creatinine and eGFR and Incidence of Elevated Serum Creatinine (All Grades) in Studies 102 and 103 at Week 144

STRIBILD
N=701
ATRIPLA
N=352
ATV + RTV + TRUVADA
N=355
Serum Creatinine (mg/dL)*0.14 (±0.14)0.01 (±0.12)0.09 (±0.15)
eGFR by Cockcroft-Gault (mL/minute)*-14.0 (±16.6)-1.9 (±17.9)-9.8 (±19.4)
Subjects with Elevations in Serum Creatinine (All Grades) (%)1226
*Mean change ± standard deviation

Emtricitabine Or TDF

In addition to the laboratory abnormalities observed with STRIBILD, the following laboratory abnormalities have been previously reported in subjects treated with emtricitabine or TDF with other antiretroviral agents in other clinical trials: Grade 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).

Serum Lipids

In the clinical trials of STRIBILD, a similar percentage of subjects receiving STRIBILD, ATRIPLA, and ATV + RTV + TRUVADA were on lipid-lowering agents at baseline (12%, 12%, and 13%, respectively). While receiving study drug through Week 144, an additional 11% of STRIBILD subjects were started on lipid-lowering agents, compared to 13% of ATRIPLA and 12% of ATV + RTV + TRUVADA subjects.

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 at Week 144 in Adult Subjects Receiving STRIBILD or Comparator in Studies 102 and 103

STRIBILD
N=701
ATRIPLA
N=352
ATV + RTV + TRUVADA
N=355
Baseline mg/dLWeek 144 Change*Baseline mg/dLWeek 144 Change*Baseline mg/dLWeek 144 Change*
Total Cholesterol (fasted)166 [N=675]+ 17 [N=535]161 [N=343]+ 22 [N=262]168 [N=337]+ 16 [N=243]
HDL- cholesterol (fasted)43 [N=675]+ 7 [N=535]43 [N=343]+ 9 [N=262]42 [N=335]+ 7 [N=242]
LDL- cholesterol (fasted)100 [N=675]+ 15 [N=535]97 [N=343]+ 19 [N=262]101 [N=337]+ 18 [N=242]
Triglycerides (fasted)122 [N=675]+ 12 [N=535]121 [N=343]+ 5 [N=262]132 [N=337]+ 22 [N=242]
*The change from baseline is the mean of within-patient changes from baseline for patients with both baseline and Week 144 values.

Clinical Trials In Pediatric Subjects

The safety of STRIBILD in 50 HIV-1 infected, treatment-naive pediatric subjects aged 12 to less than 18 years and weighing at least 35 kg was evaluated through 48 weeks in an open-label clinical trial (Study 112) [see Clinical Studies]. In this study, the safety profile of STRIBILD was similar to that in adults. Twenty-two subjects (44%) had treatment-emergent proteinuria (Grades 1-2). One subject met laboratory criteria for proximal renal tubulopathy, evidenced by sustained proteinuria and normoglycemic glycosuria beginning at Week 32. The subject continued to receive STRIBILD and was ultimately lost to follow-up.

Among the 50 pediatric subjects receiving STRIBILD for 48 weeks, mean BMD increased from baseline to Week 48, + 0.68% at the lumbar spine and + 0.77% for total body less head. Mean changes from baseline BMD Z-scores (height-age adjusted) to Week 48 were -0.09 for lumbar spine and -0.12 for total body less head. At Week 48, 7 STRIBILD subjects had significant (greater than or equal to 4%) lumbar spine BMD loss and 2 had significant total body less head BMD loss.

Postmarketing Experience

The following adverse reactions have been identified during post-approval use of TDF. 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. 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

Hepatobiliary Disorders

hepatic steatosis, hepatitis, increased liver enzymes (most commonly AST, ALT, gamma GT)

Skin And Subcutaneous Tissue Disorders

rash

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

asthenia

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)

© Stribild Patient Information is supplied by Cerner Multum, Inc. and Stribild Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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