Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir (Oral)

The combination of elvitegravir, cobicistat, emtricitabine, and tenofovir forms a powerful fixed dose treatment for HIV/AIDS.

Overview

Elvitegravir, cobicistat, emtricitabine, and tenofovir work by directly suppressing viral reproduction. The dosage is fixed, and the drug is typically used by patients just beginning antiretroviral treatment. Due to its long name, the drug is most commonly referred to as the quad pill', named for its four active ingredients.

The combination of elvitegravir, cobicistat, emtricitabine, and tenofovir is manufactured by the company Gilead Sciences under the brand name Stribild. The drug was first approved by the FDA in 2012 and changes have been made to the drug since then.

The wholesale price of Stribild is between 25 and 30 thousand dollars per patient, per year.

Conditions Treated

  • HIV
  • AIDS

Type Of Medicine

  • Antiretroviral

Side Effects

Along with the desired suppression of viral reproduction, the combination of elvitegravir, cobicistat, emtricitabine, and tenofovir can have a variety of different effects on the body. Some of these symptoms can be serious and demand medical attention, while others may only be as serious as the discomfort they cause the patient. The following side effects may be serious, and patients who begin to experience them should contact their doctor immediately:

  • Cloudy, opaque urine
  • Bloody urine
  • Changes in the appearance of urine
  • Changes in urinary patterns
  • Abdominal discomfort or pain
  • Stomach discomfort or pain
  • Bone fractures
  • Bone pain
  • Convulsions
  • Coughing
  • Light colored discoloration of stools
  • Lower back pain
  • Pain in the patient's side
  • Mood changes
  • Muscle cramps
  • Muscle pain
  • Muscle stiffness
  • Nausea, vomiting, and diarrhea
  • Numbness or tingling in the extremities, especially the hands, feet, or lips
  • Puffiness or swelling of the face, especially the eyelids, lips, or tongue
  • Dark colored urine
  • Rash, hives, or itching sensations
  • Sleepiness
  • Decreased appetite
  • Difficulty swallowing
  • Swelling, especially in the face, fingers, or calves/lower legs
  • Dry mouth
  • Fast or irregular heart beat
  • Difficulty breathing
  • Fast, shallow breathing
  • Rogue or inexplicable weakness
  • Fever
  • Weight gain
  • Yellow discoloration of the eyes or skin
  • Generalized feelings of discomfort
  • Increased feelings of thirst
  • Large, hive-like swelling of the face, eyelids, lips, tongue, throat, hands, feet, legs, or genitals

Not all side effects of the elvitegravir, cobicistat, emtricitabine, and tenofovir combination necessarily demand medical attention. Some side effects are just the product of the patient's body responding to all the new medicine. The following side effects do not necessarily require medical attention. Patients who begin to experience any of the following symptoms after beginning to take elvitegravir, cobicistat, emtricitabine, and tenofovir should contact their doctor to find out how they can lessen or mitigate the most unpleasant side effects.

  • Abnormal, vivid dreams
  • Headaches
  • Bloating
  • Feelings of fullness, as if the patient just ate a large meal
  • Gas
  • Difficulty sleeping
  • Unusual tiredness
  • Chills
  • Constipation
  • Indigestion
  • Sudden loss or lack of strength
  • Pain in the stomach, abdomen or side. Sometimes this pain will feel as though it is radiating from the patient's back.

In clinical trials, patients reported feeling nauseous, having diarrhea, and having headaches most frequently.

This is not necessarily a complete list of side effects. Patients who begin to experience new or worsening symptoms after beginning to take elvitegravir, cobicistat, emtricitabine, and tenofovir should contact their doctor immediately. Patients can report new side effects to the FDA by calling 1(800) FDA-1088 or by going to www.fda.gov.medwatch on the web.

Dosage

The combination of elvitegravir, cobicistat, emtricitabine, and tenofovir has been approved to treat patients as young as twelve years old who suffer from HIV. The standard dose for all patients (12 years old and up)is one tablet taken orally, every day.

Patients should always take their elvitegravir, cobicistat, emtricitabine, and tenofovir tablet with food. By taking elvitegravir, cobicistat, emtricitabine, and tenofovir, patients will experience indigestion and stomach upset. Patients who experience especially unpleasant side effects on their stomach/digestion may need to take an antacid to mitigate the effects. The antacid should be taken at least two hours before or after the patient takes their elvitegravir, cobicistat, emtricitabine, and tenofovir tablet.

Patients should make sure to have the CrCl (creatinine clearance rate). Urine glucose levels, and urine protein levels assessed before beginning to take elvitegravir, cobicistat, emtricitabine, and tenofovir. These metrics will give the patient a reasonable assessment of his or her kidney function.

Patients with renal impairment may need to seek alternative treatment for their condition.

Patients with an estimated CrCl of 70 ml per minute should not take elvitegravir, cobicistat, emtricitabine, and tenofovir.

Patients with severe liver dysfunction should not take elvitegravir, cobicistat, emtricitabine, and tenofovir.

Patients who undergo hemodialysis should always take their dose of elvitegravir, cobicistat, emtricitabine, and tenofovir after dialysis. Dialysis will remove emtricitabine from the blood, lowering the effectiveness of elvitegravir, cobicistat, emtricitabine, and tenofovir in treating HIV.

Interactions

Elvitegravir, cobicistat, emtricitabine, and tenofovir tablets can interact with a wide variety of different drugs, including some cancer drugs, other antiretrovirals, and opioid painkillers. Patients who are taking any of the following drugs should not also take elvitegravir, cobicistat, emtricitabine, and tenofovir. Patients who are taking any of the following drugs and must begin taking elvitegravir, cobicistat, emtricitabine, and tenofovir should consult with their doctor to discover potential alternative treatments.

Patients should disclose a complete list of any and all drugs, medications, and supplements they are taking to their doctor prior to deciding to take elvitegravir, cobicistat, emtricitabine, and tenofovir.

  • Abemaciclib
  • Acalabrutinib
  • Acyclovir
  • Adefovir
  • Aldesleukin
  • Alfentanil
  • Alfuzosin
  • Amikacin
  • Amiodarone
  • Amphotericin b
  • Amphotericin b cholesteryl sulfate
  • Amphotericin b lipid complex
  • Amphotericin b liposomal
  • Apixaban
  • Avanafil
  • Axitinib
  • Bacitracin
  • Bepridil
  • Bosentan
  • Bosutinib
  • Botulism immune globulin
  • Brexpiprazole
  • Brigatinib
  • Bromfenac
  • Budesonide
  • Butorphanol
  • Capreomycin
  • Carbamazepine
  • Carboplatin
  • Cariprazine
  • Celecoxib
  • Ceritinib
  • Cidofovir
  • Cilostazol
  • Cisapride
  • Cisplatin
  • Clofarabine
  • Cobimetinib
  • Colchicine
  • Colistimethate
  • Conivaptan
  • Copanlisib
  • Crizotinib
  • Cyclophosphamide
  • Cyclosporine
  • Cytomegalovirus immune globulin
  • Daclatasvir
  • Darifenacin
  • Dasatinib
  • Deferasirox
  • Deferoxamine
  • Deflazacort
  • Diatrizoate
  • Diclofenac
  • Didanosine
  • Diflunisal
  • Dihydroergotamine
  • Disopyramide
  • Docetaxel
  • Dronedarone
  • Edetate calcium disodium
  • Edetate disodium
  • Edoxaban
  • Eletriptan
  • Eliglustat
  • Eluxadoline
  • Enzalutamide
  • Eplerenone
  • Ergonovine
  • Ergotamine
  • Erythromycin
  • Eszopiclone
  • Etidronate
  • Etodolac
  • Everolimus
  • Fenoprofen
  • Fentanyl
  • Fesoterodine
  • Flecainide
  • Flibanserin
  • Flurbiprofen
  • Fluticasone
  • Foscarnet
  • Fosphenytoin
  • Gallium nitrate
  • Ganciclovir
  • Gentamicin
  • Guanfacine
  • Halofantrine
  • Hydrocodone
  • Ibandronate
  • Ibrutinib
  • Ibuprofen
  • Ifosfamide
  • Iloperidone
  • Immune globulin intravenous
  • Immune globulin intravenous and subcutaneous
  • Indomethacin
  • Iodamide
  • Iodipamide
  • Iodixanol
  • Iohexol
  • Iopamidol
  • Iopromide
  • Iothalamate
  • Ioversol
  • Ioxaglate
  • Ioxilan
  • Irinotecan
  • Irinotecan liposomal
  • Isavuconazonium
  • Ivabradine
  • Ivacaftor
  • Kanamycin
  • Ketoprofen
  • Ketorolac
  • Lamivudine
  • Leflunomide
  • Lithium
  • Lomitapide
  • Loperamide
  • Lovastatin
  • Lurasidone
  • Macitentan
  • Meclofenamate
  • Mefenamic acid
  • Meloxicam
  • Mesalamine
  • Methotrexate
  • Methoxyflurane
  • Methylergonovine
  • Methylprednisolone
  • Methysergide maleate
  • Metrizamide
  • Midazolam
  • Midostaurin
  • Mifepristone
  • Mipomersen
  • Mitotane
  • Modafinil
  • Nabumetone
  • Naloxegol
  • Naproxen
  • Neomycin
  • Neratinib
  • Netilmicin
  • Nilotinib
  • Nimodipine
  • Olaparib
  • Olsalazine
  • Osimertinib
  • Oxaprozin
  • Oxcarbazepine
  • Oxycodone
  • Palbociclib
  • Pamidronate
  • Panobinostat
  • Pazopanib
  • Penicillamine
  • Pentamidine
  • Phenobarbital
  • Phenylbutazone
  • Phenytoin
  • Pimavanserin
  • Pimozide
  • Piroxicam
  • Polymyxin b
  • Primidone
  • Propafenone
  • Quetiapine
  • Quinidine
  • Ranolazine
  • Red yeast rice
  • Respiratory syncytial virus immune globulin
  • Ribociclib
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Riociguat
  • Rivaroxaban
  • Rofecoxib
  • Ruxolitinib
  • Salmeterol
  • Salsalate
  • Sildenafil
  • Silodosin
  • Simeprevir
  • Simvastatin
  • Sirolimus
  • Solifenacin
  • Sonidegib
  • St. john's wort
  • Streptomycin
  • Streptozocin
  • Sulfasalazine
  • Sulindac
  • Suvorexant
  • Tacrolimus
  • Tamsulosin
  • Telavancin
  • Temsirolimus
  • Teriflunomide
  • Thioridazine
  • Ticagrelor
  • Tipranavir
  • Tobramycin
  • Tofacitinib
  • Tolmetin
  • Tolvaptan
  • Toremifene
  • Trabectedin
  • Triamcinolone
  • Triazolam
  • Valacyclovir
  • Valbenazine
  • Valdecoxib
  • Valganciclovir
  • Vancomycin
  • Vardenafil
  • Venetoclax
  • Vinblastine
  • Vincristine
  • Vincristine liposome
  • Vinorelbine
  • Vorapaxar
  • Zalcitabine
  • Zoledronic acid

Patients should avoid taking elvitegravir, cobicistat, emtricitabine, and tenofovir concurrently with any opioids. The drug cobicistat will increase blood levels of opioids, potentiating their effects and putting the patient at increased risk of side effects and even overdose. Patients who are taking any opioid painkillers or who have developed an opioid dependency should consult with their doctor to identify potential alternative treatments to the elvitegravir, cobicistat, emtricitabine, and tenofovir combination. Patients should disclose a complete list of all drugs, medications, and supplements they are taking to their doctor prior to deciding to take elvitegravir, cobicistat, emtricitabine, and tenofovir.

Patients taking any chemotherapy or cancer drugs such as brigatinib should exercise extreme caution when considering taking elvitegravir, cobicistat, emtricitabine, and tenofovir. The drug cobicistat will increase the blood levels of the cancer drug, putting the patient at increased risk of dangerous side effects which can result in dangerous complications. Patients who are taking any cancer drugs who need to begin taking elvitegravir, cobicistat, emtricitabine, and tenofovir should consult with their doctor to determine possible alternatives, to discuss risk mitigation strategies. Patients should make sure their doctor is fully apprised of all drugs, medications, and supplements they are taking prior to deciding to take elvitegravir, cobicistat, emtricitabine, and tenofovir.

Patients should not take the supplement St. John's Wort while taking elvitegravir, cobicistat, emtricitabine, and tenofovir. St. John's. Wort will lower blood levels of elvitegravir, tenofovir, and cobicistat, lowering the effectiveness of the medicine and possibly rending the elvitegravir, cobicistat, emtricitabine, and tenofovir combination useless in treating HIV. Patients should make sure their doctor tis fully apprised of any and all drugs, medications, and supplements they are taking prior to deciding to take elvitegravir, cobicistat, emtricitabine, and tenofovir.

The following drugs will interact with elvitegravir, cobicistat, emtricitabine, and tenofovir, but not necessarily with the same severity or with the same frequency. Patients who are taking any of the following drugs and must begin to take elvitegravir, cobicistat, emtricitabine, and tenofovir should consult with their doctor to determine the best course of action. Patients should disclose a complete list of all drugs, medications, and supplements they are taking to their doctor prior to deciding to take elvitegravir, cobicistat, emtricitabine, and tenofovir.

  • Abacavir
  • Afatinib
  • Albendazole
  • Aliskiren
  • Almotriptan
  • Alprazolam
  • Aluminum carbonate
  • Aluminum hydroxide
  • Amiloride
  • Amlodipine
  • Amoxapine
  • Amphetamine
  • Amprenavir
  • Aprepitant
  • Aripiprazole
  • Armodafinil
  • Atazanavir
  • Atomoxetine
  • Atorvastatin
  • Bedaquiline
  • Betamethasone
  • Betrixaban
  • Black cohosh
  • Bortezomib
  • Brentuximab
  • Budesonide nasal
  • Buprenorphine
  • Buspirone
  • Cabazitaxel
  • Cabozantinib
  • Calcium carbonate
  • Carvedilol
  • Cerivastatin
  • Cevimeline
  • Chlorpheniramine
  • Chlorpromazine
  • Ciclesonide
  • Ciclesonide nasal
  • Cimetidine
  • Cinacalcet
  • Cladribine
  • Clarithromycin
  • Clomipramine
  • Clonazepam
  • Clorazepate
  • Clotrimazole
  • Clozapine
  • Codeine
  • Dabigatran
  • Dabrafenib
  • Delavirdine
  • Desipramine
  • Dexamethasone
  • Dexfenfluramine
  • Dextromethorphan
  • Diazepam
  • Digoxin
  • Dihydroxyaluminum sodium carbonate
  • Diltiazem
  • Diphenhydramine
  • Dofetilide
  • Doxepin
  • Duloxetine
  • Dutasteride
  • Efavirenz
  • Enfuvirtide
  • Epirubicin
  • Erlotinib
  • Eslicarbazepine
  • Estazolam
  • Ethinyl estradiol
  • Ethosuximide
  • Etonogestrel
  • Etravirine
  • Exenatide
  • Felodipine
  • Fenfluramine
  • Flucytosine
  • Fludrocortisone
  • Flunisolide
  • Fluoxetine
  • Fluphenazine
  • Flurazepam
  • Fluvoxamine
  • Fosamprenavir
  • Fosaprepitant
  • Galantamine
  • Gefitinib
  • Haloperidol
  • Hydrocortisone
  • Idelalisib
  • Imatinib
  • Imipramine
  • Indinavir
  • Interferon beta-1a
  • Interferon beta-1b
  • Isradipine
  • Itraconazole
  • Ivermectin
  • Ixabepilone
  • Ketoconazole
  • Lapatinib
  • Levobupivacaine
  • Levomilnacipran
  • Levonorgestrel
  • Lidocaine
  • Magaldrate
  • Magnesium carbonate
  • Magnesium hydroxide
  • Magnesium oxide
  • Maprotiline
  • Maraviroc
  • Medroxyprogesterone
  • Metformin
  • Methamphetamine
  • Methotrimeprazine
  • Metoclopramide
  • Metoprolol
  • Mexiletine
  • Mibefradil
  • Miconazole
  • Midodrine
  • Mirtazapine
  • Mometasone
  • Mometasone nasal
  • Nafcillin
  • Naldemedine
  • Naltrexone
  • Nebivolol
  • Nelfinavir
  • Nevirapine
  • Nicardipine
  • Nifedipine
  • Nintedanib
  • Nisoldipine
  • Norethindrone
  • Norgestrel
  • Nortriptyline
  • Oritavancin
  • Orlistat
  • Ospemifene
  • Oxaliplatin
  • Paclitaxel
  • Paclitaxel protein-bound
  • Paricalcitol
  • Paroxetine
  • Peginterferon beta-1a
  • Pemetrexed
  • Perphenazine
  • Pindolol
  • Pomalidomide
  • Ponatinib
  • Posaconazole
  • Itrate
  • Prednisolone
  • Prednisone
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propoxyphene
  • Propranolol
  • Protriptyline
  • Quinine
  • Raltegravir
  • Ramelteon
  • Ranitidine
  • Ranitidine bismuth citrate
  • Regorafenib
  • Repaglinide
  • Ribavirin
  • Rilpivirine
  • Risperidone
  • Ritonavir
  • Romidepsin
  • Rosuvastatin
  • Rufinamide
  • Saquinavir
  • Saxagliptin
  • Sertraline
  • Sodium bicarbonate
  • Sodium citrate
  • Somatropin
  • Stavudine
  • Sufentanil
  • Sulfinpyrazone
  • Sunitinib
  • Tadalafil
  • Tamoxifen
  • Tasimelteon
  • Telaprevir
  • Telbivudine
  • Telithromycin
  • Tetrabenazine
  • Thioguanine
  • Timolol
  • Tolterodine
  • Tramadol
  • Trazodone
  • Tretinoin
  • Triamcinolone ophthalmic
  • Triamterene
  • Trimipramine
  • Troleandomycin
  • Trospium
  • Vemurafenib
  • Venlafaxine
  • Verapamil
  • Vilazodone
  • Voriconazole
  • Warfarin
  • Zidovudine
  • Zolpidem
  • Zonisamide
  • Abiraterone
  • Ambrisentan
  • Bexarotene
  • Citalopram
  • Dolutegravir
  • Donepezil
  • Eribulin
  • Escitalopram
  • Indacaterol
  • Memantine
  • Mirabegron
  • Pimecrolimus topical
  • Retapamulin topical
  • Ropivacaine
  • Ziprasidone

Additionally, patients should avoid taking any for of elvitegravir, cobicistat, emtricitabine, or tenofovir while taking the combination of elvitegravir, cobicistat, emtricitabine, and tenofovir. By doing so, the patients will throw off the balance of the medicine as well as put themselves at risk of increased and dangerous side effects. Patients should make sure their doctor is fully apprised of all drugs, supplements, and medications they are taking prior to deciding to take elvitegravir, cobicistat, emtricitabine, and tenofovir.

This is not necessarily a complete list of potential interactions. Patients should rely on their doctor to identify any potential interactions between elvitegravir, cobicistat, emtricitabine, and tenofovir and any drugs they are taking. To support their doctor, patients should supply their doctor with a list of all drugs, medications, and supplements they are taking.

Warnings

Patients who have previously had an allergic reaction to elvitegravir, cobicistat, emtricitabine, or tenofovir should not take elvitegravir, cobicistat, emtricitabine, and tenofovir. Patients who have previously had an allergic reaction to any drugs which are similar to elvitegravir, cobicistat, emtricitabine, or tenofovir should not take elvitegravir, cobicistat, emtricitabine, and tenofovir. Patients taking elvitegravir, cobicistat, emtricitabine, and tenofovir should remain vigilant for signs of allergic reaction, as elvitegravir, cobicistat, emtricitabine, and tenofovir have been known to cause serious allergic reactions in some patients. Symptoms of a serious allergic reaction can include hives, rash, swelling of the neck and throat, or even anaphylaxis.

Patients with hepatitis B should exercise caution when considering taking elvitegravir, cobicistat, emtricitabine, and tenofovir. Patients who have hepatitis B have reported worsening symptoms when after they stopped taking elvitegravir, cobicistat, emtricitabine, and tenofovir. Patients with hepatitis B should consult with their doctor to determine whether or not elvitegravir, cobicistat, emtricitabine, and tenofovir is right for them. Patients should never stop taking elvitegravir, cobicistat, emtricitabine, and tenofovir abruptly.

Patients with liver disease should exercise extreme caution when considering taking elvitegravir, cobicistat, emtricitabine, and tenofovir. Antiretroviral have been associated with hepatotoxicity, and this risk is elevated in patients with any form of liver disease/damage. Patients with liver disease should consult with their doctor to determine whether or not elvitegravir, cobicistat, emtricitabine, and tenofovir is right for them.

The drugs emtricitabine and tenofovir is primarily excreted through the liver. As a result, patients with renal impairment may experience increased blood levels of tenofovir and emtricitabine as it builds up in their system. For this reason, patients with renal impairment should exercise caution when considering taking elvitegravir, cobicistat, emtricitabine, and tenofovir. Patients with renal impairment should consult with their doctor to determine whether or not elvitegravir, cobicistat, emtricitabine, and tenofovir is right for them.

Tenofovir may cause bone toxicity. In studies done on animals, doses of 6 to 12 times the typical human dose have produced decreased mineral density in the studied animals. For this reason, patients with preexisting bone density problems or other bone toxicity issues will need to exercise caution when considering taking elvitegravir, cobicistat, emtricitabine, and tenofovir. Patients with preexisting bone toxicity problems should consult with their doctor to determine whether or not elvitegravir, cobicistat, emtricitabine, and tenofovir is right for them.

Patients who are breastfeeding should not take elvitegravir, cobicistat, emtricitabine, and tenofovir.

Storage

Elvitegravir, cobicistat, emtricitabine, and tenofovir tablets should be stored in the container they come with. Patients should be sure to keep the cap fastened on tightly and to store the medication out of the way of children.

Elvitegravir, cobicistat, emtricitabine, and tenofovir tablets should be stored at 77 degrees Fahrenheit. Temperatures between 59 and 86 degrees Fahrenheit are acceptable.

Summary

The drug combination of elvitegravir, cobicistat, emtricitabine, and tenofovir is a powerful, simple antiretroviral drug patients can take. Due to its fixed dose, patients will only need to remember to take one pill a day to effectively treat their condition.

All drugs come with side effects, though, and a combination of four drugs is going to come with a lot of side effects. The drug combination of elvitegravir, cobicistat, emtricitabine, and tenofovir can affect the patient's liver, kidneys, bones, digestion, and more. Patients who are healthy enough to deal with these effects and do not experience too many unpleasant side effects will find the drug ideal for them. Patients with preexisting health problems or who simply find themselves more at risk of side effects may want to seek out alternative treatments.

Like any drug, the combination of elvitegravir, cobicistat, emtricitabine, and tenofovir demands respect. Patients who properly respect the drug's power, including faithfully following their dosage regimen, storing the drug properly, and submitting to sufficient medical monitoring will be able to take the drug without significant risk to their own health.