Emtricitabine, Rilpivirine and Tenofovir (Oral)

Overview

Although there is no cure for the human immunodeficiency virus, modern treatments mean that the condition can be managed well in most cases. Whilst the human immunodeficiency virus can cause acquired immunodeficiency syndrome (AIDs), treatment can help to prevent or delay this from happening. Often used as a first-choice treatment, Emtricitabine, Rilpivirine and Tenofovir is generally given to patients who have not received any other medications for HIV.

As a combination medicine, Emtricitabine, Rilpivirine and Tenofovir contains three active ingredients. Whilst each medicine helps to treat the human immunodeficiency virus, they are thought to be far more effective when they are used in conjunction with one another. If patients with HIV-1 have not yet been treated, it's unlikely that they will have built up a resistance to anti-HIV medications. This means that a combination of Emtricitabine, Rilpivirine and Tenofovir can be particularly effective for these patients.

Although Emtricitabine, Rilpivirine and Tenofovir works as a combination therapy to treat HIV, each active ingredient plays a different role. Emtricitabine is a nucleoside reverse transcriptase inhibitor (NRTI), for example, whilst Rilpivirine is a non-nucleoside reverse transcriptase inhibitor (NNTI) and Tenofovir is a nucleotide analog reverse transcriptase inhibitor (NtRTI).

Whilst all three drugs help to prevent the replication of HIV DNA cells within the patient's body, they work in different ways. This means that the efficacy of the treatment can be increased by using combination medications. Rather than relying on just one pharmaceutical action to inhibit the reproduction of HIV DNA cells, physicians can use multiple drugs to achieve this.

When patients first contract the human immunodeficiency virus, it's important that they obtain treatment as quickly as possible. Although symptoms may not be apparent immediately, patients may experience symptoms similar to flu once the virus has entered their system. Following this, patients may not experience any symptoms at all but the virus is likely to cause hidden damage to their immune system. Unless treatment is started, the patient's immune system could become severely compromised.

By using an effective treatment, such as Emtricitabine, Rilpivirine and Tenofovir, physicians can prevent the immune system from suffering serious damage. In doing so, patients are less likely to contract illnesses and infections and may, therefore, avoid the complications associated with these conditions.

As Emtricitabine, Rilpivirine and Tenofovir prevents HIV DNA cells from replicating, it effectively lowers the amount of HIV in the patient's blood. This is referred to as the patient's 'viral load' and indicates how much of the virus is in the patient's system. When medication is used to reduce the viral load as much as possible, patients should suffer from fewer symptoms.

Although Emtricitabine, Rilpivirine and Tenofovir is used to manage the human immunodeficiency virus, it is not a cure. Whilst effective treatment can help to reduce the patient's viral load and, therefore, their symptoms and the chance of them infecting another person, it cannot guarantee these outcomes. Patients may still experience symptoms and they may still have an increased risk of developing future health problems. Furthermore, patients could still transfer the virus to another individual via the mixing of bodily fluids.

Despite this, patients with HIV can manage their condition, providing the appropriate treatment is used. By reducing the amount of HIV in their systems and preventing their viral load from increasing, Emtricitabine, Rilpivirine and Tenofovir helps to ensure that the patient's symptoms are minimized and that they're able to continue with their day-to-day activities without impediment.

Conditions Treated

  • Human immunodeficiency virus (HIV)

Type Of Medicine

  • Antiviral Medicine
  • Nucleoside reverse transcriptase inhibitor (NRTI) (Emtricitabine)
  • Non-nucleoside reverse transcriptase inhibitor (NNTI) (Rilpivirine)
  • Nucleotide analog reverse transcriptase inhibitor (NtRTI) (Tenofovir)

Side Effects

Although side-effects can occur when patients take any type of medication, they are not uncommon when patients take antiviral medicines. Fortunately, many side effects decrease as patients get used to the medication and physicians are often able to alter the patient's dose to minimize adverse effects or prescribe additional medication to control their side effects.

However, if patients notice any of the following side effects when taking Emtricitabine, Rilpivirine and Tenofovir, they should seek medical help:

  • Discouragement
  • Irritability
  • Feeling empty or sad
  • Loss of pleasure or interest
  • Lack of appetite
  • Mental depression
  • Tiredness
  • Thoughts of killing oneself
  • Difficulty sleeping
  • Trouble concentrating
  • Body pain or aches
  • Crawling, burning, prickling, numbness, itching, tingling or feelings of pins and needles
  • Pain in chest
  • Cough
  • Congestion in the ears
  • Chills or fever
  • Difficulty with breathing
  • Loss of voice
  • Headache
  • Stuffy or runny nose
  • Vomiting
  • Sneezing
  • Yellowing of the skin and/or eyes
  • Sore throat
  • Sleepiness
  • Unusual weakness or tiredness
  • Tightness in chest
  • Awkwardness or unsteadiness
  • Agitation
  • Weakness in hands, arms, feet and/or legs
  • Abdominal discomfort
  • Confusion
  • Bloating
  • Constipation
  • Cloudy or bloody urine
  • Bone pain
  • Dark urine
  • Dizziness
  • Reduced appetite
  • Diarrhea
  • Decreased urination
  • Fast heartbeat
  • Difficulty swallowing
  • Hostility
  • Dry mouth
  • Shallow, fast breathing
  • Indigestion
  • Frequent urination
  • Irritability
  • Increased thirst
  • Large, hive-like swellings on the eyelids, face, tongue, lips, throat, legs, feet, hands or sex organs
  • Muscle cramps or pain
  • Lethargy
  • Muscle weakness, wasting or tenderness
  • Light-colored stools
  • Pain in the side, stomach or abdomen, may be radiating to the back
  • Nausea
  • Rapid weight gain
  • Hives, itching or rash on the skin
  • Swelling of the ankles, feet, lower legs, hands and/or face
  • Seizures

Although the above side effects do require medical attention, patients may experience additional adverse effects when taking Emtricitabine, Rilpivirine and Tenofovir. Typically, these will be relieved when the patient becomes accustomed to the combination medicine. However, patients should seek help if they are concerned about any of the following adverse effects:

  • Sour or acid stomach
  • Abnormal dreams
  • Pain in back
  • Loss or lack of strength
  • Belching
  • Stomach upset or discomfort
  • Difficulty with moving
  • Tenderness of pain around the eyes and/or cheekbones
  • Pain in the joints
  • Heartburn

Whilst it's not uncommon for Emtricitabine, Rilpivirine and Tenofovir to cause some side effects, patients should not attempt to cope with debilitating adverse effects alone. Physicians and nurses can often provide assistance when it comes to reducing side effects so patients should seek medical advice if they experience side effects when taking this medication.

Dosage

Before prescribing Emtricitabine, Rilpivirine and Tenofovir, physicians will issue specific dosage instructions to the patient. As well as instructing patients on how much medication to take, doctors may also advise patients to take their medication at a specific time of day. Patients should, therefore, follow their doctors' guidelines when taking Emtricitabine, Rilpivirine and Tenofovir.

Generally, Emtricitabine, Rilpivirine and Tenofovir is prescribed as just one tablet. In most cases, patients will be advised to take one tablet per day and this will contain 200mg of Emtricitabine, 25mg of Rilpivirine and 300mg of Tenofovir.

In most cases, patients are advised to take Emtricitabine, Rilpivirine and Tenofovir with food. In addition to this, patients should wait at least four hours to take any medicines containing magnesium, aluminum and/or calcium, such as antacids. Alternatively, patients could take this type of medication at least two hours before taking Emtricitabine, Rilpivirine and Tenofovir.

Similarly, if patients are taking medicine for the treatment of ulcers or heartburn, they should take it at least twelve hours before Emtricitabine, Rilpivirine and Tenofovir or four hours after.

When patients have been taking Emtricitabine, Rilpivirine and Tenofovir for some time, they should feel that their symptoms are improving. It is essential, however, that patients continue to take their medication as they have been instructed to, even if they are no longer experiencing any symptoms.

If patients accidentally miss a dose of Emtricitabine, Rilpivirine and Tenofovir, they should take it as soon as they remember to. However, if their next dose is due within 12 hours, they should skip the missed dose and take their next dose as normal. Patients are not normally advised to take double doses of Emtricitabine, Rilpivirine and Tenofovir and should not do so unless their doctor specifically tells them to.

If patients are unsure how to take their medication or when they should take Emtricitabine, Rilpivirine and Tenofovir, they should seek medical advice from their physician or pharmacist. Similarly, if patients have missed a dose of medication and aren't sure how to continue with their treatment schedule, they should obtain medical advice.

Potential Drug Interactions:

As some drugs can interact with others, patients may be advised to avoid certain medications when they are taking Emtricitabine, Rilpivirine and Tenofovir. If patients are taking any of the following medications, Emtricitabine, Rilpivirine and Tenofovir may not be prescribed:

  • Carbamazepine
  • St John's Wort
  • Cisapride
  • Rifapentine
  • Dexamethasone
  • Rabeprazole
  • Dexlansoprazole
  • Phenytoin
  • Esomeprazole
  • Pantoprazole
  • Fosphenytoin
  • Omeprazole
  • Lansoprazole
  • Phenobarbital
  • Oxcarbazepine
  • Rifampin
  • Primidone

As Emtricitabine, Rilpivirine and Tenofovir can interact with the medicines listed above, doctors will not normally prescribe them at the same time. Due to this, patients may have their existing medications changed so that they're able to take Emtricitabine, Rilpivirine and Tenofovir.

Taking Emtricitabine, Rilpivirine and Tenofovir alongside the following medications is not usually advisable but may be necessary in certain situations:

  • Aluminum Carbonate, Basic
  • Dabrafenib
  • Aluminum Hydroxide
  • Dabrafenib
  • Aluminum Phosphate
  • Didanosine
  • Anagrelide
  • Cimetidine
  • Aripiprazole
  • Dasabuvir
  • Arsenic Trioxide
  • Delavirdine
  • Atazanavir
  • Degarelix
  • Buserelin
  • Delamanid
  • Deslorelin
  • Calcium Carbonate
  • Efavirenz
  • Ceritinib
  • Famotidine
  • Crizotinib
  • Escitalopram
  • Dihydroxyaluminum Aminoacetate
  • Goserelin
  • Dihydroxyaluminum Sodium Carbonate
  • Histrelin
  • Domperidone
  • Hydroxychloroquine
  • Donepezil
  • Gonadorelin
  • Etravirine
  • Rifabutin
  • Fluoxetine
  • Panobinostat
  • Idelalisib
  • Ranitidine
  • Ledipasvir
  • Ombitasvir
  • Leuprolide
  • Metronidazole
  • Levofloxacin
  • Pasireotide
  • Magaldrate
  • Nafarelin
  • Magnesium Carbonate
  • Orlistat
  • Magnesium Hydroxide
  • Ondansetron
  • Magnesium Oxide
  • Paritaprevir
  • Magnesium Trisilicate
  • Pazopanib
  • Moxifloxacin
  • Tacrolimus
  • Nevirapine
  • Tipranavir
  • Nizatidine
  • Sevoflurane
  • Triptorelin
  • Vandetanib

If patients are prescribed Emtricitabine, Rilpivirine and Tenofovir alongside any of the drugs listed above, their dose may be altered in order to prevent an interaction occurring. If possible, physicians may switch the patient's medication to an alternative which is less likely to result in an interaction.

It should also be noted that the following medicines may increase the chance of side effects occurring if they are taken at the same time as Emtricitabine, Rilpivirine and Tenofovir:

  • Boceprevir
  • Tipranavir
  • Darunavir
  • Ritonavir
  • Lopinavir

However, if doctors feel that patients will benefit from the above medications, they may modify their dose to reduce the risk of adverse effects. Alternatively, physicians may be able to provide treatment advice or additional medicines to help minimize the impact of any side effects.

Although prescription medications can interact with each other in some cases, interactions may also occur between over-the-counter medicines, vitamins and/or supplements. Patients should tell their doctor if they are taking any of these before they start taking Emtricitabine, Rilpivirine and Tenofovir. Similarly, patients will need to seek medical advice before using over-the-counter medicines, vitamins and/or supplements once they have started taking Emtricitabine, Rilpivirine and Tenofovir.

Warnings

Before patients are given Emtricitabine, Rilpivirine and Tenofovir, doctors will discuss their medical history with them. Some conditions may affect the use of Emtricitabine, Rilpivirine and Tenofovir so it's important that they are disclosed before treatment begins. These may include:

  • Weak or brittle bones (Osteoporosis)
  • Soft bones (Osteomalacia)
  • History of bone fractures
  • History of depression
  • Kidney disease (e.g. Fanconi syndrome)
  • Kidney failure
  • History of Hepatitis B or C infections
  • Heart rhythm problems

Although these conditions will not necessarily prevent Emtricitabine, Rilpivirine and Tenofovir from being prescribed, they may affect the patient's treatment. Emtricitabine, Rilpivirine and Tenofovir can make conditions such as osteoporosis worse, for example, so patients may undergo additional monitoring if they have been diagnosed with this condition prior to beginning treatment.

As Emtricitabine, Rilpivirine and Tenofovir has not been tested on children or infants, this medication is not normally prescribed to pediatric patients. If doctors believe the benefits of the medication outweigh any risks to the patient, they may prescribe Emtricitabine, Rilpivirine and Tenofovir to younger patients but this is not usual practice.

Emtricitabine, Rilpivirine and Tenofovir can be prescribed to geriatric patients, providing their existing medical conditions are not contra-indicators. Age-related heart, liver and/or kidney problems do affect the way the body processes medicines so a lower starting dose of Emtricitabine, Rilpivirine and Tenofovir may be required. Once the patient's response to the medication has been ascertained, doctors may decide to increase their dose accordingly.

The Food and Drug Administration has classified Emtricitabine, Rilpivirine and Tenofovir as a category B drug in terms of the risk for pregnant women. Although the medication has not been shown to cause harm to an unborn fetus, there may be risks if patients take this medication whilst pregnant. Patients should, therefore, discuss this with their physician if they are pregnant or are planning to become pregnant. If patients become pregnant whilst taking Emtricitabine, Rilpivirine and Tenofovir, they should contact their physician for advice.

It is not known whether Emtricitabine, Rilpivirine and Tenofovir can be passed to an infant via breastfeeding. However, HIV is transmitted via bodily fluids, such as breastmilk. Even babies who have been born without the virus can contract it via breastfeeding. Due to this, patients with HIV are normally advised not to breastfeed as it will put the infant at risk of contracting the virus.

Patients should not take this combination medicine whilst taking any other medicines containing Rilpivirine, Emtricitabine and/or Tenofovir, unless they have been advised to do so by their physician.

In rare cases, patients may develop lactic acidosis whilst taking Emtricitabine, Rilpivirine and Tenofovir. This is an excess of acid in the blood and can cause symptoms, such as:

  • Decreased appetite
  • Nausea
  • Sleepiness
  • Muscle cramping or pain
  • Shortness of breath
  • Stomach or abdominal discomfort
  • Diarrhea
  • Shallow, fast breathing
  • Unusual weakness or tiredness
  • General feeling of discomfort

If patients experience these symptoms, they should seek immediate medical assistance. Patients should inform the relevant healthcare practitioners that they are taking Emtricitabine, Rilpivirine and Tenofovir so that lactic acidosis can be ruled out or treated appropriately.

If patients have hepatitis B or have had this condition in the past, they should be closely monitored whilst taking Emtricitabine, Rilpivirine and Tenofovir. In some cases, Emtricitabine, Rilpivirine and Tenofovir can worsen hepatitis B and may cause patients to develop liver problems. If patients experience any of the following symptoms whilst taking this medication, they should seek immediate medical help:

  • Dark urine
  • Clay-colored stools
  • Fever
  • Decreased appetite
  • Itching
  • Nausea
  • Headache
  • Rash on the skin
  • Stomach tenderness or pain
  • Vomiting
  • Yellowing of the skin or eyes
  • Unusual weakness or tiredness
  • Swelling of the lower legs and/or feet

Patients may experience serious skin reactions whilst taking Emtricitabine, Rilpivirine and Tenofovir. These require medical attention and are often characterized by:

  • Peeling, loosening or blistering of the skin
  • Ulcers or sores
  • Severe skin rash
  • Acne
  • Red lesions
  • Chills and/or fever

Patients should seek urgent medical help if they experience suicidal thoughts or compulsions to harm themselves whilst taking Emtricitabine, Rilpivirine and Tenofovir. In addition to this, patients should report any changes in their thoughts, feelings or behavior to their physician.

Before undergoing any medical tests, patients should notify the relevant healthcare practitioner that they are taking Emtricitabine, Rilpivirine and Tenofovir. This medication may affect test results and this should be taken into account before tests are carried out.

Patients may develop extra body fat whilst taking this medication. If patients experience a change in body shape or notice excess fat on their stomach, neck, chest and/or back, they should inform their doctor. Patients may also experience weight loss from their arms or legs whilst taking Emtricitabine, Rilpivirine and Tenofovir.

As the treatment takes effect, the patient's immune system may become stronger. However, illnesses which were previously hidden may become symptomatic. If patients feel unwell, they should seek medical attention.

Patients should discuss any allergies with their doctor before taking Emtricitabine, Rilpivirine and Tenofovir. In rare cases, patients may experience an allergic reaction whilst taking this medication and anaphylaxis or a drug reaction with eosinophilia and systemic symptoms may occur. These reactions are life-threatening and patients will need urgent medical assistance if they experience the following symptoms:

  • Difficulty breathing
  • Difficulty swallowing
  • Fast or irregular heartbeat
  • Itching
  • Hives
  • Hoarseness
  • Dizziness or lightheadedness
  • Wheezing
  • Swelling of the face, hands, mouth, lips, tongue and/or throat

Patients can still transmit HIV to other individuals via bodily fluids, even whilst they are receiving treatment. Due to this, patients should ensure that their bodily fluids do not come into contact with other people. Patients should always use condoms during sexual intercourse, for example, and should prevent anyone from coming into contact with their blood.

Storage

Unless otherwise advised, patients should keep Emtricitabine, Rilpivirine and Tenofovir at room temperature and in a location which is away from direct light, moisture and heat. Patients should ensure that their medicine is stored in a safe location and that children and/or pets cannot access it.

If the medicine reaches its use-by date, patients should dispose of it carefully. Medicine should not be disposed of with normal household waste as it could pose a risk to other people. Patients should contact their pharmacist or physician's office for assistance with the disposal of medicines.

Summary

Although Emtricitabine, Rilpivirine and Tenofovir is not a cure for the human immunodeficiency virus, it does provide effective treatment for patients with HIV. Providing treatment is obtained quickly enough, Emtricitabine, Rilpivirine and Tenofovir can prevent the patient's immune system from being damaged. As a result, treatment with Emtricitabine, Rilpivirine and Tenofovir can help patients to avoid many of the symptoms and complications traditionally associated with HIV.