Overview of Emtricitabine (FTC) and Tenofovir Disoproxil Fumarate (TDF) Combination

Living with HIV should not be a big problem anymore. Being exposed to the virus is concerning, but with the right medication, it’s easy to avoid or prevent the virus from entering CD4 cells. TDF/FTC drug combination has been the first drug choice recommended for many illnesses in the HIV/AIDS realms. Here is what you need to know.

TDF/FTC is a medicine commonly known under the brand name Truvada. Both medicines are approved by the United States FDA. Its common brand Truvada was approved in 2004 as an anti-HIV medication and thereafter approved in 2012 as PrEP.

It’s a drug that has gained popularity due to its high efficacy and tolerability in managing HIV conditions with the best results. Here at HIVPrEP, we cover FTC/TDF exploring its uses, dosage information, and negative effects as well as other helpful information related to this drug.

🔍What Are Emtricitabine & Tenofovir Pills Used For?

Emtricitabine tenofovir pills are used in three health conditions:

  • as an anti-HIV treatment in combination with another HIV medication for high efficacy;
  • for PrEP. In this case, the brand name Truvada is used alone alongside other sexual safer strategies to prevent the acquisition of the HIV virus in individuals who are at a higher risk of being infected;
  • as an HBV medication in combination with entecavir for treatment-experienced HIV/HBV-co-infected patients [1].
  • It is also coadministered with another drug as a remedy for PEP.

There might be other uses of this medication as a combination with other medications.

Under the brand name Truvada, this medication has been the ultimate remedy for millions of people infected with HIV. It has high efficacy in reducing the virus in the blood cells with significant performance.

👩‍🔬Clinical Study: Rate of Effectiveness for HIV Prophylaxis

Having been approved in 2012, Truvada has been in the list of top-choice meds for HIV prophylaxis – either as PrEP or PEP. Truvada has high effectiveness of up to 99% or more in virus prevention if administered as prescribed [2].

As PEP (either nonoccupational or occupational), the efficacy of this drug in combination with raltegravir is extremely high. Note that PEP must be administered early on. The earlier you take the medication, the higher the protection level. As the period of time from exposure exceeds 72 hours, protection is not guaranteed.

A patient must also stick to the drug prescription for a period of 28 days without missing a dose.

As PrEP, Truvada must be used with other protective or safer sex methods. Efficacy also depends on how an individual use the medications. Consistent daily use of this drug while exercising safe sex strategies raises its efficacy to up to 99%.

There are various ways of taking Truvada for PrEP. According to the iPREx research study [3]:

  • taking PrEP meds daily or 7 pills a week, its estimated level of protection is 99%;
  • for those who administer 4 PrEP tabs per week, the estimated drug effectiveness is 96%;
  • for individuals who take 2 PrEP pills in 7 days (or per week), their estimated level of protection is reduced to 76%;
  • an individual who injects drugs, their level of protection using PrEP is 70%+.

Other factors that may fail the efficacy of this medication include drug resistance to TDF or FTC, adverse effects that force an individual to drop medication while under PEP, and other sexual high-risk behaviors [4].

🔬Drug Mechanism of Action

FTC/TDF effectively traces the virus in the blood cells and limits its mode of action. Truvada belongs to the NTRIs drug class that has been known to have high efficacy in fighting the virus – either as a prevention or treatment.

Its mode of action is to inhibit the virus in the CD4 cells and terminate its viral DNA replication. Once the virus enters the body, it targets the CD4 DNA, infects and uses it to multiply or spread in the blood.

Truvada as an NRTIs is designed to block the HIV enzyme reverse transcriptase, thus preventing the virus from multiplying. Consistent use of this drug can substantially reduce the amount of virus in the body over time.

The same CD4 cell is an essential requirement for the body’s immune system. If these cells are infected, the immune system weakens. Truvada restores the immune functions and gives the patient a stronger, healthier, and longer life.

As PrEP, the levels of Truvada concentration in the body fight the virus whenever someone engages in unsafe sex. If the person engages in sexual activity with a person with HIV-1, Truvada intercepts the virus and tackles it before reaching the blood cells. This is also the case with PEP – constantly using Truvada + raltegravir.

📝Dosage Instructions

Truvada is a daily pill that’s taken with or without meals. If used it as PrEP, take it every day. Don’t just assume you have been exposed to HIV and start taking it at those periods only. Stopping and restarting this medication can develop other complicated health conditions such as drug resistance.

Truvada comes in different dose strengths, but the commonly used strength for PrEP is 200 mg FTC and 300 mg TDF. Closely follow your prescription. Taking it as PrEP, you must apply other safe sex methods and comply with a 3-month HIV test.

Before taking this drug, consult with your medical specialist. It’s important to have your health examined for any possible problems that might arise while administering Truvada.

😵Common Side Effects

Like any med, Truvada may come with side effects. Some of these effects are minor and easily fade away after some time.

  • vomiting;
  • stomach pain;
  • nausea;
  • headache;
  • trouble sleeping;
  • diarrhea;
  • dizziness;
  • joint pain;
  • abnormal dreams;
  • depression;
  • back pain;
  • itching.

Serious effects can be:

  • loss of appetite;
  • stomach pain;
  • pink or bloody urine.

These side effects can be managed if you consult with a doctor. In case you experience adverse reactions, don’t wait, talk to your medical specialist. It’s important to consider that stopping medication without involvement with a doctor may cause more health complications.

🔁Emtricitabine and Tenofovir Interactions with Other Substances

It’s a common occurrence for medicines to interact with other medicines. TDF/FTC is known to interact with several drugs. Some of these meds can cause serious or adverse effects to your health and it should be avoided if possible.

Other meds can cause minor interactions. Your physical condition is also an important determinant on how these drugs contribute to drug-drug or drug-disease interaction. If you have a certain illness and/or used those drugs to treat that condition, then coadministering TDF/FTC with those meds can cause further health problems.

If it’s really necessary to use these drugs, it’s important to avoid and minimize possible interactions.

Here are some of the major drugs that may cause interactions with TDF/FTC:

  • didanosine;
  • HIV-1 protease inhibitors;
  • hep C antiviral agents;
  • meds affecting renal function.

There are other drugs that can cause interactions with this medicine. Let your doctor examine all the meds you are using. Those meds may likely cause drug-drug interactions and adverse reactions. Furthermore, don’t use any other medicine without talking to your doctor first.

⚠Warnings and Precautions

There are some contraindications associated with a drug combination of TFC/TDF. It’s very important to let your doctor assess your health if have any disease (or illness) that may get worse while taking Truvada or any med in combination with TDF/FTC.

TDF/FTC warnings and precautions include:

  • if you have been diagnosed with HBV before or while using a drug combination of TDF/FTC, and stop this medication, it’s very likely that the HBV may worsen or appear once again. If you stop this medication, it’s important to monitor HBV for several months after stopping FTC/TDF;
  • since FTC/TDF is primarily eliminated by the kidneys, it’s very likely that there could be new or worsening of renal problems such as cases of Fanconi syndrome and acute renal failure;
  • the buildup of lactic acidosis;
  • coadministered with other meds of the same drug class or containing TDF/FTC;
  • tenofovir may affect bones, such as a decrease in BMD;
  • highly effective drug, it may cause immune reconstitution syndrome.

There are other drug warnings and precautions which your medical specialist should inform you about. Strictly adhering to your drug prescription can reduce health-related problems.

🤰Is This Medication Safe for Pregnant Women?

Taking medication during pregnancy should be first determined by a medical specialist. From a study, taking this drug during pregnancy appears to be safe. But it’s not known if the safety is guaranteed if taking TDF/FTC with a range of other meds [5].

If you plan to be pregnant while under TDF/FTC medication, talk with your doctor first, especially if you are using other meds. More research on safety during pregnancy is needed to fully recommend a dosage of TDF/FTC drug combinations. If you are in good health without any known illnesses, you can safely take Truvada either as PrEP or anti-HIV.

📜Takeaway

Truvada is only the approved brand version of FTC/TDF. There are several meds that have the composition of this drug combination. Although there is no approved generic of Truvada in the USA, there are other generics that work the same.

Teva has been given exclusive rights to manufacture generic Truvada (for the US market) after its patent expires in 2020 [6]. Thereafter, generic versions of Truvada will be available from various pharmaceutical companies.

Nonetheless, there are other generics containing Truvada active medicines from large companies such as Mylan, Cipla, and Hetero. Generic meds contain the same drug composition, quality, and effectiveness. The only difference is the price. Generics are more than 90% cheaper than Truvada. It’s also easy to get these tablets OTC from various sources, including online via mail order.

Cheaper generic versions of the original Truvada drug include Tenvir-EM, Ricovir-EM, Tavin-EM, and Tenof-EM, among others. You don’t have to waste thousands of dollars buying original Truvada (at around $1800 for 30 tabs) when there are generics that have the same drug efficacy and tolerability costing less than $60 for 30 tabs.

Some online drugstores sell generic PrEP plus anti-HIV meds at substantially lower cost.

📚References:

  1. Entecavir and Truvada an option for HBV for treatment-experienced HIV/HBV-co-infected patients. Michael Carter. Infohep.org. Retrieved 30 March 2011.
  2. Is Truvada, the Pill to Prevent H.I.V., 99 Percent Effective? Don’t Be So Sure. Josh Barro. Retrieved July 2014. Nytimes.com.
  3. Emtricitabine-Tenofovir Concentrations and Pre-Exposure Prophylaxis Efficacy in Men Who Have Sex with Men. Peter L. Anderson, David V. Glidden, Albert Liu, and group. Science Translational Medicine 12 Sep 2012: Vol. 4, Issue 151, pp. 151ra125.
  4. Pre-Exposure Prophylaxis for HIV Prevention: Safety Concerns.Raymond A. Tetteh corresponding author, Barbara A. Yankey, Edmund T. Nartey, Margaret Lartey, Hubert G. M. Leufkens, and Alexander N. O. Dodoo. Published online 2017 Jan 28.
  5. PrEP appears to be safe in pregnancy. Mdedge.com. Jim Kling. Retrieved February 22, 2017.
  6. Generic PrEP to Arrive in September 2020, but Will Big Savings Follow? Trenton Straube. Retrieved May 9, 2019. Poz.com.
Logan Morris

Expert in pharmaceutical practice and antiviral medicine, founder of HIVPrEP. Main goal is to popularize HIV topics and create awareness for global masses on how to prevent the disease and how to use HIV medication safely.

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