8 Biktarvy Side Effects You Should Know About

Biktarvy (bictegravir / emtricitabine / tenofovir alafenamide) is a combination medication that treats human immunodeficiency virus (HIV) infection. It contains three different antiretroviral medications, and each component has risks and side effects to consider. Knowing which side effects to expect, how to manage them, and when to contact your prescriber can help you get the most from Biktarvy.

Biktarvy side effects at a glance

Common and rare Biktarvy side effects are listed below. Many common Biktarvy side effects happen within the first 6 months of treatment and improve over time. But keep in mind that Biktarvy can affect people differently. So it’s best to contact your healthcare team about Biktarvy side effects you experience, even if they aren’t listed below.

Common Biktarvy side effects include:

• Diarrhea

• Nausea

• Headache

• Fatigue

• Dizziness

• Insomnia (trouble sleeping) or abnormal dreams

• Bloated stomach

Rare but serious Biktarvy side effects include:

• Immune reconstitution syndrome (a reaction that can happen as your immune system responds to the medication)

• New or worsening kidney problems

• Liver problems

• Lactic acidosis

Biktarvy also has a boxed warning (the FDA’s strictest warning for medications). If you’re living with both HIV and hepatitis B, you may experience a severe worsening of hepatitis B if you stop taking Biktarvy. You should stop the medication only under the close supervision of a healthcare professional if this applies to you.

Let’s take a more detailed look at eight Biktarvy side effects and what to do if they occur.

1. Diarrhea

Diarrhea is one of the most common Biktarvy side effects. It’s usually mild and often improves with time as your body adjusts to the medication. Staying hydrated and avoiding fried, fatty, or spicy foods can help manage diarrhea in the meantime. Talk to your healthcare team before taking an over-the-counter (OTC) medication for diarrhea; some may interact with Biktarvy.

Seek medical care if your diarrhea is severe or you notice signs of dehydration, such as dizziness, dry mouth, or peeing less often than usual.

Good to know: Diarrhea and other Biktarvy side effects may make it tempting to skip a dose of Biktarvy or stop taking it for a short time. But you shouldn’t stop taking Biktarvy or even skip a dose unless your prescriber tells you to. A missed dose can make it easier for HIV to change form and become resistant to treatment.

2. Nausea

Some people experience nausea when starting Biktarvy. Nausea and loss of appetite seem to be more common in adults over age 45. But in most cases, nausea is mild and improves over time.

Taking Biktarvy with food may help reduce nausea. Eating smaller, more frequent meals and avoiding greasy or spicy foods may also help.

If your nausea is severe or doesn’t improve, tell your healthcare team. They may suggest an anti-nausea medication. But don’t take antacids or other OTC medications for nausea without your prescriber’s OK. Some of these medications can make Biktarvy less effective if they’re taken together.

3. Headache

Headache is another common Biktarvy side effect. As with other common side effects, headaches are usually mild and tend to improve as your body gets used to the medication.

Getting enough sleep, staying hydrated, and managing stress may help reduce headaches. An OTC pain medication can help reduce headache pain if your prescriber OKs it. But it’s best to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin). They can raise the risk of kidney problems if you take them with Biktarvy.

Let your healthcare team know if your headaches are severe or don’t go away. They can help determine the cause and the best steps to manage them.

4. Fatigue

Fatigue, or feeling unusually tired, can occur while taking Biktarvy. HIV itself can also contribute to low energy levels, so it’s sometimes hard to know the exact cause. Fatigue may improve as Biktarvy works to strengthen your immune system over time.

Getting regular exercise and eating high-energy foods can help lessen fatigue. But if it’s severe or persistent, or it interferes with your daily activities, talk with your healthcare team. They may want to check for other possible causes.

5. Insomnia or abnormal dreams

Some people taking Biktarvy experience insomnia or vivid, unusual dreams.

Good sleep habits may help reduce insomnia. Try to go to bed and wake up at the same time each day, avoid caffeine late in the day, and limit screen time before bed. If sleep problems continue or are affecting your quality of life, ask your healthcare team for guidance. They may recommend a sleep medication, or they may want you to try a different HIV treatment regimen.

6. Immune reconstitution syndrome

Immune reconstitution syndrome, also known as immune reconstitution inflammatory syndrome (IRIS), is a rare but serious side effect that can occur after starting HIV treatment, including Biktarvy.

As Biktarvy helps your immune system recover, your body may begin reacting to infections that were previously hidden or inactive. This can cause inflammation and infection symptoms.

Symptoms of IRIS can vary, but they may include:

• Fever

• Swollen lymph nodes

• Cough

• Shortness of breath

• Night sweats

• Memory and thinking problems

In most cases, IRIS will resolve as your immune system continues to respond to Biktarvy treatment. But you may need additional support depending on the underlying infection that appears. It’s best to contact your healthcare team right away if you develop signs of inflammation or infection after starting Biktarvy.

7. Liver or kidney problems

In rare cases, Biktarvy may cause new or worsening kidney problems. Liver problems are also possible.

Signs and symptoms of kidney problems include:

• Swelling in your feet, ankles, or legs

• Changes in how much or how often you pee

• Bone pain or pain in your arms, legs, or feet

• Muscle pain or weakness

Signs and symptoms of liver problems can include:

• Jaundice (yellowing of the skin or eyes)

• Dark urine

• Swollen or painful stomach

• Loss of appetite

• Nausea or vomiting

Your healthcare team will likely monitor your kidney and liver function with blood tests before and during Biktarvy treatment. But contact them right away if you develop symptoms of either issue.

8. Lactic acidosis

Lactic acidosis is a rare but potentially life-threatening Biktarvy side effect. It happens when too much lactic acid builds up in the body. Signs and symptoms may include:

• Severe weakness or fatigue

• Muscle pain

• Shortness of breath or fast breathing

• Stomach pain

• Nausea and vomiting

• Cold or blue hands and feet

• Dizziness

If you experience any signs or symptoms of lactic acidosis, call 911 or seek emergency care right away.

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Written by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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