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Pifeltro

doravirine
Used for HIV Treatment
Used for HIV Treatment

Pifeltro (doravirine) is an HIV antiretroviral (ARV) medication. It's only for people who've never taken HIV ARVs or who're currently on HIV ARVs and have a viral load of less than 50 copies/mL. Pifeltro (doravirine) is only taken once a day, but needs to be take in combination with other HIV ARVs. Some common side effects include dizziness, nausea, and headaches.

Reviewed by:
reviewer
Hope Chang, PharmD, AAHIVP
reviewer
Michelle Nguyen, PharmD
Last reviewed on April 17, 2022
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageCostContraindicationsAlternativesPricesMedicare
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What is Pifeltro (doravirine)?

What is Pifeltro (doravirine) used for?

  • HIV treatment for adults and children (who weigh around 77 lbs or more), in combination with other HIV ARVs

How Pifeltro (doravirine) works

Pifeltro (doravirine) is a non-nucleoside reverse transcriptase inhibitor (NNRTI). It stops an important enzyme (reverse transcriptase), which prevents the HIV virus from making copies of itself and spreading.

Drug Facts

Common BrandsPifeltro
Drug ClassHIV ARV
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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Avg retail price
$2255.13(save 24.08%)
GoodRx discount
$1712.02
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What are the side effects of Pifeltro (doravirine)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Please note: Pifeltro (doravirine) was taken with other HIV AVRs during clinical trials, so side effects might not all be caused by Pifeltro (doravirine) alone.
  • Dizziness (7%)
  • Nausea (5-7%)
  • Headache (4-6%)
  • Extreme tiredness (4-6%)
  • Diarrhea (4-6%)
  • Strange dreams (1-5%)
  • Stomach pain (1-5%)

Other Side Effects

  • Rash
  • Trouble sleeping
  • Sleepiness
  • Confusion, cloudy thoughts

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

pros-and-cons

Pros and cons of Pifeltro (doravirine)

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Pros

Convenient, one tablet once a day

Can be taken with or without food

Safe for most people with kidney or liver problems

No weight gain, unlike other HIV ARV drug classes (integrase inhibitors and protease inhibitors)

Doesn't interact with antacids and acid-lowering medications, unlike some other HIV ARVs like rilpivirine (Edurant)

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Cons

Not a complete regimen, must be taken with other HIV ARVs

Serious drug interactions that can cause Pifeltro (doravirine) to not work well

Has a lower barrier of resistance than other HIV ARVs, meaning HIV can become resistant to the medication if doses are missed

NNRTIs can cause sleep disturbances and psych-related side effects

Brand only, can be expensive

pharmacist-tips

Pharmacist tips for Pifeltro (doravirine)

pharmacist

  • Take Pifeltro (doravirine) at the same time every day. Continue to take this medication and your other HIV ARVs, unless your provider tells you to stop.

    • Make sure you get your blood tests drawn regularly, so your provider can see if your HIV ARVs are working safely.

      • Some medications, such as rifabutin (Mycobutin), can lower the level of Pifeltro (doravirine) in your body and cause it to not work well. You might need to separate some medications from Pifeltro (doravirine), take a different dose of Pifeltro (doravirine), or avoid taking some medications with Pifeltro (doravirine) altogether. Always talk to your care team before starting any new medication, so they can check for interactions and make adjustments, if needed.

        • Make sure you contact your pharmacy to order a refill when you're running low on tablets. Sometimes it can take a little extra time to process refills for high-cost medications like HIV ARVs and you don't want to run out of medication.

          • If you have to go to the hospital for any reason, make sure you bring Pifeltro (doravirine) and your other HIV ARVs with you. Not every hospital pharmacy will have these medications available. The staff has special procedures they will follow if they need to administer your own supply of medication, while you're in the hospital.

            faqs

            Frequently asked questions about Pifeltro (doravirine)

            When should I take Pifeltro (doravirine)?
            You can take Pifeltro (doravirine) any time of the day. The most important thing is to pick a time of day when you'll always remember. Many people find it helpful to take their HIV ARVs at the same time. Yet, if you experience a lot of side effects, like dizziness or headache with Pifeltro (doravirine), taking it at night allows you to sleep through them. Talk with your provider if you have questions about when's the best time to take your medication.
            Can Pifeltro (doravirine) be used during pregnancy?
            There isn't enough information to know if Pifeltro (doravirine) is safe in pregnancy. Let your provider know if you have plans to become pregnant, there might be other HIV regimens that are appropriate and have data regarding pregnancy safety. Your provider can also discuss with you the benefits and risk of taking Pifeltro (doravirine) while pregnant. If you decide to take this medication during pregnancy, you're encouraged to enroll in the Antiretroviral Pregnancy Registry (APR) by calling 1-800-258-4263 to help researchers better understand how Pifeltro (doravirine) affects pregnancy.
            Is it ok to take Pifeltro (doravirine) when you're breastfeeding?
            There isn't enough information to know if Pifeltro (doravirine) is safe during breastfeeding. Generally speaking, it's not recommended for people with HIV to breastfeed due to the risk of passing HIV to the breastfed infant. Talk with your provider if you have any questions about Pifeltro (doravirine) and breastfeeding.
            What happens if I miss a dose of Pifeltro (doravirine)?
            It's best not to miss a dose of Pifeltro (doravirine). If you miss a dose of Pifeltro (doravirine), the amount of medication in your system might become too low to stop the HIV virus from spreading. If this happens, there's a chance that the new HIV viruses can become resistant and can't be treated with Pifeltro (doravirine), even if the medication levels are the right amount in the future. If you do miss a dose of Pifeltro (doravirine), take it as soon as possible. But if it's almost time for your next dose, just skip the missed dose and take your next dose at the usual time. Don't double up on your medication to make up for missed doses.
            Why do you need a low viral load to switch to Pifeltro (doravirine)?
            The FDA approved Pifeltro (doravirine) for people new to HIV ARVs, and for people who have controlled HIV on their current regimen, but want to change. This comes from the results of the company's DRIVE-SHIFT trial, which studied a HIV ARV regimen switch to a regimen containing Pifeltro (doravirine), in people who had low viral loads. Right now, there isn't any data regarding a HIV ARV switch to Pifeltro (doravirine) in people with high viral loads on their current HIV ARV regimen. Talk with your provider if you're considering starting or switching to Pifeltro (doravirine).
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            What are the risks and warnings for Pifeltro (doravirine)?

            Pifeltro (doravirine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

            risk-warning

            Serious drug interactions

            • Risk factors: Taking a lot medications

              Always make sure your healthcare team has a full list of the medications you're taking, including over-the-counter (OTC) medications and supplements. Don't start taking new medications without talking to your provider or pharmacist. Many medications can interact with Pifeltro (doravirine). Some interactions, such as with carbamazepine (Tegretol), rifampin (Rifadin), and nevirapine (Viramune), lowers Pifeltro (doravirine) levels in your body and cause this medication to not work well.

              risk-warning

              Immune reconstitution syndrome (inflammation)

              • Risk factors: Weakened immune system | Current untreated infection

                Pifeltro (doravirine) can cause harmful inflammation in your body as it starts to work. This is because as the medication helps you fight HIV, your immune system starts to recover and becomes more active in fighting other infections. This is good, but can also lead to a lot of inflammation, which can be bad. Your healthcare provider might order labs to check your body for infections before starting your Pifeltro (doravirine), especially if it's your first time taking an HIV ARV. If you do have other infections, you might need to get those treated first before you can start this medication. Call your provider if you experience fever, difficulty breathing, or sudden changes to your health after starting Pifeltro (doravirine).

                The inflammation caused by Pifeltro (doravirine) can also lead to autoimmune problems in your body. This can happen months after you start this medication. Let your provider know experience any fever, aches and pains all over your body, extreme tiredness, or rash.

                dosage

                Pifeltro (doravirine) dosage forms

                The average cost for 30 tablets of 100mg of Pifeltro (doravirine) is $1712.02 with a free GoodRx coupon. This is 24.08% off the average retail price of $2255.13.
                tablet
                Tablet
                DosageQuantityPrice as low asPrice per unit
                100mg30 tablets$1712.02$57.07

                Typical dosing for Pifeltro (doravirine)

                The typical dose is 100 mg by mouth daily, with or without food.

                drug-cost

                How much does Pifeltro (doravirine) cost?

                To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
                Pifeltro (brand)
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                contraindications-icon

                Pifeltro (doravirine) contraindications

                Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Pifeltro (doravirine) will not be safe for you to take.

                • Can't be taken at the same time as medications that stongly affect Pifeltro (doravirine) metabolism, such as the herbal product St. John's wort and some antiseizure and tuberculosis treatment medications

                alternatives

                What are alternatives to Pifeltro (doravirine)?

                There are a number of medications that your doctor can prescribe in place of Pifeltro (doravirine). Compare a few possible alternatives below.
                Pifeltro (doravirine)
                Used for:

                • HIV treatment for adults and children (who weigh around 77 lbs or more), in combination with other HIV ARVs

                $1712.02 Lowest GoodRx priceView Prices
                Efavirenz (Sustiva)
                Used for:

                • Treatment of HIV infection in people ages 3 months and older

                $42.64 Lowest GoodRx priceView Prices
                Edurant (rilpivirine)
                Used for:

                • Treatment of HIV-1 infection in people 2 years and older, weighing at least 30 pounds, with an HIV viral load of less than 100,000 copies/mL and who haven't taken HIV medications before

                • Short-term treatment of HIV-1 infection in certain people ages 12 years and older, weighing at least 77 pounds, who are planning to start or planning to miss a dose of Cabenuva (cabotegravir / rilpivirine)

                $1458.97 Lowest GoodRx priceView Prices

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