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Rukobia

fostemsavir
Used for HIV Treatment
Used for HIV Treatment

Rukobia (fostemsavir), also known as FTR, is an attachment inhibitor. Rukobia (fostemsavir) is used as part of an antiretroviral therapy (ART) for hard-to-treat human immunodeficiency virus (HIV) infections in adults. It's taken by mouth twice daily, with or without food. One of the more common side effects of Rukobia (fostemsavir) is nausea.

Reviewed by:
reviewer
Ally Tsai, PharmD
reviewer
Connie Zheng, PharmD
Last reviewed on November 26, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageCostContraindicationsAlternativesReferencesPricesMedicare
basics-icon

What is Rukobia (fostemsavir)?

What is Rukobia (fostemsavir) used for?

Human immunodeficiency virus type 1 (HIV-1) infection in adults who've received HIV medications in the past, and:

  • Past HIV medications are no longer working, or

  • Can't tolerate side effects of past HIV medications, or

  • Safety concerns about past HIV medication

How Rukobia (fostemsavir) works

Rukobia (fostemsavir) is an HIV attachment inhibitor. It attaches to a protein on the surface of HIV. This prevents the virus from infecting healthy cells and spreading.

Drug Facts

Common BrandsRukobia
Drug ClassHIV ARV
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of Rukobia (fostemsavir)?

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

Other Side Effects

  • Stomach pain
  • Indigestion
  • Feeling tired
  • Rash
  • Trouble sleeping
  • Feeling weak
  • Vomiting

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Serious liver problems: nausea, vomiting, not feeling hungry, pain in the right side of the stomach, yellowing of the whites of the eyes or skin, dark-colored urine, light-colored stool
  • Abnormal heart rhythm: chest pounding, trouble breathing, chest pain, feeling faint or lightheaded

Source: DailyMed

The following side effects have also been reported

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

  • Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
  • Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing

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

pros-and-cons

Pros and cons of Rukobia (fostemsavir)

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Pros

Might work well for people who didn’t see benefits with other medications for HIV

Can take with or without food

A possible option for people with kidney or liver problems

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Cons

Oral tablets smell like vinegar

Requires regular blood work and lab tests

Interacts with a lot of medications

pharmacist-tips

Pharmacist tips for Rukobia (fostemsavir)

pharmacist

  • Rukobia (fostemsavir) oral tablets might smell like vinegar, which is normal.

    • Get your routine blood tests done on time while you’re taking Rukobia (fostemsavir). Lab work is important to make sure that Rukobia (fostemsavir) works against the virus, and that the medication isn't causing unwanted effects.

      • Rukobia (fostemsavir) can interact with many medications. Some medications might need to be stopped or the dose changed before you start HIV ARV regimen. Let your provider or pharmacist know what medications you're taking, including over-the-counter products and supplements.

        • Talk to your provider before stopping Rukobia (fostemsavir) or any of your HIV medications. Doing so can cause the virus to spread and become harder to treat.

          • Make sure you contact your pharmacy to order a refill when you're running low on tablets. If you have to go to the hospital or emergency room, bring your Rukobia (fostemsavir) tablets. Not every hospital will have this medication in their pharmacy and you don't want to miss doses.

            • Rukobia (fostemsavir) has been shown to raise the levels of estrogen when taken together, which can cause serious blood clots. Talk with your provider if you're on birth controls with ethinyl estradiol (estrogen). Get medical attention right away if you have signs and symptoms of a heart attack (e.g., chest pain, sweating, nausea, or dizziness) or a stroke (e.g., weakness or numbness in your arms, legs, trouble speaking, blurry vision, dizziness, loss of balance, trouble walking, or confusion).

              faqs

              Frequently asked questions about Rukobia (fostemsavir)

              Is Rukobia (fostemsavir) an entry inhibitor?
              Rukobia (fostemsavir) is an entry inhibitor (also known as an attachment inhibitor). It works by attaching to a protein on the surface of HIV. This prevents the virus from infecting healthy cells and slows down the spread of HIV.
              When was Rukobia (fostemsavir) approved?
              Rukobia (fostemsavir) is an oral HIV ARV that was first approved in 2020. It's for adults who've been on HIV treatment for a while but haven't been successfully treated because of drug resistance or side effects.
              How do you take Rukobia (fostemsavir)?
              Take Rukobia (fostemsavir) by mouth twice daily, in addition to the other HIV medications prescribed by you provider. You can take it with or without food, but make sure to check the instructions on your other HIV ARVs and how to best take them. It's important to take your HIV medications at the same time every day to make sure they work as well as they can to treat your infection. Missing or skipping any of your doses can cause the virus to spread and become even harder to treat. One tip to help keep track of your HIV medications include using an app on your phone to remind you when it's time to take your medications or order refills.
              What is the most common adverse reaction to Rukobia (fostemsavir)?
              One of the more common side effects of Rukobia (fostemsavir) is nausea. If you experience nausea, don't stop taking this medication without speaking to your provider since it can cause the virus to become harder to treat. Consider taking Rukobia (fostemsavir) with food, using ginger chews, or drinking more water to help cope with symptoms of nausea. Talk to your provider if these symptoms doesn't go away. If appropriate, your provider can recommend medications to help treat nausea. Another common side effect is higher creatinine levels, which is detected through blood tests. Having higher creatinine levels might be a sign of kidney problems. If your levels are high, your provider can talk with you about next-steps.
              Are there situations where a patient should avoid taking Rukobia (fostemsavir)?
              Before starting or stopping any HIV medications, it's important to talk to your provider about what treatment option is the best for you. In particular, Rukobia (fostemsavir) shouldn't be used by adults who are allergic to fostemsavir. In addition, Rukobia (fostemsavir) isn't a good option for people who are taking certain medications that can lower its levels in the body and cause it to not work well to fight HIV, such as carbamazepine (Tegretol), phenytoin (Dilantin), or St. John’s wort.
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              What are the risks and warnings for Rukobia (fostemsavir)?

              Rukobia (fostemsavir) 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

              Overactive immune system

              Taking Rukobia (fostemsavir) can cause changes to your immune system called immune reconstitution syndrome. This is a medical condition where your immune system becomes stronger after you start Rukobia (fostemsavir) treatment and it begins to fight off different infections (infections your immune system was too weak to fight off before). In rare cases, your immune system may become so strong that it starts to attack normal cells in your body (autoimmune). You can experience immune reconstitution syndrome as early as during the first few weeks of Rukobia (fostemsavir) treatment, or many months later. Tell your healthcare provider right away if you start having any new symptoms, such as anxiety, hair loss, bulging eyes, or sweating, after starting Rukobia (fostemsavir).

              risk-warning

              Heart rhythm problems (QT prolongation)

              • Risk factors: History of heart problems | Taking medications that affect heart rhythm | Elderly people

                Rukobia (fostemsavir) can affect your heart rhythm, which can be serious and life-threatening. Your risk is higher if you have certain conditions, including heart rhythm problems, or are taking other medications that cause heart rhythm problems. Your risk is also higher if you're over 65 years old. If you feel your chest pounding, have trouble breathing, have chest pain, or feel faint or lightheaded while taking Rukobia (fostemsavir), get medical attention right away.

                risk-warning

                Liver problems

                • Risk factors: Hepatitis B or C | History of liver problems

                  People who also have hepatitis B or C infections have reported liver problems after starting Rukobia (fostemsavir). Your provider will order blood tests for you before and during treatment so they can make sure this medication is safe for your liver. Let your provider know immediately if you experience signs and symptoms of liver damage, such as feeling sleepy, nausea, loss of appetite, light-colored stool, upper right stomach pain, yellowing of the skin or eyes, or dark urine.

                  risk-warning

                  Interaction with other medications

                  Some medications can interfere with how your body removes Rukobia (fostemsavir). This can affect the amount of Rukobia (fostemsavir) in your body, how well it works, and the risk of side effects. It's important to know that this medication can stay in your body for 9 months or longer after your last dose.

                  Taking certain medications for seizures (e.g., carbamazepine (Tegretol), phenytoin (Dilantin)), St. John’s wort, or antibiotics (e.g., rifampin (Rifadin)) along with Rukobia (fostemsavir) should also be avoided. This is because these medications can lower the amount of Rukobia (fostemsavir) in your body and cause it to not work as well.

                  Rukobia (fostemsavir) also interferes with how your body removes other medications. For example, taking Rukobia (fostemsavir) with some statins (e.g., rosuvastatin (Crestor), simvastatin (Zocor)) can cause your body to absorb more of these statins and raise your risk for serious muscle problems.

                  dosage

                  Rukobia (fostemsavir) dosage forms

                  The average cost for 60 tablets of 600mg of Rukobia (fostemsavir) is $8976.60 with a free GoodRx coupon. This is 15.68% off the average retail price of $10646.27.
                  tablet
                  Tablet
                  DosageQuantityPrice as low asPrice per unit
                  600mg60 tablets$8976.60$149.61

                  Typical dosing for Rukobia (fostemsavir)

                  The typical dose is 600 mg by mouth twice daily.

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                  How much does Rukobia (fostemsavir) cost?

                  To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
                  Rukobia (brand)
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                  $8976.60

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                  contraindications-icon

                  Rukobia (fostemsavir) 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 Rukobia (fostemsavir) will not be safe for you to take.

                  Certain medications called CYP3A inducers that lower the levels of Rukobia (fostemsavir) in your body, such as carbamazepine (Tegretol), rifampin (Rifadin), or phenytoin (Dilantin)

                  alternatives

                  What are alternatives to Rukobia (fostemsavir)?

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

                  Human immunodeficiency virus type 1 (HIV-1) infection in adults who've received HIV medications in the past, and:

                  • Past HIV medications are no longer working, or

                  • Can't tolerate side effects of past HIV medications, or

                  • Safety concerns about past HIV medication

                  $8976.60 Lowest GoodRx priceView Prices
                  Trogarzo (ibalizumab)
                  Used for:

                  • HIV (in combination with other HIV medications) when other HIV treatments haven't worked well

                  View Prices

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                  References

                  Best studies we found

                  ClinicalInfoHIV.gov. (n.d.). Attachment inhibitor.

                  ClinicalInfoHIV.gov. (n.d.). Entry inhibitor.

                  ClinicalInfoHIV.gov. (n.d.). Immune reconstitution inflammatory syndrome (IRIS).

                  View All References (6)

                  HIVinfo.NIH.gov. (2021). Drug resistance.

                  National Kidney Foundation. (n.d.). Creatinine.

                  Thapa, S., et al. (2023). Immune reconstitution inflammatory syndrome. StatPearls.

                  U.S. Food and Drug Administration. (2020). FDA approves new HIV treatment for patients with limited treatment options.

                  U.S. Food and Drug Administration. (2023). Drug development and drug interactions | Table of substrates, inhibitors and inducers.

                  ViiV Healthcare Company. (2023). Rukobia- fostemsavir tromethamine tablet, film coated, extended release [package insert]. DailyMed.

                  GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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