efavirenz / lamivudine / tenofovir
Symfi is an HIV antiretroviral (ARV) combination tablet that contains 3 different medications: efavirenz, lamivudine, and tenofovir. It also comes as Symfi LO, which has a lower dose of efavirenze compared with Symfi. This once-daily medication is considered a complete HIV treatment regimen for many people. Symfi isn't a first choice treatment option because it can cause a lot of serious side effects, such as mood, liver, and kidney problems.
What is Symfi?
What is Symfi used for?
HIV
How Symfi works
Symfi is an HIV ARV combo medication that contains 3 medications that prevent HIV from infecting your cells and making copies of itself.
Efavirenz is a non-nucleoside reverse transcriptase inhibitor (NNRTI). It stops reverse transcriptase, an important enzyme needed for HIV DNA.
Lamivudine & tenofovir are both nucleoside reverse transcriptase inhibitors (NRTIs). They insert themselves into the virus's DNA and stop the DNA-making process.
Drug Facts
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What are the side effects of Symfi?
Common Side Effects
- Rash (13%)
- Dizziness (9%)
- Trouble sleeping (4%)
- Headache (3%)
- Diarrhea (3%)
- Vomiting (2%)
- Stomach flu (2%)
- Fever (1%)
- Cough, sore throat, and other cold or flu symptoms (1—2%)
- Shingles (1%)
- Rash (9%)
- Dizziness (6%)
- Trouble sleeping (3%)
- Cough, sore throat, and other cold or flu symptoms (3%)
- Shingles (3%)
- Diarrhea (2%)
- Stomach flu (2%)
- Fever (2%)
- Vomiting (1%)
- Headache (1%)
Serious Side Effects
- Suicide and thoughts of suicide or self-harm
- Inflammation of the pancreas: stomach pain that spreads to your back, nausea, vomiting, fast heartbeat
- High blood acid levels (lactic acidosis): muscle pain, bad stomach pain, breathing fast, tiredness, weakness, changes in heartbeat
- Severe rash, allergic reaction: blistering rash, fever, muscle or joint aches, shortness of breath, skin peeling
- Liver problems: fever, tiredness, nausea, vomiting, dark urine, clay-colored stool, stomach pain, yellowing of your skin and eyes
Source: FDA
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
- High lactic acid level—muscle pain or cramps, stomach pain, trouble breathing, general discomfort and fatigue
- Infection—fever, chills, cough, or sore throat
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Lipodystrophy—increased fat in the upper back or midsection, decreased fat in the face, arms, or legs
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
- Pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Symfi
Pros
Convenient, once-a-day tablet
Comes in two different strengths, with different amounts of efavirenz
Available as a lower-cost generic
Symfi LO can be used in children who weigh at least 88 pounds
Cons
Not a first choice treatment option for HIV
Can cause more fat to appear in the belly and upper back, and less fat in the face, arms, and legs
Not a good option for people with kidney problems, liver problems, or certain heart rhythm problems
Should be avoided during pregnancy
Pharmacist tips for Symfi
Make sure you take Symfi on an empty stomach.
Symfi can weaken your bones and put you at higher risk for broken bones. Ask your provider if you need to take calcium and vitamin D supplements while you're on this medication. Let your provider know right away if you fall or feel bone pain so they can order tests to check your bone health or look for broken or fractured bones.
Symfi can raise your cholesterol levels. Let your provider know if you have high cholesterol or are taking cholesterol medications. They might order labs to check your cholesterol regularly and might make changes to the dose of your cholesterol medications.
Symfi can put you at higher risk for seizures, especially if you're taking medications for seizures or if you've had seizures in the past. Symfi can affect the levels of some seizure medications in your body, such as phenytoin (Dilantin), and your provider might adjust your dose. Let your family or caregivers know of this risk so they can help you get medical care if you have a seizure.
Make sure your providers are aware of all the medications you're currently taking and don't start taking new medications, supplements, or vitamins without talking with your provider or pharmacist first. Symfi can interact with many medications. It can often lower the levels of other medications in your body, such as sertraline (Zoloft), ethinyl estradiol and norgestimate birth control pills, and diltiazem (Cardizem), and cause them to not work as well. Few medications, such as rifampin (Rifadin), can affect the level of Symfi and put you at higher risk for HIV infection that's difficult to control.
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 or emergency room, bring your Symfi tablets. Not every hospital will have this medication in their pharmacy, and you don't want to miss doses.
Frequently asked questions about Symfi
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What are the risks and warnings for Symfi?
Symfi 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.
Worsening of hepatitis B
Risk factors: Hepatitis B virus (HBV) | Stopping Symfi
You should get tested for HBV before starting Symfi. Don't suddenly stop taking Symfi if you have both HIV and HBV. Doing so can worsen your hepatitis B. If you have hepatitis B and your provider has instructed you to stop Symfi, you'll need to get labs drawn regularly for a few months so your provider can monitor your liver and hepatitis B infection. Sometimes, you might need to start taking medications to treat your hepatitis B infection. Let your provider know if you experience symptoms of hepatitis B infection, such as fever, tiredness, nausea, vomiting, dark urine, clay-colored stool, or yellowing of your skin and eyes.
High level of acid in the blood (lactic acidosis) and liver damage (hepatomegaly with steatosis)
Risk factors: Female | Obesity
Medications, such as Symfi, that contain lamivudine are linked to rare, but life-threatening blood acid problems and liver damage. Symptoms can include appetite loss, stomach pain, muscle pain, fast and shallow breathing, extreme tiredness, and sudden weakness. Stop taking Symfi and go to the emergency room right away if this happens.
Kidney problems
Risk factors: Kidney problems | Taking other medications that can damage the kidneys
Symfi can cause new or worsening kidney problems because of tenofovir, a medication that's removed from the body by your kidneys. Avoid other medications that can also harm the kidney, such as high doses of NSAIDs, including ibuprofen (Advil) and naproxen (Aleve). Your provider might ask you to do lab work regularly to monitor your kidneys. Let your provider know right away if you experience symptoms of kidney damage, such as bone pain, pain in your legs and feet, getting fractures more easily, and muscle pain or weakness.
Mental health effects
Risk factors: History of mental health conditions | Taking medications for mental health | History of substance abuse
Efavirenz in Symfi can put you at risk for mood problems, such as depression, thoughts of suicide, strong feelings of anger, and seeing or believing things that aren't real. If your mood changes after you start taking Symfi, let your provider know. If you want to, ask friends or family members that you trust to help you watch for changes in your mood or behavior. If you start thinking about wanting to harm yourself or others, get medical attention right away.
Central nervous system (CNS) side effects
Risk factors: Taking alcohol or other drugs that also affect your nervous system
Efavirenz in Symfi can put you at risk for CNS side effects, such as dizziness, trouble sleeping, difficulty concentrating, drowsiness, and strange dreams. These side effects are more common in the first month after you start Symfi and usually go away with time. If they don't improve or are preventing you from taking your medications daily, let your provider know.
In some cases, CNS side effects can appear months or even years after you start Symfi. Let your provider know right away if this happens. Sometimes this can be a sign of a genetic condition and you might need to switch to an HIV medication without efavirenz.
Rash
Efavirenz, one of the HIV ARVs in Symfi, can cause rash. Most of the time, the rashes appear within the first 2 weeks after you start this medication, are mild, and goes away on their own after about a month. Very rarely, some people get a very serious skin reaction that includes symptoms such as fever, and blister or peeling skin peeling. If this happens, stop taking Symfi right away and get medical help.
Liver toxicity
Risk factors: Liver problems | Hepatitis B or C infection
The efavirenz in Symfi can cause serious liver damage, especially in people with liver problems or liver infections. Your provider might have you do lab work to check the health of your liver before you start and throughout your treatment with this medication. Let your provider know immediately if you have symptoms of liver damage, such as tiredness, nausea, vomiting, dark urine, clay-colored stool, stomach pain, and yellowing of your skin and eyes.
Inflammation of the pancreas (pancreatitis)
Risk factors: Children who have history of pancreatitis | Children who have taken NRTIs in the past
Some people might experience pancreatitis while taking Symfi. Children who have taken NRTIs before, have a history of pancreatitis, or are at a high risk for pancreatitis should use Symfi with caution. Stop taking Symfi and get medical help right away if you or your child experiences stomach pain that spreads to the back, nausea, vomiting, fast heartbeat, or fever, as these could be signs of pancreatitis.
Immune reconstitution syndrome (inflammation)
Risk factors: Weakened immune system | Current untreated infection
Symfi 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 Symfi, 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 Symfi.
Symfi dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 600mg/300mg/300mg | 90 tablets | $4158.47 | $46.21 |
Typical dosing for Symfi
The typical dose is one tablet by mouth daily.
Adults and children weighing about 77 lbs (35 kg) or more: Take the Symfi LO tablet that contains 400 mg of efavirenz, 300 mg of lamivudine, and 300 mg of tenofovir.
Adults and children weighing about 88 lbs (40 kg) or more: Take the Symfi tablet that contains 600 mg of efavirenz, 300 mg of lamivudine, and 300 mg of tenofovir
How much does Symfi cost?
Symfi contraindications
Taking at the same time as elbasvir/grazoprevir (Zepatier)
What are alternatives to Symfi?
People who have never taken HIV ARVs
People who are well controlled on an HIV ARV regimen, have a viral load of less than 50, and want to switch regimens
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