Symtuza
Symtuza is a combination medication that treats human immunodeficiency virus (HIV). It's a tablet that contains three antiretroviral (ARV) medications — darunavir, emtricitabine, and tenofovir alafenamide — and a "booster" that helps the ARVs work better against the virus called cobicistat . Symtuza, also known as DRV/c/TAF/FTC, is a complete therapy for people with HIV weighing at least 88 pounds. It's taken once daily with food. Some common side effects of Symtuza include nausea and diarrhea.
What is Symtuza?
What is Symtuza used for?
Treatment of HIV
How Symtuza works
Symtuza is a combination of four active ingredients that work together to treat HIV.
Emtricitabine and tenofovir alafenamide are nucleoside reverse transcriptase inhibitors (NRTIs). These medications insert themselves into the genetic material of the virus to block the HIV protein called reverse transcriptase from working. As a result, emtricitabine and tenofovir alafenamide prevent HIV from making copies of itself.
Darunavir is a protease inhibitor. It blocks HIV protease, a protein that helps the virus mature and infect other healthy cells. By blocking protease from working, darunavir prevents the virus from spreading.
Cobicistat is commonly called a "booster" medication when it's taken along with other HIV antiretrovirals. It can slow the breakdown of other HIV ARVs, particularly darunavir, in the body. This "boosts" the levels of the other HIV ARVs in the body, which helps them to work better to fight the infection.
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What are the side effects of Symtuza?
Common Side Effects
- Diarrhea (9%)
- Rash (8%)
- Nausea (6%)
- Feeling tired (4%)
- Headache (3%)
Other Side Effects
- Belly discomfort
- Excess gas
Serious Side Effects
- Buildup of lactic acid in the blood (lactic acidosis): feeling more tired or weak, belly pain, muscle pain, breathing problems
- Kidney problems: tiredness, confusion, nausea, urinating less than usual, swelling in your legs, joint or bone pain
- 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
- Severe allergic reactions: facial swelling, hives, rash, itchy skin, blistering or peeling of skin, body aches, trouble breathing
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
- High blood sugar (hyperglycemia)—increased thirst or amount of urine, unusual weakness or fatigue, blurry vision
- 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
- Rash, fever, and swollen lymph nodes
- 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 Symtuza
Pros
Only taken once a day
Is a complete treatment for HIV
Can split tablet into two pieces with a pill splitter if you have trouble swallowing pills
Cons
Must take with food
Requires regular blood work and lab tests to make sure your liver and kidneys are healthy
Interacts with many medications, including blood thinners, statins, sedatives, and others
Pharmacist tips for Symtuza
Take Symtuza every day with food to help the medication treat HIV the best it can. You can use an app on your phone to help you remember.
If you have trouble swallowing, you can cut the tablet into two smaller pieces using a pill splitter so it's easier to take.
Make sure to get your routine lab tests done on time while you’re taking Symtuza. This helps your healthcare team make sure that the medication is working for you and that you don't have concerning side effects.
It's important to let your care team know what medications you're taking or planning to take. These include prescription medications, over-the-counter products, and supplements. Symtuza can interact with many medications, which can either make your medications work less well or put you at risk for side effects. Your prescribers might need to adjust your medications to keep you safe.
Speak with your healthcare team before you stop Symtuza or any of your HIV medications. Stopping your HIV medications too soon can cause the virus to spread and become harder to treat. And if you also have hepatitis B, stopping Symtuza can cause your hepatitis B infection to come back or worsen.
Symtuza might raise your blood sugar levels. This can lead to or worsen diabetes. Ask your care team if you should check your blood sugar while you're taking this medication. You might need to take additional medications to help control your sugar levels if they're too high.
If your child is taking Symtuza and you notice major weight changes in your child, make sure to tell the prescriber. This medication might not be safe for those weighing under 88 pounds.
Frequently asked questions about Symtuza
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What are the risks and warnings for Symtuza?
Symtuza 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 infection in people with HIV and hepatitis B
Risk factors: Have hepatitis B and HIV | Stopping Symtuza | Severe liver problems
Before you start Symtuza, your healthcare team will check whether you're infected with the hepatitis B virus (HBV). This is because HBV can sometimes worsen if you take Symtuza and then stop the medication. This is also known as a hepatitis B flare. In some cases, it's led to a sudden worsening of liver function or liver failure.
If you have HBV and HIV, don't stop taking Symtuza without talking with your healthcare team first. Make sure to get your refills on time so that your treatment isn't interrupted. If you need to stop taking the medication, your healthcare team will continue to follow up with you for several months after you stop treatment. Your healthcare team will order blood work to check your liver for a hepatitis B flare.
Liver problems and lactic acidosis
Risk factors: Liver problems, including hepatitis B or C
In some rare cases, people who take medications containing NRTIs, such as Symtuza, have had liver problems. These liver problems can include a buildup of fat in the liver, leading to swelling and inflammation of the liver. Symtuza can also cause a buildup of lactic acid in the blood (lactic acidosis). Both conditions can be life-threatening.
Make sure to get the blood tests that your prescriber recommended as you continue treatment. These blood tests help your care team check for harmful effects on the liver and make sure Symtuza is still safe to take.
Talk with your healthcare team right away if you have signs and symptoms of liver damage, such as upper right-sided stomach pain, yellowing of the skin or whites of the eyes, or dark urine. Also let your care team know if you have symptoms of lactic acidosis, such as weakness, confusion, muscle pain, and rapid breathing.
Severe skin reactions and allergic reactions
Risk factor: Sulfa allergies
Symtuza, specifically the darunavir component of the combination medication, can sometimes cause rash and other severe skin reactions. In studies, some people developed a mild or moderate rash within the first 4 weeks of treatment.
If you develop a mild or moderate rash while you're taking Symtuza, continue taking the medication and let your healthcare team know. Oftentimes, the rash goes away on its own. But if you develop a severe rash or if your rash gets worse, talk with your care team right away. Stop taking Symtuza and get medical help right away if you have a severe rash with fever, general discomfort, muscle or joint pain, mouth sores, blisters, or facial swelling.
People with a sulfa allergy might experience similar allergic reactions, including rash, with Symtuza. Make sure your healthcare team knows about all of your medication allergies, especially if they're severe.
Overactive immune system
Risk factors: Current untreated infection
Taking Symtuza can cause your body to have an intense immune response called immune reconstitution syndrome. Your immune system becomes stronger and more active once you start taking Symtuza to treat HIV. Your immune system then begins to fight off any infections that it was too weak to defend against before you started treatment. This intense immune response can lead to a lot of inflammation.
In rare cases, your immune system can become so strong that it starts to attack healthy cells in your body, leading to certain autoimmune problems. These autoimmune problems can appear as early as during the first few weeks of treatment or many months later.
Tell your healthcare team if you have a fever, difficulty breathing, cough, or any new, unusual symptoms, such as sweating more or hair loss, after you start Symtuza. These might be signs and symptoms of immune reconstitution syndrome and its complications.
Kidney problems
Risk factors: History of kidney problems | Taking other medications that can harm the kidneys
Some people who take Symtuza have had kidney problems as early as two weeks after starting treatment. To prevent kidney injury, it's recommended that you avoid taking other medications that can also harm the kidneys, like high doses of nonsteroidal anti-inflammatory drugs (NSAIDs).
Before starting Symtuza, your healthcare team will order blood work or urine tests to check on your kidneys. They'll continue to check periodically during treatment. Let your care team know right away if you experience swelling, muscle pain, or general weakness that don't go away. These might be signs of kidney problems.
Changes in body fat
In some rare cases, people who take HIV medications, such as Symtuza, can notice changes in body fat. These changes include fat buildup in the back of the neck, breast, and around the middle of the body. Some people also lost fat from the legs, arms, and face. It's not clear whether Symtuza causes these changes to body fat, why this happens, and whether it'll affect your health in the future. Let your healthcare team know if these changes occur while you're taking Symtuza.
Bleeding in people with hemophilia
Some people with a bleeding condition called hemophilia have had more bleeding after they started taking protease inhibitors, including Symtuza. In about half of the reported cases, people could continue to take this medication after the bleeding stops. It's not clear whether taking Symtuza was related to having more bleeding episodes.
Tell your care team if you have bleeding episodes more often while you're taking Symtuza. Contact your care team right away if you have pain and swelling in your joints or bruising on your skin. These can be signs that blood has built up under the skin or in your joints.
Interactions with other medications
Symtuza can interact with many medications. Some drug interactions, such as with certain other HIV medications or anti-seizure medications, can make Symtuza work less well. This can make it more likely for HIV to spread and become harder to treat. Other types of drug interactions can raise your risk for side effects.
Because of the potential for drug interactions with Symtuza, tell your healthcare team about all the medications you take or plan to take. They can make sure your medications are safe to take together.
Symtuza dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 800mg/150mg/200mg/10mg | 30 tablets | $4588.31 | $152.94 |
Typical dosing for Symtuza
Each Symtuza tablet contains 800 mg of darunavir, 150 mg of cobicistat, 200 mg of emtricitabine, and 10 mg of tenofovir alafenamide)
Adults and children who weigh at least 88 pounds: The typical dose is 1 tablet by mouth once daily with food.
How much does Symtuza cost?
Symtuza contraindications
Taking with certain medications that interact with Symtuza and raise the risk for serious side effects or make medications work less well
What are alternatives to Symtuza?
Treatment of HIV infection (in people who weigh at least 22 pounds)
Starting HIV treatment for the first time, or
Have a HIV viral load of less than 50 copies/mL from a previous ART
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References
Best studies we foundCenters for Disease Control and Prevention. (2024). About hemophilia.
Chang, M. L., et al. (2014). Hepatitis B flares in chronic hepatitis B: Pathogenesis, natural course, and management. Journal of Hepatology.
ClinicalInfoHIV.gov. (n.d.). Boosting.
ClinicalInfoHIV.gov. (n.d.). Immune reconstitution inflammatory syndrome (IRIS).
ClinicalInfoHIV.gov. (n.d.). Nucleoside reverse transcriptase inhibitor (NRTI).
ClinicalInfoHIV.gov. (n.d.). Reverse transcriptase.
ClinicalInfoHIV.gov. (2024). What to start: Initial combination antiretroviral regimens for people with HIV. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV.
Janssen Products LP. (2024). Symtuza- darunavir, cobicistat, emtricitabine, and tenofovir alafenamide tablet, film coated [package insert]. DailyMed.
Johnson & Johnson. (2018). Janssen announces U.S. FDA approval of SYMTUZA™ (D/C/F/TAF), the first and only complete darunavir-based single-tablet regimen for the treatment of HIV-1 infection.
Thapa, S., et al. (2023). Immune reconstitution inflammatory syndrome. StatPearls.
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