4 Truvada Interactions and How to Manage Them

The FDA’s approval of Truvada in 2012 was a groundbreaking event. It was the first HIV prevention medication to hit pharmacy shelves. It’s still a very popular medication today.

Truvada is available as an oral tablet that’s made up of two active ingredients that also come as their own individual medications, emtricitabine (Emtriva) and tenofovir disoproxil fumarate (Viread). These two medications work together to stop the HIV virus from replicating. So, if you’re exposed to HIV, it can prevent the virus from taking hold in your body. Truvada is effective at treating HIV when combined with other medications, too.

It’s important to protect Truvada’s intended effects — no matter the use. It’s considered a life-changing medication after all. In some cases, this involves being aware of drug interactions that can affect Truvada’s safety and effectiveness.

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Let’s review four important Truvada interactions you should know about and how you can manage them.

1. Medications that impact your kidney health

Your kidneys play an important role in removing Truvada from your body. Because of this, you should try to avoid medications that could injure your kidneys. Your healthcare professional (HCP) can help you with this.

Several medications fall into this category. And some have a higher risk of it than others. For instance, common products that are linked to kidney injury include zoledronic acid (Reclast, Zometa), amphotericin B (Ambisome), and contrast dyes, such as Omnipaque (iohexol).

If you need medications like these, keep an eye out for symptoms of sudden kidney injury, including difficulty producing urine, fatigue, and lower leg swelling. Bone and muscle pain are possible symptoms of kidney injury too. Contact your HCP for further evaluation if you’re experiencing any of these.

Medications that rely on your kidneys for breakdown and removal

Your kidneys may remove other medications from your body the same way they remove Truvada. This competition could cause the amount of both medications in your body to increase when they’re taken together. In turn, this increases your chances of experiencing side effects from one or both products. Examples include:

• Acyclovir (Zovirax)

• Ganciclovir

• Valacyclovir (Valtrex)

• Valganciclovir (Valcyte)

• Gentamicin

It’s important to share a complete list of all medications and supplements you take with your HCP. They can screen your medication list for interactions to reduce your risk of kidney injury and medication side effects.

2. NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and diclofenac (Cambia, Cataflam), treat many health conditions involving pain and inflammation. They don’t always mix well with Truvada, though. Similar to medications listed above, they can cause kidney damage or worsen kidney problems you may already have. 

Why the risk? NSAIDs decrease blood flow to the kidneys. This can potentially cause kidney damage. This risk is more prevalent among those who take high doses of NSAIDs or multiple NSAIDs in quick succession. It’s likely not a problem if you take a dose of ibuprofen for an occasional headache, though. 

To be safe, consider taking other medications that don’t have this interaction. Acetaminophen (Tylenol) is likely a safer pain reliever to use if you’re taking Truvada.

3. HIV protease inhibitors

Protease inhibitors are a broad class of medications that treat HIV. Examples of protease inhibitors include Prezista (darunavir) and Reyataz (atazanavir). These medications are often included in combination medications that fight HIV too, such as Prezcobix (darunavir / cobicistat) and Evotaz (atazanavir / cobicistat). 

However, combining an HIV protease inhibitor with Truvada can affect the safety of both medications.

Truvada may decrease the amount of Reyataz in your body. This interaction can reduce Reyataz’s ability to fight HIV. On the other hand, protease inhibitors may increase levels of a component of Truvada in your blood: tenofovir disoproxil fumarate (TDF). When TDF levels rise, this can increase your likelihood of experiencing Truvada side effects. Common side effects include rash, diarrhea, and headache.

Good to know: This interaction is generally only an issue if you’re taking Truvada to treat HIV — the interacting medications are used less often for HIV prevention.

4. Hepatitis C medications

Hepatitis C medications are powerful medications that can treat, and even cure, hepatitis. Harvoni (ledipasvir / sofosbuvir), Mavyret (glecaprevir / pibrentasvir), and Epclusa (velpatasvir / sofosbuvir) are all common choices. But several of them may interact with Truvada. 

Your hepatitis C medication can increase the levels of TDF in your blood. Again, this worsens the risk of developing side effects from Truvada.

It's important to tell your HCP if you need to start treatment for hepatitis C. You should also tell them if you’re currently taking a hepatitis C medication (if they don’t already know). Your HCP can adjust your HIV or hepatitis C medication routine so there isn’t an interaction.

Does alcohol make Truvada less effective?

Alcohol doesn’t directly impact Truvada’s effectiveness. But the combination still has a few risks.

Excessive alcohol consumption may impair your judgment and lead to risky behaviors. In some cases, these can increase HIV transmission risks. Truvada won’t work well to treat or prevent HIV if alcohol consumption is interfering with your ability to take Truvada regularly.

What’s more, dizziness is a possible side effect of Truvada. It can also happen after drinking alcohol — especially in large amounts. This effect can be additive when taking Truvada and alcohol together. It's important to drink alcohol responsibly while taking Truvada. 

Can you take Viagra with PrEP?

Yes, it’s OK to take Viagra (sildenafil) while taking Truvada or Descovy (emtricitabine / tenofovir alafenamide) for HIV pre-exposure prophylaxis (PrEP). Viagra belongs to a class of medications that treat erectile dysfunction (ED). While there are many medications that may interact with Viagra, Truvada isn’t one of them. 

When to contact your healthcare professional about a Truvada interaction

Several Truvada drug interactions are minor and may not require immediate medical attention. For example, some medications may cause Truvada levels to slightly increase in your body. This may put you at increased risk of side effects, such as mild diarrhea. If you find it hard to tolerate these side effects, let your HCP know.

Other interactions have more severe risks. These require more prompt assistance. For instance, taking high doses of NSAIDs can cause kidney injury while taking Truvada. This can be sudden and severe. If you’re having trouble producing urine, develop swelling in your legs, or feel unusually fatigued or tired, these can be symptoms of trouble. Seek immediate medical attention if you’re experiencing symptoms like these.

It's much easier to prevent problems in the first place. Have your pharmacist scan your medication list before you start taking anything new. Be sure to share a list with your prescriber too. They can proactively evaluate your medications and make changes as needed.

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Written by:

Mandeep Sohal, PharmD

Mandeep Sohal, PharmD, has more than 7 years of experience in the pharmaceutical industry and is licensed in California. In his career, he’s had experience with specialty pharmacy, community pharmacy, pharmacy benefit management, and pharmaceutical manufacturers.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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