6 Truvada Side Effects for PrEP and How to Manage Them

Using condoms, getting tested for sexually transmitted infections, and avoiding shared needles are all important parts of a well-rounded HIV prevention strategy. But many people benefit from preventative medications, too. Pre-exposure prophylaxis (PrEP) medications further reduce your chances of getting HIV if you’re at risk for it.

Truvada (emtricitabine / tenofovir disoproxil fumarate) is one example of a PrEP medication you can take to prevent HIV. It’s effective and well tolerated, but it still has some risks to keep in mind.

Here, we’ll review some important side effects that are possible with Truvada for PrEP. Most side effects are mild and short lived, but some are potentially serious.

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Truvada side effects at a glance

Truvada isn’t associated with many side effects, especially when taken for PrEP. Mild Truvada side effects include:

• Headache

• Stomach pain

• Weight loss

Rare but serious Truvada side effects may include:

• Kidney problems

• Difficult-to-treat HIV

• Severe hepatitis B (HBV) flare-up after stopping Truvada

• Weaker bones

• Lactic acidosis

Let’s dive into six notable side effects of Truvada and how to manage them.

Good to know: You may experience additional side effects if you take Truvada alongside other medications to treat HIV. These side effects are likely due to the combination of medications you’ll need to fight an active HIV infection.

1. Headache

Some people taking Truvada in clinical studies experienced headaches. However, they’re not very common and tend to go away with time.

You can take a few steps to start feeling better if you have a headache. Maintaining adequate hydration, practicing good sleep hygiene, and meditating are good starting points. You should also avoid dietary triggers and stressful situations, when possible. All of these strategies can help prevent headaches in the first place, too.

Over-the-counter (OTC) medications, such as acetaminophen (Tylenol), can offer added relief when needed. But it’s generally a good idea to avoid or minimize pain relievers such as ibuprofen (Advil, Motrin) due to how Truvada and NSAIDs can affect your kidneys. Your pharmacist can recommend an OTC headache medication that’s safe for you to take.

2. Stomach pain

A number of people taking Truvada for PrEP experience stomach pain. But, again, it’s not very common and should gradually improve.

If you do develop stomach pain, know that it’s manageable in most cases. You can take Truvada with or without food, but taking it with a meal or snack may help minimize discomfort. You can also take it at a different time of the day. Some people report less stomach discomfort when taking it shortly before bedtime (rather than the morning).

3. Weight loss

People taking Truvada for PrEP occasionally experience minor weight loss. A lower body weight may be a welcome change in many cases. However, it can also be an undesired effect — especially if you don’t want to lose weight in the first place.

Achieving or maintaining your target body weight may be a conversation you want to have with your healthcare professional (HCP) during your annual wellness visit. You can also talk to them about this potential risk at any point you become concerned about it.

4. New or worsening kidney problems

Truvada is a combination product that contains two medications. One component is emtricitabine, and the other is tenofovir disoproxil fumarate (TDF). TDF is sometimes associated with new or worsening kidney problems.

Before you start taking Truvada, your HCP may take a blood or urine sample from you. They’ll use the samples to run tests to make sure your kidneys are healthy enough to receive Truvada. This helps prevent kidney-related problems in advance.

Your HCP will likely monitor your kidney health throughout treatment. If any signs of harm arise, they may pause or stop your prescription. They may tell you to avoid other medications that may harm your kidneys, too. In other cases, they may opt to prescribe a PrEP medication that’s more “kidney friendly,” such as Descovy (emtricitabine / tenofovir alafenamide) or Apretude (cabotegravir).

5. Hepatitis B flare-ups

Let your HCP know if you’ve ever had hepatitis B. Do this before you start taking Truvada. They’ll want to run tests to see if the hepatitis B virus is in your body. 

Truvada suppresses the hepatitis B virus from multiplying, so stopping the medication may potentially cause a hepatitis B infection to flare up. There have been situations where this has resulted in serious liver problems in some people. Truvada has a boxed warning for this risk, the FDA’s most serious medication warning.

For this reason, if you stop taking Truvada, your HCP may still want to routinely check in with you for a few months to make sure no liver issues come up. In some cases, you may end up receiving medications to treat hepatitis B.

Good to know: If you’ve never had hepatitis B, you can still protect yourself against hepatitis by getting vaccinated. Highly effective hepatitis A and B vaccines are available. They help protect against potentially serious complications down the road, such as liver failure.

6. HIV drug resistance

You take Truvada for PrEP to avoid getting HIV — it’s a preventative treatment. However, if you test positive for HIV and continue taking Truvada by itself, the virus will likely be harder to treat. It may become resistant to certain HIV medications. This is because Truvada alone isn’t well-equipped to fight an active case of HIV.

Because of this risk, make sure to attend regularly scheduled appointments with your HCP while you’re taking PrEP. These appointments will help you stay on top of your medication regimen, and they’ll also allow you to make a swift medication change in case you ever test positive for HIV.

Do Truvada’s side effects differ if it’s used for treatment versus prevention?

Potentially. You may experience additional side effects if you’re taking Truvada in combination with another medication for HIV treatment. The side effects you experience may be from Truvada, the other medication, or both.

That being said, these are the most common side effects of Truvada-based HIV treatment:

• Fatigue

• Changes in mood, including depression

• Insomnia

• Strange dreams

• Nausea

• Diarrhea

When to contact a healthcare professional about Truvada side effects

Reach out to your HCP at any point if you experience side effects related to Truvada, such as a headache or stomach pain. They can offer tips to help you tolerate it better. You should do this even if your symptoms feel minor.

And contact your HCP right away if you develop potential symptoms of a new HIV infection, such as a fever, pronounced fatigue, and muscle aches. They can start you on an effective medication regimen to treat HIV if you have it. This will help avoid issues with medication resistance, too.

However, preventing problems is ideal when possible. You should attend regularly scheduled visits with your HCP so they can keep an eye on your kidney health, body weight, and HIV status. If necessary, they can also monitor for any signs or symptoms of hepatitis B. These checks will help you on your path to maintaining optimal health while taking Truvada.

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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:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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