emtricitabine / tenofovir
Truvada, also known as TDF/FTC, is a combination medication that contains the antiretrovirals emtricitabine and tenofovir disoproxil fumarate. Truvada is used as part of an antiretroviral (ARV) regimen to treat HIV (human immunodeficiency virus) infections in adults and children. It's also preferred for HIV PrEP (pre-exposure prophylaxis or prevention). This medication works against HIV by stopping the virus from making copies of itself and spreading. Truvada tablets are taken by mouth once daily. Side effects when it's used for treating HIV include nausea, diarrhea, and dizziness. And Truvada side effects when used for PrEP include headache and belly pain.
What is Truvada?
What is Truvada used for?
Treatment of HIV infection
Prevention of HIV infection (PrEP or pre-exposure prophylaxis)
How Truvada works
Truvada is a combination of two HIV antiretroviral medications: emtricitabine and tenofovir disoproxil fumarate. Both medications are nucleoside reverse transcriptase inhibitors (NRTIs). They insert themselves into the genetic material of the virus. As a result, Truvada prevents HIV from making copies of itself and spreading.
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What are the side effects of Truvada?
Common Side Effects
Note: Side effects for HIV treatment were reported by people taking Truvada with efavirenz (Sustiva).
- Higher cholesterol levels (22%)
- Higher creatine kinase levels (9%)
- Feeling tired (9%)
- Depression (9%)
- Nausea (9%)
- Diarrhea (9%)
- Dizziness (8%)
- Upper respiratory infections (8%)
- Sinus infection (congestion; 8%)
- Rash (7%)
- Headache (6%)
HIV PrEP (prevention)
- Headache (7%)
- Belly pain (4%)
- Lower weight (3%)
Other Side Effects
- Vomiting
- Trouble sleeping
- Discolored skin
Serious Side Effects
- Buildup of lactic acid in the blood (lactic acidosis): feeling more tired and weak, belly pain, muscle pain, breathing problems
- Kidney problems: tiredness; confusion; nausea; urinating less than usual; swelling in your legs, ankles, or feet; 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
- Bone fracture
Source: DailyMed
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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
- Bone pain
- 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
- 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
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Truvada
Pros
Only taken once a day
Available as a lower-cost generic medication
Is a complete regimen for HIV PrEP
99% effective for preventing HIV infection from sex when used as prescribed for PrEP
Cons
Requires regular blood work and lab tests to make sure your liver and kidneys are healthy
Not a complete treatment for HIV (must take one other medication with it)
Can worsen hepatitis B if you stop taking the medication all of a sudden
More likely to cause bone problems than similar medications
Pharmacist tips for Truvada
Take Truvada every day to help the medication treat or prevent HIV the best it can. You can use an app on your phone to help you remember.
You can take Truvada with or without food.
Make sure to get your routine blood tests done on time before and while you’re taking Truvada. This helps your provider make sure the medication is working for you and not causing side effects.
Taking Truvada can sometimes put you at risk for kidney problems. It's best to avoid other medications that can raise your risk of kidney damage, such as ibuprofen (Advil) and naproxen (Aleve), while you're taking Truvada. Let your provider or pharmacist know what medications you're taking or planning to take, including over-the-counter products and supplements.
Talk to your provider about what you can do to keep your bones healthy during treatment because Truvada might weaken your bones. Ask your provider whether you need to take supplements such as calcium and vitamin D to strengthen your bones.
Speak with your provider before stopping Truvada 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 Truvada suddenly can cause your hepatitis B infection to come back or worsen.
If your child is taking Truvada and you notice major weight changes in your child, make sure to tell the healthcare team. Your child's Truvada dose might need to be changed with changes in weight (for those weighing less than 77 pounds).
Tips for taking Truvada for HIV PrEP (prevention):
Let your provider know if you have flu-like symptoms within the past month before you start Truvada for PrEP. Symptoms of a new HIV infection, such as tiredness, vomiting, diarrhea, fever, joint or muscle aches, sore throat, or night sweats, are similar to flu symptoms. You'll probably need to make an appointment for HIV testing.
Make sure to get tested for HIV before starting PrEP and at least every 3 months during PrEP.
While you're taking Truvada, continue to practice safe sex and use condoms to lower your risk of HIV and other sexually transmitted infections (STIs).
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Frequently asked questions about Truvada
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What are the risks and warnings for Truvada?
Truvada 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
Risk factors: Have hepatitis B and HIV | Stopping Truvada | Severe liver problems
If you have hepatitis B virus (HBV), suddenly stopping Truvada can make your liver condition worse (also called an HBV flare-up). Don't stop taking Truvada without talking with your provider first. Make sure to get your refills on time so that your treatment isn't interrupted. If you need to stop taking Truvada, your provider will follow up with you for several months after you stop treatment. Your provider will order blood work to check your liver for an HBV flare-up.
PrEP only for people who test negative for HIV
Risk factors: Undetected HIV infection while taking Truvada for PrEP
Truvada can be used as PrEP, also known as pre-exposure prophylaxis (prevention). It's for people who don't have HIV to help prevent infection before they're potentially exposed to the virus (e.g., through sex, through sharing needles). You'll need to test for HIV to make sure that you don't have HIV before you start PrEP and at least every 3 months while you're taking Truvada. Truvada alone isn't enough to treat HIV. So taking this medication for PrEP while you have HIV can make it easier for the virus to change form and make Truvada stop working.
Kidney problems
Risk factors: History of kidney problems | Taking other medications known to harm kidneys
Some people taking Truvada have had kidney problems. 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 and during treatment with Truvada, your provider will order blood work or urine tests to check on your kidneys. Let your provider know right away if you experience bone or muscle pain, pain in your arms or legs, and general weakness that don't go away. These might be signs of kidney problems.
Overactive immune system
Taking Truvada can cause changes to your immune system called immune reconstitution syndrome. This medical condition happens when your immune system becomes more active after you start Truvada. Your immune system begins to fight off different infections that it was too weak to fight off before you started treatment. In rare cases, your immune system might improve so much with treatment that it starts to attack normal cells in your body (autoimmune). You can develop immune reconstitution syndrome as early as during the first few weeks of taking Truvada or many months later. Tell your healthcare provider right away if you start having any new symptoms, such as fever, pain, hair loss, bulging eyes, or sweating, after you start Truvada.
Bone problems
Risk factors: History of bone fractures | HIV infection | Osteoporosis | History of kidney problems
People who take tenofovir disoproxil fumarate (which is in Truvada) can have lower bone mineral density (BMD) and bone loss. This might lead to higher risk of osteoporosis and bone fractures. In addition, some people with kidney problems who took Truvada also had bone problems that led to bone pain, pain in the arms or legs, joint pain, and muscle pain.
To check for your risk for bone problems, your provider might order additional tests to check your bone density. Talk to your provider about taking calcium and vitamin D supplements to strengthen your bone during treatment with Truvada. Let your provider know if you have bone, muscle, or joint pain or a bone fracture anytime during your treatment with Truvada.
Liver problems and lactic acidosis
Rarely, people who take medications containing NRTIs, such as Truvada, can have liver problems, like fatty liver disease. Truvada can also cause a buildup of lactic acid in the blood (lactic acidosis). Both conditions can be life-threatening.
Make sure to get blood tests done while you take Truvada so your provider can check for these harmful side effects and make sure the medication is still safe to take. Talk with your provider right away if you experience signs and symptoms of liver damage, such as upper right stomach pain, yellowing of the skin or whites of the eyes, or dark urine. Also, let your provider know if you have symptoms of lactic acidosis, such as feeling weak, muscle pain, and trouble breathing.
Interaction with other medications
Taking certain medications to treat hepatitis C (e.g., Epclusa, Harvoni) can raise the amount of Truvada in your body. This can worsen your side effects, such as fatigue, diarrhea, and nausea. Because of the potential for drug interactions with Truvada, tell your provider and pharmacist about all the medications you take or plan to take. They can make sure your medications are safe to take together.
Truvada dosage forms
Typical dosing for Truvada
Treatment of HIV
Adults and children who weigh at least 77 pounds: The typical dose is 1 tablet by mouth once daily. Each tablet contains 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate.
Children who weigh 61 to 76 pounds: The typical dose is 167 mg/250 mg (emtricitabine/tenofovir disoproxil fumarate) by mouth once daily.
Children who weigh 48 to 60 pounds: The typical dose is 133 mg/200 mg (emtricitabine/tenofovir disoproxil fumarate) by mouth once daily.
Children who weigh 37 to 47 pounds: The typical dose is 100 mg/150 mg (emtricitabine/tenofovir disoproxil fumarate) by mouth once daily.
Prevention of HIV (PrEP)
Adults and children who weigh at least 77 pounds: The typical dose is 1 tablet by mouth once daily. Each tablet contains 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate.
Your dose might differ if you have kidney problems.
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How much does Truvada cost?
Truvada contraindications
For HIV PrEP: People who have HIV (tested positive for HIV) or aren't sure what their HIV status is
What are alternatives to Truvada?
Treatment of HIV infection
Prevention of HIV infection (PrEP or pre-exposure prophylaxis)
What is the latest news about Truvada?
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References
Best studies we foundAurobindo Pharma Limited. (2023). Emtricitabine and tenofovir disoproxil fumarate tablet, film coated [package insert]. DailyMed.
Centers for Disease Control and Prevention. (n.d.). Truvada medication information sheet.
Centers for Disease Control and Prevention. (2021). Preexposure prophylaxis for the prevention of HIV infection in the United States– 2021 update.
Centers for Disease Control and Prevention. (2022). Pre-Exposure Prophylaxis (PrEP)
Clinical Info HIV.gov. (n.d.). Immune reconstitution inflammatory syndrome (IRIS).
Clinical Info HIV.gov. (n.d.). Nucleoside reverse transcriptase inhibitor (NRTI).
Clinical Info HIV.gov. (2022). What to start.
HIV.gov. (2023). Taking your HIV medicine as prescribed.
HIVinfo.NIH.gov. (2021). Drug resistance.
MedlinePlus. (2017). Fatty liver disease.
MedlinePlus. (2023). Creatine kinase.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Bone mineral density tests: What the numbers mean.
Thapa, S., et al. (2023). Immune reconstitution inflammatory syndrome. StatPearls.
Wassner, C., et al. (2020). A review and clinical understanding of tenofovir: tenofovir disoproxil fumarate versus tenofovir alafenamide. Journal of the International Association of Providers of AIDS Care.
Zucker, J., et al. (2018). Positive or not, that is the question: HIV testing for individuals on pre-exposure prophylaxis. Journal of Acquired Immune Deficiency Syndromes.
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