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Brand Name: Atripla
Common Name: efavirenz, emtricitabine, and tenofovir DF
Class: Dual-class fixed dose combination; single dose regimen—nucleoside analogs (also called nucleoside reverse transcriptase inhibitors, NRTI or nukes) and non-nucleoside analog (also called non-nucleoside reverse transcriptase inhibitor, NNRTI or non-nuke)
Standard Dose: One tablet ([600 mg] Sustiva and Truvada [200 mg Emtriva, 300 mg Viread]), once-a-day; on an empty stomach or with a light, low-fat snack. Take missed dose as soon as possible, but do not double up on your next dose.
AWP: $1,438.60 / month
Manufacturer contact: Bristol-Myers Squibb,
www.atripla.com, 1 (800) 334–4486 and Gilead Sciences,
www.gilead.com, 1 (800) GILEAD5 (445–3235)
AIDSInfo:1 (800) HIV–0440 (448–0440), www.aidsinfo.nih.gov
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| Potential side effects and toxicity: |
Rash. See Sustiva, Emtriva, and Viread. Dose cannot be adjusted for people with kidney problems.
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| Potential drug interactions: |
| See Sustiva, Emtriva, and Viread. Do not take Sustiva, Emtriva, or Viread while taking Atripla, since these medications are already in Atripla. |
| Tips: |
Where to begin to sing the praises of Atripla? The new HIV drug, approved in the summer of 2006, is a complete HIV treatment by itself—no other pills needed. And this is only one pill, once a day. It’s a first in HIV and maybe all of medicine. A great benefit: the single med cuts the number of insurance co-pays. The medicines in Atripla can be very tolerable, or not, depending on the person taking them. It is well-tolerated in most people. Atripla, however, is not for everyone. Most treatment-experienced people, those who’ve already been on HIV therapy, may not be able to use it due to their having developed drug resistance, when medications may no longer work against the virus. Drug resistance most commonly occurs when people don’t take their HIV medicine as prescribed, but you may also be infected with a drug-resistant virus against which some of the medications in Atripla will not work. Because it is one dose once a day, it is important not to miss a dose. The separate components of Atripla have their various considerations: Sustiva cannot be taken during pregnancy, and use of Viread must be monitored in people with underlying kidney problems. And with Atripla, the Viread dose cannot be adjusted.
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| Doctor |
| Atripla contains in a single pill one of the DHHS preferred initial treatments for HIV infections (efavirenz plus tenofovir plus emtricitabine), making it the most convenient potent treatment currently available. Advantages include once-a-day dosing, a good safety profile, documented efficacy, and need for only one co-payment. Disadvantages to Atripla relate mostly to the individual drugs, with a low barrier to resistance being my major concern. Though the half-lives of the individual components are a better match than when efavirenz is used with AZT plus 3TC (the relative short-half lives of those drugs leave efavirenz very exposed when the combination is stopped at once), resistance to both efavrirenz and 3TC can still develop when Atripla is stopped. My own practice is to generally use Truvada plus Sustiva separately for several months to insure that all components are tolerated before changing to the combined formulation in order to avoid having to stop Atripla (thus wasting the remainder of the prescription) in case of a significant side effect. This regimen has two drugs active against hepatitis B for co-infected patients.—Keith Henry, MD |
| Activist |
| Atripla is the long awaited collaboration between Gilead Sciences (the makers of Truvada) and Bristol-Myers Squibb (Sustiva). This is the first-ever fixed dose combination pill with drugs from two different companies. Once they haggled through the piles and piles of legal paperwork, and tried an assortment of different formulations to get the potency just right… voilà! We have a one pill, once-a-day HIV drug. Great news for a lot of people who will have to pay one less co-pay now, and talk about convenience. The companies were smart about the pricing and charge the same as the component ingredients, which is the right thing to do. The only downside to this new pill is the Sustiva, which limits its use to people who can tolerate it, and to women who absolutely will not be getting pregnant any time soon.—Cathy Olufs |
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