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Brand Name: Emtriva

Common Name: emtricitabine or FTC

Class:nucleoside analog (also called nucleoside reverse transcriptase inhibitor, NRTI or nuke)

Standard Dose:One 200 mg capsule once-a-day, with no food restrictions (may be taken with or without food). The dosing frequency needs to be adjusted for people who have decreased kidney function. It is also available as an oral solution, but the dose is 240 mg (or 24 mL). Take missed dose as soon as possible, but do not double up on your next dose. It may be given to children ages three months to 17 years old at a dose of 6 mg/kg up to a maximum of 240 mg of the oral solution.

AWP: $333.22 / month; $78.60 for 10 mg/mL, 170 mL

Manufacturer contact:Gilead Sciences,
www.gilead.com, 1 (800) GILEAD5 (445–3235)

AIDSInfo:1 (800) HIV–0440 (448–0440), www.aidsinfo.nih.gov

Potential side effects and toxicity:

Most common side effects include headache, diarrhea, nausea and rash. Skin discoloration observed as a darkening of the skin on the palms and the soles of the feet can occur and usually does not cause any symptoms. More hyperpigmentation seen in pediatric studies than adult studies. Rare but potentially fatal toxicity with all NRTIs is hepatomegaly with steatosis (enlarged, fatty liver) and lactic acidosis (accumulation of lactate in the blood and abnormal acid-base balance). Lactic acidosis has been seen in patients taking NRTIs but is more common and more severe in women, people who are obese and people who have been taking nukes for a long time; and more common in people with liver disease, but can occur in people without a history of liver damage. People with lactic acidosis may experience persistent fatigue, abdominal pain or distension, nausea/vomiting, and difficulty breathing or shortness of breath; and enlarged, fatty liver.

Potential drug interactions:
Do not take Emtriva if you are on Epivir or Epivir-containing product. No significant drug interactions.
Tips:
Emtriva (FTC) is called a “me-too” drug because of its similarity to Epivir (3TC); both drugs are associated with the M184V mutation (which suggests drug resistance). However, unlike Epivir, Emtriva remains in blood cells in excess of the 24-hour dosing interval (it remains inside of the cell longer).
Flare up of HBV in people co-infected with HIV/HBV has occurred when Emtriva was discontinued. Patients co-infected with HIV/HBV who stop taking Emtriva should be closely followed by their physician. Emtriva is available as a combination pill with Viread (tenofovir), which is called Truvada. In 2006, Emtriva has been combined with Sustiva (efavirenz) and Viread in one pill, which is known as Atripla.
Doctor
Emtricitabine (FTC) can be viewed as a long-acting form of lamivudine (3TC) with similar side effect and resistance characteristics. Its long half-life is a good match when combined with tenofovir and/or efavirenz allowing the drugs to protect each other from resistance in the setting of variable adherence or missed doses. Hyperpigmentation is seen occasionally (more often in African Americans). Less information is available compared to 3TC regarding the residual antiretroviral activity of FTC in the setting of the M184V mutation or impact on viral fitness though it is assumed to have similar effects. Often overlooked is the need to adjust the dose for significant renal insufficiency (also applies to combination products containing FTC). Although anti-hepatitis B activity has been demonstrated, there is much less data for FTC compared to 3TC. It is available in two-fixed dose combinations (Truvada and Atripla). —Keith Henry, MD
Activist
A newer drug than 3TC (but basically similar in most aspects) is Emtriva. It has a longer half-life than 3TC, which means that it can hang around in the body a bit longer, but it performs nearly the same. Like 3TC and some of the other nukes, it also has some activity against hepatitis B, and may be used to treat that infection as well. It is available in a co-formulation with Viread (tenofovir) and these two nukes combined into a once-a-day tablet are called Truvada. Side effects from Emtriva (like all the other HIV medications) vary from person to person, and we haven’t heard too many negative things out there, so that makes this drug a fair option as a backbone for your HIV regimen. —Cathy Olufs
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