Written by Rachel Nall | Published on October 25, 2013
Medically Reviewed by George Krucik, MD, MBA on October 25, 2013

What Is Atripla?

Brand Name: Atripla
Generic Name: Efavirenz, emtricitabine, tenofovir disoproxil fumarate, EFV/FTC/TDF

Atripla is a combination drug that contains 600 milligrams of efavirenz (Sustiva), 200 milligrams of emtricitabine (Emtriva), and 300 milligrams of tenofovir disoproxil fumarate (Viread). It is prescribed for the treatment of HIV.

Read the FDA description of Atripla.

What Does Atripla Do?

Two components of Atripla are emtricitabine and tenofovir disoproxil fumarate. These medications are nucleoside reverse transcriptase inhibitors (NRTIs). They block the effectiveness of the reverse transcriptase enzyme, which HIV needs to replicate in the body. Efavirenz is the third Atripla component. It is a non-nucleoside transcriptase inhibitor (NNRTI). It also reduces the ability of HIV to replicate in the body.

Atripla is not a cure for HIV. It is meant to slow the progression of the virus. You can take this medication on an empty stomach. Taking the medication at night can help to minimize side effects (FDA, 2008).

This information is a summary. Before starting this medication, discuss questions with your healthcare provider and make sure you understand dosage instructions.

What Should I Tell My Doctor Before Starting Atripla?

Tell your doctor if you:

  • have an allergy to Atripla or to any of the medications contained in Atripla
  • are abusing drugs or alcohol
  • are pregnant or planning on becoming pregnant
  • are taking medications for seizures
  • have been diagnosed with a kidney disorder and/or are currently undergoing dialysis
  • have experienced a life-threatening skin reaction, including Stevens-Johnson syndrome
  • have hepatitis B; the FDA has not approved Atripla for use in treating hepatitis B.

What Medications May Interact with Atripla?

Always tell your physician about any prescription medications or herbal remedies you are taking.

Medications that can adversely interact with Atripla include:

  • antifungal medications, such as voriconazole (Vfend)
  • antihistamines, such as astemizole (Hismanal)
  • benzodiazepines, including midazolam (Dormicum, Hypnovel, Versed), and triazolam (Apo-Triazo, Halcion, Hypam, Trilam)
  • calcium channel blockers, such as bepridil (Vascor)
  • ergot derivatives used to treat migraines, including dihydroergotamine (Migranal), ergonovine (such as Ergotrate), ergotamine (Ergomar), and methylergonovine (Methergine)
  • GI motility agents, such as cisapride (for example, Propulsid)
  • medications containing lamivudine, including Combivir, Epivir, Epivir-HBV, Epzicom, and Trizivir
  • neuroleptic medications, such as pimozide (Orap)
  • St. John’s wort

Possible Side Effects of Atripla

The following are severe and emergent side effects of Atripla. Contact your medical provider immediately if you experience:

  • hepatotoxicity, such as hepatomegaly with steatosis, that affects your liver functioning; symptoms of this condition include dark urine, decrease in appetite, fatigue, jaundice or yellowing skin, nausea, light-colored bowel movements, and tenderness over the liver
  • psychiatric problems, such as suicidal thoughts, aggressive behavior, delusions, and paranoia
  • a rash that appears suddenly; because a rash can be a life-threatening condition when taking Atripla, see your medical provider immediately
  • symptoms associated with an allergic reaction, such as hives, difficulty breathing, or sweating
  • symptoms associated with lactic acid buildup or lactic acidosis; symptoms include weakness, tiredness, difficulty breathing, stomach pain, feeling cold or feeling dizzy

The following side effects may occur but do not usually represent an emergency. Discuss them with your doctor or healthcare professional if they continue or are bothersome.

  • changes in bone density
  • changes in the distribution of body fat, such as an increasing amount of fat on the neck
  • depression
  • diarrhea
  • headache
  • immune reconstitution syndrome where the immune system experiences an inflammatory response due to the medication—this can cause other viruses in the blood to re-emerge, such as cytomegalovirus or tuberculosis
  • insomnia
  • nausea
  • rash
  • skin discolorations, such as the appearance of small freckles or spots
  • vomiting

This list may not describe all possible side effects. Call your doctor or healthcare provider for advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Atripla and Rash

Atripla can cause severe skin rashes in some patients. Examples of serious side effects include blistering, moist desquamation (where the skin thins and starts to seep moisture), and skin ulcers. See your physician immediately if you experience these side effects. An estimated 26 percent of patients in the Atripla clinical trials experienced some form of a skin rash (FDA, 2008). However, most rashes were mild to moderate.

Atripla and Alcohol

Drinking alcohol while taking Atripla can magnify the side effects of the medication, such as dizziness or psychiatric changes. Discontinue drinking alcohol to avoid these side effects.

Where Should I Keep Atripla?

Atripla should be stored at room temperature—around 77 degrees Fahrenheit (25 degrees Celsius). Keep the medication tightly closed and in its original container.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

FDA WARNING: Atripla carries a black box warning (meaning the medication has potentially lethal side effects) for its potential to cause lactic acidosis or severe hepatomegaly. The warning advises people who take Atripla to suspend medication use if they suspect they may be experiencing a toxic reaction.

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Article Sources:

●      Atripla. (2008). U.S. Food and Drug Administration. Retrieved October 21, 2013, from
●      Atripla Label Update Reflects New Efficacy, Safety and Resistance Data in Treatment Experienced Patients. (2010, January 8). U.S. Food and Drug Administration. Retrieved October 21, 2013, from
●      Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate. (2013, August 23). National Institutes of Health. Retrieved October 21, 2013, from

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