Truvada is a brand-name prescription medication that’s used for treating HIV infection. It’s also used for preventing HIV infection in people who have a high risk of getting HIV. This use, in which the treatment is given before the person may be exposed to HIV, is called pre-exposure prophylaxis (PrEP).

Truvada contains two drugs in one pill: emtricitabine and tenofovir disoproxil fumarate. Both drugs are classified as nucleoside reverse transcriptase inhibitors (NRTIs). These are antiviral drugs, which are used to treat infection from viruses. These specific antiviral drugs fight HIV (human immunodeficiency virus).

Truvada comes as a tablet you take by mouth once daily.

Effectiveness

Truvada has been found to be effective for both treating and preventing HIV.

For HIV treatment

According to treatment guidelines, Truvada, in combination with another antiviral drug, is considered a first-choice option for a person who’s starting HIV treatment.

First-choice drugs for HIV are medications that are:

  • effective for reducing virus levels
  • have fewer side effects than other options
  • easy to use

In some cases, Truvada may be used to treat people who’ve tried a different HIV treatment that didn’t work for them.

Truvada is considered a “backbone” medication. That means it’s one of the drugs that an HIV treatment plan is based on. Other drugs are taken in combination with a backbone medication. Antiviral drugs that may be used with Truvada include dolutegravir (Tivicay) and raltegravir (Isentress).

In one study, 84 percent of people treated with Truvada in combination with efavirenz (Sustiva) were considered responders after 48 weeks of treatment. After 144 weeks, 71 percent were considered responders. A responder is a person for whom a treatment reduces their HIV level by a certain amount.

In another study, more than 90 percent of people treated with Truvada and dolutegravir (Tivicay) were considered responders after 48 weeks.

How well Truvada works for each person depends on many factors. These factors include:

  • characteristics of their HIV disease
  • other health conditions they have
  • how closely they stick to their treatment regimen

For HIV prevention (PrEP)

Truvada is the only treatment approved by the Food and Drug Administration (FDA) for PrEP. It’s also the only PrEP treatment recommended by the Centers for Disease Control and Prevention (CDC).

In studies, Truvada reduced the risk of HIV infection by 42 percent to 53 percent in men who have sex with men, and transgender women who have sex with men.

In another study, Truvada reduced the risk of HIV transmission by 75 percent between heterosexual, mixed-status couples. Mixed-status couples have one partner with HIV and one partner without it.

Truvada is available only as a brand-name medication. It’s not currently available in generic form.

Truvada contains two active drug ingredients: emtricitabine and tenofovir disoproxil fumarate.

Truvada can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Truvada. This list does not include all possible side effects.

For more information on the possible side effects of Truvada, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common side effects of Truvada include:

  • fatigue
  • depression
  • nausea
  • vomiting
  • diarrhea
  • dizziness
  • respiratory infections
  • sinus infection
  • rash
  • headache
  • trouble sleeping
  • sore throat
  • high cholesterol

Many of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects can include:

  • bone loss
  • immune reconstitution syndrome
  • kidney problems
  • lactic acidosis
  • liver problems

See below for more information about these serious side effects.

Bone loss

Truvada might cause bone loss in adults, and decrease bone growth in children. In a study lasting about 1.5 years, 13 percent of people who took Truvada had a 5 percent or greater decrease in bone mass. In this same study, 1.7 percent of people who took Truvada had a bone fracture.

If you take Truvada, your doctor may do tests to check for bone loss. They may also recommend that you take vitamin D and calcium supplements to help prevent bone loss.

Immune reconstitution syndrome

Treatment of HIV with Truvada or similar medications can cause a quick improvement in the function of your immune system (which fights disease).

In some cases, this can cause your body to respond to infections you’ve had in the past. This can make it seem like you have a new infection, but it’s really just your body's strengthened immune system reacting to an older infection.

This condition is called immune reconstitution syndrome. It’s also called immune reconstitution inflammatory syndrome (IRIS), because your body often responds to the infection with high levels of inflammation.

Examples of infections that can “reappear” with this condition include tuberculosis, pneumonia, and fungal infections. If these infections reoccur, your doctor will likely prescribe antibiotic or antifungal medications to treat them.

Kidney problems

In some people, Truvada can cause or worsen kidney problems. However, the risk seems to be low. In a study lasting about 1.5 years, decreased kidney function occurred in less than 1 percent of people taking Truvada.

Your doctor will do blood tests to check your kidney function before and during your treatment with Truvada. If your kidneys aren’t working well, your doctor may change your dosage of Truvada. If you have severe kidney problems, you may not be able to take Truvada.

Symptoms of kidney problems can include:

  • bone or muscle pain
  • weakness
  • fatigue
  • nausea
  • vomiting
  • decreased urine output

Lactic acidosis

There are some reports of lactic acidosis in people who take Truvada. Lactic acidosis is a buildup of acid in the body that can become life-threatening. If you develop symptoms of lactic acidosis, your doctor may recommend stopping your treatment with Truvada.

Symptoms of lactic acidosis can include:

  • muscle cramps
  • confusion
  • fruity-smelling breath
  • weakness
  • fatigue
  • trouble breathing

Liver problems

Some people can have liver damage while taking Truvada. How often this happens isn’t clear. If you develop symptoms of liver damage, your doctor may recommend stopping your treatment with Truvada. When Truvada treatment is stopped, liver problems may improve.

Symptoms of liver damage can include:

  • pain or swelling in your abdomen
  • nausea
  • vomiting
  • fatigue
  • yellowing of your skin and the whites of your eyes

Worsening of hepatitis B virus infection

Worsening of hepatitis B virus infection can happen in people with hepatitis B who stop taking Truvada. If you have hepatitis B and stop taking Truvada, your doctor will do blood tests from time to time to check your liver for several months after stopping the drug.

Symptoms of hepatitis B infection can include:

  • pain or swelling in your abdomen
  • nausea
  • vomiting
  • fatigue
  • yellowing of your skin and the whites of your eyes

Long-term side effects

Long-term use of Truvada can increase your risk of:

  • Bone loss. In a study lasting about 1.5 years, 13 percent of people who took Truvada had a decrease in bone density of 5 percent or more. In this same study, 1.7 percent of those who took Truvada had a bone fracture.
  • Kidney problems. In a study lasting about 1.5 years, decreased kidney function occurred in less than 1 percent of people taking Truvada.

If these side effects occur or become severe, your doctor may recommend that you stop taking Truvada and switch to another treatment.

When used for treating HIV, Truvada is used in combination with other antiviral drugs. Depending on what other drugs are taken with Truvada, other long-term side effects may also occur.

Skin rash

Rash is a common side effect of Truvada. In a clinical study, 7 percent of people who took Truvada had a rash. This side effect may go away with continued use of the drug.

Weight loss or gain

Weight loss occurred in 3 percent of people in a clinical study of Truvada. Weight gain has not been reported in studies of Truvada.

Diarrhea

Diarrhea is a common side effect of Truvada. In a clinical study, 9 percent of people who took Truvada had diarrhea. This side effect may decrease or go away with continued use of the drug.

Upset stomach

Stomach upset, including stomach pain, nausea, vomiting, and diarrhea, can happen in people who take Truvada. In one study of people taking Truvada:

  • 9 percent had diarrhea
  • 9 percent had nausea
  • 4 percent had stomach pain
  • 2 percent had vomiting

These side effects may decrease or go away with continued use of the drug.

Nausea

Nausea is a common side effect of Truvada. In a clinical study, 9 percent of people who took Truvada had nausea. This side effect may go away with continued use of the drug.

Depression

Depression is a common side effect of Truvada. In a clinical study, 9 percent of people who took Truvada had symptoms of depression. This side effect may go away with continued used of the drug. If symptoms of depression don’t go away or they become severe, talk with your doctor.

Fatigue or tiredness

Fatigue is a common side effect of Truvada. In a clinical study, 9 percent of people who took Truvada had fatigue. This side effect may go away with continued use of the drug.

Headache

Headache is a common side effect of Truvada. In a clinical study, 6 percent of people who took Truvada had headaches. This side effect may go away with continued use of the drug.

Insomnia

Insomnia (trouble sleeping) is a common side effect of Truvada. In a clinical study, 5 percent of people who took Truvada had insomnia. This side effect may go away with continued use of the drug.

Sore throat

Sore throat is a common side effect of Truvada. In a clinical study, 5 percent of people who took Truvada had sore throat. This side effect may go away with continued used.

Joint, bone, and muscle pain

Bone, joint, and muscle pain have been reported by people who take Truvada or the individual drugs contained in Truvada. How often these side effects happen in people taking Truvada isn’t clear.

Diabetes

Diabetes is not a side effect that has been reported in studies of Truvada. However, a kidney condition called nephrogenic diabetes insipidus has occurred in people taking Truvada. With this condition, the kidneys don’t function correctly, and the person passes a large amount of urine. This can lead to dehydration.

If you have this condition and it becomes severe, your doctor may stop your treatment with Truvada.

Symptoms of nephrogenic diabetes insipidus can include:

  • dry skin
  • decreased memory
  • dizziness
  • fatigue
  • headache
  • muscle pain
  • weight loss
  • orthostatic hypotension (low blood pressure causing dizziness upon standing)

Hair loss

Hair loss is not a side effect that has been reported in clinical studies of Truvada. If you have hair loss that’s troublesome or becomes severe, talk with your doctor.

Constipation

Constipation is not a side effect that has been reported in clinical studies of Truvada. If you have constipation that doesn’t go away or becomes severe, talk with your doctor.

Acne

Acne is not a side effect that has been reported in clinical studies of Truvada. If you have acne that’s troublesome or becomes severe, talk with your doctor.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Drug forms and strengths

Truvada comes as an oral tablet that contains two drugs in each pill: emtricitabine and tenofovir disoproxil fumarate. It comes in four strengths:

  • 100 mg emtricitabine / 150 mg tenofovir disoproxil fumarate
  • 133 mg emtricitabine / 200 mg tenofovir disoproxil fumarate
  • 167 mg emtricitabine / 250 mg tenofovir disoproxil fumarate
  • 200 mg emtricitabine / 300 mg tenofovir disoproxil fumarate

Dosage for HIV treatment

The dosage of Truvada depends on a person’s weight. These are typical dosages:

  • For adults or children who weigh 35 kg (77 lbs) or more: One tablet, 200 mg emtricitabine / 300 mg tenofovir disoproxil fumarate, taken once daily.
  • For children who weigh 28 to 34 kg (62 to 75 lb): One tablet, 167 mg emtricitabine / 250 mg tenofovir disoproxil fumarate, taken once daily.
  • For children who weigh 22 to 27 kg (48 to 59 lb): One tablet, 133 mg emtricitabine / 200 mg tenofovir disoproxil fumarate, taken once daily.
  • For children who weigh 17 to 21 kg (37 to 46 lb): One tablet, 100 mg emtricitabine / 150 mg tenofovir disoproxil fumarate, taken once daily.

For people with kidney disease: Your doctor may change how often you take Truvada.

  • For mild kidney disease, no dosage change is needed.
  • For moderate kidney disease, you may take Truvada every other day.
  • For severe kidney disease, including if you’re on dialysis, you may not be able to take Truvada.

Dosage for HIV prevention (PrEP)

For adults or adolescents who weigh 35 kg (77 lbs) or more, one tablet of 200 mg emtricitabine / 300 mg tenofovir disoproxil fumarate is taken once daily. (The manufacturer doesn’t provide dosage for people who weigh less than 35 kg [77 lbs]).

If you have kidney disease, you may not be able to take Truvada for pre-exposure prophylaxis (PrEP).

What if I miss a dose? Should I take a double dose?

If you miss a dose, take it as soon as you remember. But if it’s almost time for your next dose, just take that one dose. Don’t double the dose to catch up. Taking two doses at once could increase your risk of serious side effects.

If you think you’ve accidentally taken two or more doses in one day, call your doctor. They may recommend treatment for any symptoms you may be having, or treatment to prevent side effects from occurring.

Testing before starting Truvada

Before starting Truvada, your doctor will do certain blood tests. These tests will check for:

  • hepatitis B virus infection
  • kidney and liver function problems
  • presence of HIV infection (for PrEP only)
  • HIV and immune system blood cell counts (for HIV treatment only)

Your doctor will do these blood tests and others before you start taking Truvada, and from time to time during your treatment with the medication.

The Food and Drug Administration (FDA) approves prescription drugs such as Truvada to treat certain conditions.

Approved uses for Truvada

Truvada is FDA-approved for treating HIV infection, and for preventing HIV infection in people who have a high risk of getting HIV. This second use, in which the treatment is given before the person may be exposed to the HIV virus, is called pre-exposure prophylaxis (PrEP).

Truvada for HIV

Truvada is approved to treat HIV infection in both adults and children. Truvada is always used along with at least one other antiviral drug for treating HIV. Examples of antiviral drugs that may be used with Truvada to treat HIV include:

  • Isentress (raltegravir)
  • Tivicay (dolutegravir)
  • Evotaz (atazanavir and cobicistat)
  • Prezcobix (darunavir and cobicistat)
  • Kaletra (lopinavir and ritonavir)
  • Prezista (darunavir)
  • Reyataz (atazanavir)
  • Norvir (ritonavir)

Truvada for pre-exposure prophylaxis (PrEP)

Truvada is approved for preventing HIV in adults and adolescents with a high risk of getting HIV. People with a high risk of getting HIV include those who:

  • have a sex partner who has HIV infection
  • are sexually active in a geographic area where HIV is common and have other risk factors, such as:

Uses that are not approved

Truvada may be used off-label for other uses. Off-label use is when a drug that’s approved for one purpose is used for a different purpose.

Truvada for herpes

Some clinical studies have tested whether Truvada, when used for PrEP, can also prevent herpes infection.

In one study, when Truvada was used for PrEP in heterosexual men and women in Kenya and Uganda, the risk of infection with herpes virus was reduced by about 30 percent.

However, a study of men who have sex with men in the United States, South America, Africa, and Thailand had different results. When Truvada was used for PrEP in these people, it didn’t lower the risk of getting herpes.

The U.S. Department of Health and Human Services doesn’t recommend Truvada for preventing herpes infection in people with HIV infection.

Truvada for post-exposure prophylaxis (PEP)

Truvada is used off-label for preventing HIV infection in people who may already have been exposed to HIV. This includes adults or children who may have been exposed through an accidental needlestick injury, sex, or injection drug use.

When used for PEP, Truvada is typically used along with another antiviral drug. Examples of antiviral drugs that may be used with Truvada for PEP include:

  • Isentress (raltegravir)
  • Tivicay (dolutegravir)
  • Prezista (darunavir)
  • Norvir (ritonavir)

According to the Centers for Disease Control and Prevention, using Truvada in combination with another antiviral drug is a first-choice approach for PEP.

Truvada is used for treating HIV infection. It’s also used for preventing HIV infection in people who have a high risk of getting HIV. This second use is called pre-exposure prophylaxis (PrEP).

Truvada for HIV treatment

When used for treating HIV, Truvada is used in combination with other antiviral drugs.

In one study, 84 percent of people treated with Truvada in combination with efavirenz (Sustiva) were considered responders after 48 weeks of treatment. After 144 weeks, 71 percent were considered responders. A responder is a person for whom a treatment reduces their HIV level by a certain amount.

According to HIV treatment guidelines, Truvada combined with another antiviral drug such as Tivicay (dolutegravir) or Isentress (raltegravir) is considered a first-choice option when starting HIV treatment. In some cases, Truvada may be used to treat people who’ve tried a different HIV treatment that didn’t work for them.

First-choice drugs for HIV are medications that are:

  • effective for reducing virus levels
  • have fewer side effects than other options
  • easy to use

Truvada and Tivicay

Tivicay (dolutegravir) is a type of drug called an HIV integrase inhibitor. Tivicay is often used in combination with Truvada for treating HIV.

According to treatment guidelines, taking Truvada with Tivicay is a first-choice option for people who are starting HIV treatment.

Truvada and Isentress

Isentress (raltegravir) is a type of drug called an HIV integrase inhibitor. Isentress is often used in combination with Truvada for treating HIV.

According to HIV treatment guidelines, taking Truvada with Isentress is a first-choice option for people who are starting HIV treatment.

Truvada and Kaletra

Kaletra contains two drugs in one pill: lopinavir and ritonavir. Both drugs contained in Kaletra are classified as protease inhibitors.

Kaletra is sometimes combined with Truvada to treat HIV. Although the combination is effective for treating HIV, treatment guidelines don’t recommend it as a first-choice option for most people starting HIV treatment. That’s because this combination has a higher risk of side effects than other options.

Truvada for HIV PrEP

Truvada is the only FDA-approved treatment for pre-exposure prophylaxis (PrEP). It’s also the only PrEP treatment recommended by the Centers for Disease Control and Prevention (CDC).

In studies, Truvada reduced the risk of HIV infection by 42 percent to 53 percent in men who have sex with men, and transgender women who have sex with men.

In another study, Truvada reduced the risk of HIV transmission by 75 percent between heterosexual, mixed-status couples. Mixed-status couples have one partner with HIV and one partner without it.

Drinking alcohol while taking Truvada might increase your risk of some side effects, such as:

  • nausea
  • vomiting
  • diarrhea
  • headache

Drinking too much alcohol and taking Truvada might also increase your risk of liver or kidney problems.

If you take Truvada, talk with your doctor about whether drinking alcohol is safe for you.

Truvada can interact with several other medications. It can also interact with certain supplements, as well as with grapefruit juice.

Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Truvada and other medications

Below is a list of medications that can interact with Truvada. This list does not contain all drugs that may interact with Truvada.

Before taking Truvada, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Drugs that affect kidney function

Truvada is removed from your body by your kidneys. Taking Truvada with other drugs that are removed by your kidneys, or drugs that can damage your kidneys, can increase Truvada levels in your body and increase your risk of side effects.

Examples of drugs that are removed by your kidneys or that can damage your kidneys include:

  • acyclovir (Zovirax)
  • adefovir (Hepsera)
  • aspirin
  • cidofovir
  • diclofenac (Cambia, Voltaren, Zorvolex)
  • ganciclovir (Cytovene)
  • gentamicin
  • ibuprofen (Motrin)
  • naproxen (Aleve)
  • valacyclovir (Valtrex)
  • valganciclovir (Valcyte)

Truvada and atazanavir

Taking Truvada with atazanavir (Reyataz) can decrease levels of atazanavir in your body. This can make atazanavir less effective. To prevent this interaction, when atazanavir is taken with Truvada, it should be taken along with either ritonavir (Norvir) or cobicistat (Tybost).

Taking the drug combination Evotaz (atazanavir and cobicistat) along with Truvada is a recommended treatment for HIV in certain people.

Truvada and didanosine

Taking Truvada with didanosine (Videx EC) can increase didanosine levels in your body and increase your risk of didanosine side effects. To prevent this interaction, your doctor may need to lower your dosage of didanosine.

Truvada and Epclusa

Epclusa contains two drugs in one pill: sofosbuvir and velpatasvir. Taking Epclusa with Truvada might increase your body’s levels of tenofovir, one of the components of Truvada. This could increase your risk of side effects from tenofovir.

Truvada and Harvoni

Harvoni contains two drugs in one pill: sofosbuvir and ledipasvir. Taking Harvoni with Truvada might increase your body’s levels of tenofovir, one of the components of Truvada. This could increase your risk of side effects from tenofovir.

Truvada and Kaletra

Kaletra contains two drugs in one pill: lopinavir and ritonavir. Taking Kaletra with Truvada might increase your body’s levels of tenofovir, one of the ingredients of Truvada. This could increase your risk of side effects from tenofovir.

Truvada and Tylenol

There are no reported interactions between Tylenol (acetaminophen) and Truvada. However, taking high doses of Tylenol can cause liver damage. In some cases, Truvada has also caused liver damage. Taking high doses of Tylenol along with Truvada might increase your risk of liver damage.

Truvada and grapefruit

Drinking grapefruit juice while taking Truvada might increase your body’s levels of tenofovir, one of the ingredients in Truvada. This could increase your risk of side effects from tenofovir. If you’re taking Truvada, don’t drink grapefruit juice.

There haven’t been studies on the effects of eating grapefruit while taking Truvada. However, it might be a good idea to avoid eating large amounts of grapefruit to avoid possible increased side effects.

Truvada contains two drugs in one pill: emtricitabine and tenofovir disoproxil fumarate. These drugs are classified as nucleoside reverse transcriptase inhibitors (NRTIs). Truvada is used to treat and prevent HIV infection.

There are many other drugs that are used for treating HIV. Some may be better suited for you than others. Talk to your doctor to learn more about other medications that may work well for you.

Alternatives for treating HIV

When used to treat HIV, Truvada is combined with other HIV antiviral medications. The most common Truvada combinations are Truvada plus Isentress (raltegravir), and Truvada plus Tivicay (dolutegravir). These are considered first-choice treatment options for people who are starting HIV treatment.

Examples of other first-choice HIV drug combinations that may be used to treat HIV include:

  • Biktarvy (bictegravir, emtricitabine, tenofovir alafenamide)
  • Genvoya (elvitegravir, cobicistat, tenofovir alafenamide, emtricitabine)
  • Stribild (elvitegravir, cobicistat, tenofovir disoproxil fumarate, emtricitabine)
  • Isentress (raltegravir) plus Descovy (tenofovir alafenamide and emtricitabine)
  • Isentress (raltegravir) plus Viread (tenofovir disoproxil fumarate) and lamivudine
  • Tivicay (dolutegravir) plus Descovy (tenofovir alafenamide and emtricitabine)
  • Tivicay (dolutegravir) plus Viread (tenofovir disoproxil fumarate) and lamivudine
  • Triumeq (dolutegravir, abacavir, lamivudine)

First-choice drugs for HIV are medications that:

  • help reduce virus levels
  • have fewer side effects than other options
  • are easy to use

There are many other drugs and drug combinations that are used to treat HIV in certain situations, but these are typically only used when first-choice drug combinations can’t be used.

Alternatives for HIV pre-exposure prophylaxis (PrEP)

Truvada is the only FDA-approved treatment for PrEP. It’s also the only PrEP treatment recommended by the Centers for Disease Control and Prevention (CDC). Currently, there are no alternatives to Truvada for PrEP.

You may wonder how Truvada compares to other medications that are prescribed for similar uses. Below are comparisons between Truvada and several other medications.

Truvada vs. Descovy

Truvada contains two drugs in one pill: emtricitabine and tenofovir disoproxil fumarate. Descovy also contains two drugs in one pill: emtricitabine and tenofovir alafenamide.

Both medications contain the drug tenofovir, but in different forms. Truvada contains tenofovir disoproxil fumarate and Descovy contains tenofovir alafenamide. These drugs are very similar, but they have slightly different effects in the body.

Uses

Truvada and Descovy are both FDA-approved to treat HIV infection when used in combination with other antiviral drugs.

Truvada is also approved for preventing HIV in people who have a high risk of getting HIV. This is called pre-exposure prophylaxis (PrEP).

Forms and administration

Truvada and Descovy both come as oral tablets that are taken once daily.

Side effects and risks

Truvada and Descovy are very similar drugs and cause similar common and severe side effects.

More common side effects

Examples of the more common side effects of Truvada and Descovy include:

  • diarrhea
  • headache
  • fatigue
  • respiratory infections
  • sore throat
  • vomiting
  • rash

Serious side effects

Examples of serious side effects shared by Truvada and Descovy include:

  • bone loss
  • kidney damage
  • liver damage
  • lactic acidosis
  • immune reconstitution syndrome

Both Truvada and Descovy have boxed warnings from the FDA. A boxed warning is the strongest kind of warning the FDA requires. The warnings state that these drugs can cause worsening of hepatitis B infection when use of the drugs is stopped.

Truvada and Descovy can both cause bone loss and kidney damage. However, Descovy causes less bone loss than Truvada. Descovy is also less likely to cause kidney damage than Truvada.

Effectiveness

The effectiveness of Truvada and Descovy has not been directly compared in clinical studies. However, an indirect comparison showed that Truvada and Descovy may be equally effective for treating HIV.

According to treatment guidelines, Truvada or Descovy combined with another antiviral drug, such as Tivicay (dolutegravir) or Isentress (raltegravir), are considered first-choice options when starting HIV treatment.

Costs

Truvada and Descovy are brand-name medications. They don’t have generic forms, which usually cost less than brand-name versions.

The actual price you pay for either drug will depend on your insurance plan.

Truvada vs. Atripla

Truvada contains two drugs in one pill: emtricitabine and tenofovir disoproxil fumarate.

Atripla contains three drugs in one pill: emtricitabine, tenofovir disoproxil fumarate, and efavirenz.

Uses

Truvada and Atripla are both FDA-approved to treat HIV infection. Truvada is approved for use in combination with another antiviral drug. Atripla can be used alone or in combination with other antiviral drugs.

Truvada is also approved for preventing HIV in people who have a high risk of getting HIV. This is called pre-exposure prophylaxis (PrEP).

Forms and administration

Truvada and Atripla both come as oral tablets that are taken once daily.

Side effects and risks

Truvada, when used with efavirenz, and Atripla are the same combination of drugs and cause similar common and serious side effects.

More common side effects

Examples of the more common side effects of Truvada (with efavirenz) and Atripla include:

  • fatigue
  • depression
  • nausea
  • diarrhea
  • dizziness
  • respiratory infections
  • rash
  • headache
  • sore throat
  • vomiting

Serious side effects

Examples of serious side effects shared by Truvada (with efavirenz) and Atripla include:

  • bone loss
  • kidney damage
  • liver damage
  • lactic acidosis
  • immune reconstitution syndrome

Both Truvada and Atripla have boxed warnings from the FDA. A boxed warning is the strongest kind of warning the FDA requires. The warnings state that these drugs can cause worsening of hepatitis B virus infection when use of the drugs is stopped.

Examples of other serious side effects that can occur due to the efavirenz ingredient of Atripla, or when Truvada is combined with efavirenz, include:

  • convulsions (in children)
  • hallucinations
  • confusion
  • agitation
  • depression and suicidal thoughts
  • increased body fat
  • heart rhythm changes

Effectiveness

Truvada and Atripla contain two of the same drugs: emtricitabine and tenofovir disoproxil fumarate. Atripla also contains a third drug, efavirenz.

Truvada is meant to be used with one or more additional antiviral drugs. One of the drugs that Truvada has been used with is efavirenz, the third drug contained in Atripla.

In fact, Truvada was approved by the FDA to treat HIV based on a study that combined the ingredients of Truvada with efavirenz. The combination of Truvada and efavirenz would be equally effective as Atripla. However, Truvada isn’t typically used with efavirenz due to that drug’s risk of side effects.

The advantage of Atripla is that it contains the three-drug combination in one pill. Additional antiviral medications are not usually needed. Truvada, on the other hand, must be taken with one or more additional antivirals.

According to treatment guidelines, the three-drug combination of Atripla is not usually a first-choice option. This is because of the increased risk of side effects associated with efavirenz.

However, it may be recommended in some circumstances, such as when a one-pill, once-daily treatment is needed.

Costs

Truvada and Atripla are brand-name medications. They don’t have generic forms, which usually cost less than brand-name versions.

Atripla costs much more than Truvada. However, this is because Atripla contains three drugs in one pill and Truvada contains only two drugs in one pill. Truvada is usually taken with a third drug. So, the total cost of Truvada and a third drug may have a price closer to the price of Atripla.

The actual price you pay for either drug will depend on your insurance plan.

Truvada vs. Stribild

Truvada contains two drugs in one pill: emtricitabine and tenofovir disoproxil fumarate.

Stribild contains four drugs in one pill: emtricitabine, tenofovir disoproxil fumarate, elvitegravir, and cobicistat.

Uses

Truvada and Stribild are both FDA-approved to treat HIV infection. Truvada is approved for use in combination with another antiviral drug. Since Stribild contains four drugs in one pill, it does not need to be used with another antiviral drug.

Truvada is also approved for preventing HIV in people who have a high risk of getting HIV. This is called pre-exposure prophylaxis (PrEP).

Both Truvada and Stribild are used off-label for preventing HIV infection. It’s used in adults and children who may have been exposed to HIV through an accidental needlestick injury, sex, or injection drug use. This is called post-exposure prophylaxis (PEP).

Forms and administration

Truvada and Stribild both come as oral tablets that are taken once daily.

Side effects and risks

Stribild causes mostly the same common and serious side effects as Truvada when Truvada is used with another antiviral. However, specific side effects for Truvada will depend on which other medications are taken with it.

More common side effects

Examples of the more common side effects of Truvada (and another antiviral) and Stribild include:

  • diarrhea
  • nausea
  • respiratory infections
  • headache
  • fatigue
  • depression
  • insomnia (trouble sleeping)
  • sinus infection
  • rash
  • dizziness

Serious side effects

Examples of serious side effects shared by Truvada (and another antiviral) and Stribild include:

  • bone loss
  • kidney damage
  • liver damage
  • lactic acidosis
  • immune reconstitution syndrome

Both Truvada and Stribild have boxed warnings from the FDA. A boxed warning is the strongest kind of warning the FDA requires. The warnings state that these drugs can cause worsening of hepatitis B virus infection when use of the drugs is stopped.

Effectiveness

Truvada and Stribild contain two of the same drugs: emtricitabine and tenofovir disoproxil fumarate. Stribild also contains two additional drugs: elvitegravir and cobicistat.

According to treatment guidelines, the four-drug combination of Stribild is a first-choice option for treating HIV. Truvada is also a first-choice option when it’s combined with either Tivicay (dolutegravir) or Isentress (raltegravir).

An advantage of Stribild is that it’s considered a complete treatment in one pill. Additional antiviral medications are not needed. Truvada, on the other hand, must be taken with one or more additional antivirals.

Stribild has been compared to Truvada plus other antivirals in a few clinical studies. One 96-week study looked at Stribild as an initial treatment for HIV. Stribild worked about as well as emtricitabine and tenofovir disoproxil fumarate (the drugs contained in Truvada) in combination with Sustiva (efavirenz).

In a 48-week study, Stribild worked about as well as Truvada plus Reyataz (atazanavir) and Norvir (ritonavir) as an initial treatment for HIV. A follow-up study showed that the positive effects continued and were still about the same after 96 weeks of treatment.

Another study evaluated people who switched from Truvada plus Isentress (raltegravir) to Stribild, which is a simpler treatment regimen. After the switch, their previously reduced HIV levels were maintained over 48 weeks.

Costs

Truvada and Stribild are brand-name medications. They don’t have generic forms, which usually cost less than brand-name versions.

Stribild costs much more than Truvada. However, this is because Stribild contains four drugs in one pill and Truvada contains only two drugs in one pill. Truvada is usually taken with a third drug. The total cost of Truvada and a third drug may be closer to the cost of Stribild.

The actual price you pay for either drug will depend on your insurance plan.

Truvada vs. Genvoya

Truvada contains two drugs in one pill: emtricitabine and tenofovir disoproxil fumarate.

Genvoya contains four drugs in one pill: emtricitabine, tenofovir alafenamide, elvitegravir, and cobicistat.

Uses

Truvada and Genvoya are both FDA-approved to treat HIV infection. Truvada is approved for use in combination with another antiviral drug. Since Genvoya contains four drugs in one pill, it does not need to be used with another antiviral drug.

Truvada is also approved for preventing HIV in people who have a high risk of getting HIV. This is called pre-exposure prophylaxis (PrEP).

Forms and administration

Truvada and Genvoya both come as oral tablets that are taken once daily.

Side effects and risks

Genvoya causes mostly the same common and serious side effects as Truvada when Truvada is used with another antiviral. However, specific side effects will depend on which medications are taken with Truvada.

More common side effects

Examples of more common side effects of Truvada (and another antiviral) and Genvoya include:

  • diarrhea
  • nausea
  • respiratory infections
  • headache
  • fatigue
  • depression
  • insomnia (trouble sleeping)
  • sinus infection
  • rash
  • dizziness

Serious side effects

Examples of serious side effects shared by Truvada (and another antiviral) and Genvoya include:

  • bone loss
  • kidney damage
  • liver damage
  • lactic acidosis
  • immune reconstitution syndrome

Both Truvada and Genvoya have boxed warnings from the FDA. A boxed warning is the strongest kind of warning the FDA requires. The warnings state these drugs can cause worsening of hepatitis B virus infection when use of the drugs is stopped.

Truvada and Genvoya can both cause bone loss and kidney damage. However, Genvoya causes less bone loss than Truvada. Genvoya is also less likely to cause kidney damage than Truvada.

Effectiveness

The effectiveness of Truvada and Genvoya for treating HIV has not been compared in clinical studies.

According to treatment guidelines, the four-drug combination of Genvoya is a first-choice option for treating HIV. Truvada is also a first-choice option when it’s combined with either Tivicay (dolutegravir) or Isentress (raltegravir).

An advantage of Genvoya is that it’s considered a complete treatment in one pill. Additional antiviral medications are not needed. Truvada must be taken with one or more additional antivirals.

Costs

Truvada and Genvoya are brand-name medications. They don’t have generic forms, which usually cost less than brand-name versions.

Genvoya costs much more than Truvada. However, this is because Genvoya contains four drugs in one pill, and Truvada contains only two drugs in one pill. Truvada is usually taken with a third drug. The total cost of Truvada and a third drug may be closer to the cost of Stribild.

The actual price you pay for either drug will depend on your insurance plan.

You should take Truvada according to your doctor’s instructions.

Timing

Truvada should be taken once daily at about the same time each day.

Taking Truvada with food

Truvada can be taken with or without food. Taking it with food might help decrease any stomach upset that could be caused by the medication.

Can Truvada be crushed?

Truvada oral tablet should not be crushed. It must be swallowed whole.

Truvada contains two drugs: emtricitabine and tenofovir disoproxil fumarate. These drugs are both nucleoside reverse transcriptase inhibitors (NRTIs).

These drugs block an enzyme called reverse transcriptase that HIV needs to copy itself. By blocking this enzyme, Truvada prevents the virus from growing and copying itself. As a result, the levels of HIV in your body begin to decrease.

How long does it take to work?

The medications contained in Truvada begin to work right away to reduce virus levels. However, it may take one to six months of treatment before your HIV levels are low enough that they’re no longer detectable in your blood. (This is the goal of treatment. When HIV is no longer detectable, it’s no longer transmissible to another person.)

FDA warnings

  • This medication has boxed warnings from the Food and Drug Administration (FDA). A boxed warning is the strongest warning that the FDA requires. A boxed warning alerts doctors and patients about drug effects that may be dangerous.
  • Worsening of hepatitis B virus (HBV) infection: HBV infection can worsen in people who have HBV infection and stop taking Truvada. If you have HBV and stop taking Truvada, your doctor will do blood tests to check your liver from time to time for several months after you stop the drug. You may need treatment for HBV infection.
  • Resistance to Truvada: Truvada should not be used for pre-exposure prophylaxis (PrEP) in people who already have HIV because this can cause viral resistance to Truvada. Viral resistance means that HIV can no longer be treated with Truvada. If you’re using Truvada for PrEP, your doctor will do blood tests for HIV infection before you start treatment and at least every three months during your treatment.

Other warnings

Before taking Truvada, talk with your doctor about any medical conditions you have. Truvada may not be right for you if you have certain medical conditions. Examples of these conditions include:

  • Kidney disease: Truvada can worsen kidney function in people who have kidney disease. If you have kidney disease, you may need to take Truvada every other day instead of daily. If you have severe kidney disease, you may not be able to take Truvada.
  • Liver disease: Truvada can cause liver damage. If you have liver disease, Truvada might make your condition worse.
  • Bone disease: Truvada can cause bone loss. If you have bone disease, such as osteoporosis, you may have an increased risk of bone fracture if you take Truvada.

Also, Truvada can’t be crushed and must be swallowed whole. So, if you or your child can’t swallow a pill, you may need to take a different HIV medication.

Taking too much of this medication can increase your risk of serious side effects.

Overdose symptoms

Symptoms of an overdose can include:

  • stomach upset
  • diarrhea
  • vomiting
  • fatigue
  • headache
  • dizziness
  • symptoms of kidney damage, such as:
    • bone or muscle pain
    • weakness
    • fatigue
    • nausea
    • vomiting
    • decreased urine output
  • symptoms of liver damage, such as:
    • pain or swelling in your abdomen
    • nausea
    • vomiting
    • fatigue
    • yellowing of skin or the whites of your eyes

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

Taking Truvada during the first trimester of pregnancy does not appear to increase the risk of birth defects. However, there’s no information available about the effects of Truvada if it’s taken during the second or third trimesters, or if Truvada increases the risk of miscarriage.

In animal studies, Truvada did not have harmful effects on offspring. However, animal studies don’t always reflect how humans would respond.

If you’re pregnant or planning to become pregnant, talk with your doctor before taking Truvada. If you become pregnant while taking Truvada, talk with your doctor right away.

The drugs contained in Truvada are passed in breast milk. Mothers who are taking Truvada should not breastfeed, because a child who is breastfed may have side effects from Truvada.

Another reason not to breastfeed is that HIV may be transmitted to a child through breast milk. In the United States, the Centers for Disease Control and Prevention (CDC) recommends that women with HIV avoid breastfeeding.

(The World Health Organization still encourages breastfeeding for women with HIV in many countries.)

Here are answers to some frequently asked questions about Truvada.

Can Truvada be crushed?

Truvada tablets should not be crushed. They must be swallowed whole. If you can’t swallow a tablet whole, you may need to use a different medication for HIV.

How long does Truvada take to work?

Truvada starts to work right away after you take it. However, it may take one to six months of treatment before HIV levels are low enough that they’re no longer detectable in your blood.

Will I have withdrawal symptoms if I stop taking Truvada?

No, Truvada does not cause withdrawal symptoms when you stop taking it. However, if you have hepatitis B virus (HBV) infection, stopping treatment with Truvada may cause worsened symptoms of HBV. You may need treatment for HBV.

When Truvada is dispensed from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically one year from the date the medication was dispensed. The purpose of this expiration date is to guarantee the effectiveness of the medication during this time.

The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. However, an FDA study showed that many medications may still be good beyond the expiration date listed on the bottle.

How long the medication remains good can depend on many factors, including how and where the medication is stored. Truvada should be stored in the original container at room temperature, at about 77°F (25°C).

If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

The following information is provided for clinicians and other healthcare professionals.

Mechanism of action

Truvada contains two drugs: emtricitabine and tenofovir disoproxil fumarate. These drugs are both nucleoside reverse transcriptase inhibitors (NRTIs).

Emtricitabine (FTC) is a synthetic analog of the nucleoside cytidine, which is phosphorylated to form emtricitabine 5-triphosphate (FTC-TP). FTC-TP decreases HIV replication by inhibiting HIV reverse transcriptase.

Tenofovir disoproxil fumarate (TDF) is an acyclic nucleoside phosphate diester, which is an analog of adenosine monophosphate. TDF is converted to tenofovir diphosphate (TFV-DP), which decreases HIV replication through inhibition of HIV reverse transcriptase.

Pharmacokinetics and metabolism

Truvada contains two component drugs: emtricitabine and tenofovir disoproxil fumarate.

Emtricitabine has an oral bioavailability of 92 percent. It reaches peak concentration in about two hours. Emtricitabine is primarily eliminated renally. The half-life is about 10 hours.

Tenofovir disoproxil fumarate has an oral bioavailability of 25 percent. It reaches peak concentration in about 30 minutes. Tenofovir is primarily eliminated renally. The half-life is about 17 hours.

Contraindications

When used for HIV pre-exposure prophylaxis (PrEP), Truvada is contraindicated in people who have HIV or whose HIV status is not known.

Storage

Truvada should be stored in its original container at room temperature, at about 77°F (25°C).

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.