Atripla is a single-tablet regimen approved by the US FDA for the treatment of HIV infection in adults and adolescents 12 years of age and older, weighing at least 40 kilograms. It was granted approval in 2006 and was the first fixed dose, one pill, once daily combination to be released in the market. The drug has done well ever since until its removal from the US Department of Health and Human Services (HHS) HIV guideline’s priority list. In 2015, Atripla was downgraded to the “alternative” treatment category from the “recommended” list or first-line antiretroviral treatment regimens for treatment-naïve (those who have not received anti-HIV treatment in the past) patients.
Your doctor may prescribe this medication if you have a viral load of less than 50 copies per ml for more than three months while on your current antiretroviral regimen. Atripla is not recommended for patients who have experienced treatment failure in the past and those who have shown resistance to any of the three active substances of this regimen. Associated side effects include diarrhea, nausea, fatigue, dizziness, headache, insomnia, depression, rash, and abnormal dreams.
Before Taking Atripla
- Do not take Atripla if you are allergic to any of the three substances it contains: efavirenz (Sustiva), emtricitabine (Emtriva), or tenofovir (Viread).
- This drug should not be used together with adefovir, atazanavir, voriconazole, or other combination antiretroviral regimens that contain lamivudine, emtricitabine, and tenofovir.
- You should not take Atripla if you are below 40 kilograms or 88 pounds because the fixed dose tablet cannot be adjusted for your weight.
- Inform your health care provider if you have: liver or kidney impairment, low bone mineral density, hepatitis B or C infection, a history of mental illness or antipsychotic drug use, and a family history of sudden death or QT interval prolongation on ECG.
Recommended dose and method of administration
Each dose of Atripla contains 600mg efavirenz (EFV), 200mg emtricitabine (FTC), and 300mg tenofovir disoproxil fumarate (TDF). Take Atripla once a day on an empty stomach, preferably before going to bed. Do not take less or more than the prescribed dose as it can cause serious, life-threatening effects. The efavirenz in Atripla may cause undesirable effects on the nervous system; taking it before bedtime may improve tolerability. Separate preparations of efavirenz, emtricitabine, and tenofovir are available if dose adjustment is necessary
- For adults and children
The safety and efficacy of Atripla have not been established in patients under the age of 18 years.
- For patients with renal impairment
Take the prescribed dose if your creatinine clearance is equal to or greater than 50 ml/min. This regimen is not recommended for patients with moderate or severe kidney impairment.
- For patients who are taking rifampin (anti-TB drug)
Your doctor may prescribe an additional 200mg/day of EFV provided your weight is 50 kilograms or more.
- For patients with hepatic impairment
You may take the recommended dose if you have mild liver disease. This is not the drug of choice for patients with severe liver impairment.
Missed doses and extra doses
If you miss a dose of Atripla within 12 hours of its regular schedule, take it as soon as possible. If it is almost time for your next dose or if 12 hours have passed since your last dose, simply take the next dose at the scheduled time without taking the missed dose.
If you vomit within an hour after taking Atripla, take another dose. If you vomit after more than hour, do not take another dose.
How Atripla works against HIV
Atripla contains two nucleoside reverse transcriptase inhibitors (NRTI) emtricitabine and tenofovir, also known as “nukes,” and one non-nucleoside inhibitor (NNRTI) efavirenz. All three substances block the activity of the enzyme reverse transcriptase. The enzyme is essential for the virus to multiply and penetrate the immune cells. By blocking the activity of this enzyme, the virus won’t be able to make copies of itself. Antiretrovirals such as Atripla do not cure HIV or AIDS, but they can hold off the progression of the disease to help the immune system recover and prevent the development of infection and other opportunistic diseases associated with AIDS.
One advantage of Atripla over other combination pills is that it causes less body fat change—a common problem for long time users of antiretroviral agents such as zidovudine and lamivudine. Efavirenz has also shown superior efficacy and durability compared with a combination containing lopinavir.