(em trye SYE ta been)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Emtriva: 200 mg [contains fd&c blue #2 (indigotine)]
Emtriva: 10 mg/mL (170 mL) [contains edetate disodium, fd&c yellow #6 (sunset yellow), methylparaben, propylene glycol, propylparaben; cotton candy flavor]
Brand Names: U.S.
- Antiretroviral, Reverse Transcriptase Inhibitor, Nucleoside (Anti-HIV)
Nucleoside reverse transcriptase inhibitor; emtricitabine is a cytosine analogue which is phosphorylated intracellularly to emtricitabine 5'-triphosphate which interferes with HIV viral RNA dependent DNA polymerase resulting in inhibition of viral replication.
Converted intracellularly to the active triphosphate form; undergoes minimal biotransformation via oxidation and glucuronide conjugation
Urine (86% primarily as unchanged drug, 13% as metabolites, 9% of dose as oxidative metabolite; 4% as glucuronide metabolite); feces (14%)
Clearance: Renal clearance is greater than creatinine clearance; thus, emtricitabine may be eliminated by both glomerular filtration and active tubular secretion
Time to Peak
Plasma: 1-2 hours
Normal renal function:
Infants, Children, and Adolescents: Elimination half-life (emtricitabine):
Single dose: 11 hours
Multiple dose: 7.9 to 9.5 hours
Infants 0 to 3 months (n=20; median age: 26 days): 12.1 ± 3.1 hours
Infants 3 to 24 months (n=14): 8.9 ± 3.2 hours
Children 25 months to 6 years (n=19): 11.3 ± 6.4 hours
Children 7 to 12 years (n=17): 8.2 ± 3.2 hours
Adolescents 13 to 17 years (n=27): 8.9 ± 3.3 hours
Adults: Emtricitabine: 10 hours; Intracellular half-life (emtricitabine 5'-triphosphate): 39 hours
Special Populations: Renal Function Impairment
Cmax and AUC are increased in patients with CrCl less than 50 mL/minute or ESRD requiring dialysis.
Special Populations: Children
Exposure is similar to adults. In neonates, the AUC was similar to the AUC observed in children at least 3 mo to 17 years of age.
Use: Labeled Indications
Treatment of HIV infection in combination with at least two other antiretroviral agents
Hypersensitivity to emtricitabine or any component of the formulation
HIV-1 infection, treatment: Oral:
Capsule: 200 mg once daily
Solution: 240 mg once daily
HIV-1 nonoccupational postexposure prophylaxis (nPEP) (off-label use): Oral: Capsule: 200 mg once daily; initiate therapy within 72 hours of exposure and continue for 28 days in combination with other antiretrovirals (3-drug regimen) Note: The fixed-dose emtricitabine and tenofovir disoproxil fumarate combination product is recommended for these components of the 3-drug regimen (HHS [nPEP] 2016).
HIV-1 occupational postexposure prophylaxis (oPEP) (off-label use): Oral: Capsule: 200 mg once daily in combination with tenofovir and raltegravir; initiate therapy as soon as possible after occupational exposure (and within 72 hours) and continue for 4 weeks; Note: The fixed-dose emtricitabine and tenofovir disoproxil fumarate combination product is recommended for these components of the regimen (Kuhar 2013).
Refer to adult dosing.
HIV-1 infection, treatment: Oral: Note: Due to bioavailability differences, dosage forms are not bioequivalent; oral solution and capsules should not be interchanged on a mg:mg basis.
Infants 1 to <3 months: Solution: 3 mg/kg/dose once daily
Infants ≥3 months, Children, and Adolescents ≤17 years:
Capsule: Children >33 kg and able to swallow capsule whole: 200 mg once daily
Solution: 6 mg/kg once daily; maximum: 240 mg/day
Adolescents ≥18 years: Refer to adult dosing.
HIV-1 nonoccupational postexposure prophylaxis (nPEP) (off-label use) (HHS [nPEP] 2016): Oral: Note: Initiate therapy within 72 hours of exposure and continue for 28 days in combination with other antiretroviral agents.
Infants 1 to <3 months: Solution: 3 mg/kg/dose once daily
Infants ≥3 months and Children:
Capsules: Patient weight >33 kg and able to swallow capsule whole: 200 mg once daily
Solution: 6 mg/kg/dose once daily; maximum daily dose: 240 mg/day
Adolescents: Refer to adult dosing.
Dosing: Renal Impairment
Adults (consider similar adjustments in children):
CrCl 30 to 49 mL/minute: Capsule: 200 mg every 48 hours; solution: 120 mg every 24 hours
CrCl 15 to 29 mL/minute: Capsule: 200 mg every 72 hours; solution: 80 mg every 24 hours
CrCl <15 mL/minute (including hemodialysis patients): Capsule: 200 mg every 96 hours; solution: 60 mg every 24 hours; administer after dialysis
Dosing: Hepatic Impairment
No dosage adjustment required.
May be administered with or without food.
May be taken with or without food.
Capsules: Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).
Oral solution: Store at 2°C to 8°C (36°F to 46°F). Use within 3 months if stored at 25°C (77°F) with excursions permitted to 15°C to 30°C (59°F to 86°F).
LamiVUDine: May enhance the adverse/toxic effect of Emtricitabine. Avoid combination
Orlistat: May decrease the serum concentration of Antiretroviral Agents. Monitor therapy
Clinical trials were conducted in patients receiving other antiretroviral agents, and it is not possible to correlate frequency of adverse events with emtricitabine alone. The range of frequencies of adverse events is generally comparable to comparator groups, with the exception of hyperpigmentation, which occurred more frequently in patients receiving emtricitabine. Unless otherwise noted, percentages are as reported in adults.
Central nervous system: Dizziness (4% to 25%), headache (6% to 22%), insomnia (5% to 16%), abnormal dreams (2% to 11%)
Dermatologic: Hyperpigmentation (children: 32%; adults: 2% to 4%; primarily of palms and/or soles but may include tongue, arms, lip and nails; generally mild and nonprogressive without associated local reactions such as pruritus or rash), skin rash (17% to 30%; includes hypersensitivity reaction, maculopapular rash, pruritus, pustular rash, vesiculobullous rash)
Gastrointestinal: Diarrhea (children: 20%; adults: 9% to 23%), vomiting (children: 23%; adults: 9%), nausea (13% to 18%), abdominal pain (8% to 14%), gastroenteritis (children: 11%)
Infection: Infection (children: 44%)
Neuromuscular & skeletal: Weakness (12% to 16%), increased creatine phosphokinase (grades 3/4: 11% to 12%)
Otic: Otitis media (children: 23%)
Respiratory: Cough (children: 28%; adults; 14%), rhinitis (children: 20%; adults: 12% to 18%), pneumonia (children: 15%)
Miscellaneous: Fever (children: 18%)
1% to 10%:
Central nervous system: Depression (6% to 9%), paresthesia (5% to 6%), neuritis (≤4%), neuropathy (≤4%)
Endocrine & metabolic: Increased serum triglycerides (grades 3/4: 4% to 10%), increased amylase (grades 3/4: children: 9%; adults: 2% to 5%), dysglycemia (grades 3/4: 2% to 3%)
Gastrointestinal: Dyspepsia (4% to 8%), increased serum lipase (grades 3/4: ≤1%)
Genitourinary: Hematuria (grades 3/4: 3%)
Hematologic & oncologic: Anemia (children: 7%), neutropenia (grades 3/4: children: 2%; adults: 5%)
Hepatic: Increased serum transaminases (grades 3/4: 2% to 6%), increased serum alkaline phosphatase (>550 units/L: 1%), increased serum bilirubin (grades 3/4: 1%)
Neuromuscular & skeletal: Myalgia (4% to 6%), arthralgia (3% to 5%)
Respiratory: Sinusitis (8%), upper respiratory tract infection (8%), pharyngitis (5%)
<1% (Limited to important or life-threatening): Immune reconstitution syndrome
Concerns related to adverse effects:
• Fat redistribution: May cause redistribution of fat (eg, buffalo hump, peripheral wasting with increased abdominal girth, cushingoid appearance).
• Immune reconstitution syndrome: Patients may develop immune reconstitution syndrome resulting in the occurrence of an inflammatory response to an indolent or residual opportunistic infection during initial HIV treatment or activation of autoimmune disorders (eg, Graves’ disease, polymyositis, Guillain-Barré syndrome) later in therapy; further evaluation and treatment may be required.
• Lactic acidosis/hepatomegaly: [US Boxed Warning]: Lactic acidosis and severe hepatomegaly with steatosis have been reported with nucleoside analogues, including fatal cases; use with caution in patients with risk factors for liver disease (risk may be increased with female gender, obesity, pregnancy or prolonged exposure) and suspend treatment in any patient who develops clinical or laboratory findings suggestive of lactic acidosis or hepatotoxicity (transaminase elevation may/may not accompany hepatomegaly and steatosis).
• Chronic hepatitis B: [US Boxed Warning]: Safety and efficacy during coinfection of HIV and HBV have not been established; acute, severe exacerbations of HBV have been reported following discontinuation of antiretroviral therapy. Not indicated for treatment of chronic hepatitis B. All patients with HIV should be tested for HBV prior to initiation of treatment. Caution in patients with known or suspected hepatitis B or C infection (monitoring of liver function is recommended). In HBV coinfected patients, acute HBV infection exacerbations have occurred following discontinuation; monitor hepatic function closely for several months.
• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment required.
Concurrent drug therapy issues:
• Duplicate therapy: Concomitant use of other emtricitabine-containing products should be avoided.
• Lamivudine: Concomitant use of lamivudine or lamivudine-containing products should be avoided; cross-resistance may develop.
Dosage form specific issues:
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated with hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Zar 2007).
Viral load, CD4, liver function tests; hepatitis B testing is recommended prior to initiation of therapy
Pregnancy Risk Factor
Adverse events were not observed in animal reproduction studies. Emtricitabine has a high level of transfer across the human placenta; no increased risk of overall birth defects has been observed according to data collected by the antiretroviral pregnancy registry. Cases of lactic acidosis/hepatic steatosis syndrome related to mitochondrial toxicity have been reported with use of nucleoside analogues. In addition, these adverse events are similar to other rare but life-threatening syndromes which occur during pregnancy (eg, HELLP syndrome). In general nucleoside reverse transcriptase inhibitors are well tolerated and the benefits of use generally outweigh potential risk. The HHS Perinatal HIV Guidelines consider emtricitabine with tenofovir to be a preferred NRTI backbone in antiretroviral-naive pregnant women. The HHS Perinatal HIV Guidelines consider emtricitabine plus tenofovir a recommended dual NRTI/NtRTI backbone for HIV/HBV coinfected pregnant women. Use caution with hepatitis B coinfection; hepatitis B flare may occur if emtricitabine is discontinued postpartum. A pharmacokinetic study shows a slight decrease in emtricitabine serum levels during the third trimester and immediately postpartum; however, there is no clear need to adjust the dose.
Combination antiretroviral therapy (cART) therapy is recommended for all HIV-infected pregnant women. The goal of therapy is to keep the viral load below the limit of detection and prevent perinatal transmission. Therapy must be individualized. In general, women who become pregnant on a stable cART regimen may continue that regimen if viral suppression is effective, contraindications for use in pregnancy are not present, and the regimen is well tolerated. For HIV infected couples planning a pregnancy, maximum viral suppression with cART is recommended prior to conception for the HIV-infected partner(s). When HIV is diagnosed during pregnancy in a woman who has never received antiretroviral therapy, cART should be considered as soon as possible after diagnosis to reduce the risk of perinatal transmission. If antiretroviral drug-resistance testing is done, treatment may be started prior to obtaining results, then adjusted accordingly. Monitoring during pregnancy is more frequent than in non-pregnant adults. If cART must be interrupted for <24 hours, stop then restart all medications simultaneously in order to decrease the chance of developing resistance. Long-term follow-up is recommended for all infants exposed to antiretroviral medications; children who develop significant organ system abnormalities (particularly of the CNS or heart) should be evaluated for potential mitochondrial dysfunction.
HIV infected women not planning a pregnancy may use any available type of contraception, considering possible drug interactions and contraindications of the specific method. In addition, consistent use of condoms is also recommended (even during pregnancy) to prevent transmission of HIV or other sexually transmitted diseases.
Health care providers are encouraged to enroll pregnant women exposed to antiretroviral medications as early in pregnancy as possible in the Antiretroviral Pregnancy Registry (1-800-258-4263 or www.APRegistry.com). Health care providers caring for HIV-infected women and their infants may contact the National Perinatal HIV Hotline (888-448-8765) for clinical consultation (HHS [perinatal] 2016).
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience dizziness, loss of strength and energy, headache, insomnia, abdominal pain, nausea, vomiting, diarrhea, or rhinorrhea. Have patient report immediately to prescriber signs of lactic acidosis (fast breathing, tachycardia, abnormal heartbeat, vomiting, fatigue, shortness of breath, severe loss of strength and energy, severe dizziness, feeling cold, or muscle pain or cramps), signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), depression, skin discoloration, change in body fat, nightmares, or signs of infection (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
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Other brands: Emtriva