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Emtricitabine Side Effects

In Summary

More frequently reported side effects include: increased serum alanine aminotransferase, increased serum amylase, increased serum aspartate aminotransferase, and neutropenia. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to emtricitabine: oral capsule, oral solution

Warning

Oral route (Capsule; Solution)

Severe acute exacerbations of hepatitis B (HBV) have been reported in patients who are coinfected with HIV-1 and HBV and have discontinued emtricitabine. Hepatic function should be monitored closely with both clinical and laboratory follow-up for at least several months in patients who are coinfected with HIV-1 and HBV and discontinue emtricitabine. If appropriate, initiation of anti-hepatitis B therapy may be warranted.

Side effects requiring immediate medical attention

Along with its needed effects, emtricitabine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking emtricitabine:

More common

  • Body aches or pain
  • chest pain or tightness
  • chills
  • cough
  • diarrhea
  • difficulty in breathing
  • ear congestion
  • earache
  • fever
  • headache
  • hoarseness
  • loss of appetite
  • loss of voice
  • lower back or side pain
  • nasal congestion
  • nausea
  • painful or difficult urination
  • pale skin
  • redness or swelling in the ear
  • runny nose
  • sneezing
  • sore throat
  • stomach pain
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Less common

Side effects not requiring immediate medical attention

Some side effects of emtricitabine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Abnormal dreams
  • belching
  • darkening of the skin
  • difficulty in moving
  • discouragement
  • feeling sad or empty
  • heartburn
  • indigestion
  • irritability
  • joint pain or swelling
  • lack or loss of strength
  • loss of interest or pleasure
  • muscle pain, cramps, or stiffness
  • skin rash
  • stomach discomfort or upset
  • trouble concentrating
  • trouble sleeping

Less common

  • Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • dizziness
  • stabbing pain

For Healthcare Professionals

Applies to emtricitabine: oral capsule, oral solution

General

The most common side effects reported during clinical trials in adults were headache, diarrhea, elevated creatine kinase, nausea, fatigue, dizziness, depression, insomnia, abnormal dreams, rash, abdominal pain, asthenia, increased cough, and rhinitis. The most common side effects reported during clinical trials in children were anemia and skin discoloration/hyperpigmentation.[Ref]

Dermatologic

Grades 2 to 4 rash event and rash were reported in 7% and 5% of patients, respectively.

Skin discoloration (manifested by hyperpigmentation primarily on the palms and/or soles) was generally mild and asymptomatic. Clinical significance and mechanism are unknown; according to some authorities, skin discoloration was of little clinical significance.

Skin discoloration (hyperpigmentation) was very common in pediatric patients.[Ref]

Very common (10% or more): Rash event (included rash, pruritus, maculopapular rash, urticaria, vesiculobullous rash, pustular rash, exfoliative rash, generalized rash, macular rash, pruritic rash, vesicular rash, allergic reaction; up to 30%)

Common (1% to 10%): Vesiculobullous rash, pustular rash, maculopapular rash, rash, pruritus, urticaria, skin discoloration (hyperpigmentation)

Postmarketing reports: Angioedema

Combination antiretroviral therapy:

-Frequency not reported: Lipodystrophy/redistribution of body fat[Ref]

Nervous system

Grades 2 to 4 dizziness and headache were reported in 8% and 6% of patients, respectively.[Ref]

Very common (10% or more): Dizziness (up to 25%), headache (up to 22%)

Common (1% to 10%): Paresthesia, neuropathy/peripheral neuritis

Frequency not reported: Somnolence[Ref]

Gastrointestinal

Very common (10% or more): Diarrhea (up to 23%), nausea (up to 18%), abdominal pain (up to 14%)

Common (1% to 10%): Elevated amylase (including elevated pancreatic amylase), elevated serum lipase, vomiting, dyspepsia

Frequency not reported: Gastroenteritis[Ref]

Grades 2 to 4 diarrhea, nausea, and vomiting were reported in 9%, 9%, and 2% of patients, respectively.

Elevated serum amylase (greater than 2 times the upper limit of normal [2 x ULN), pancreatic amylase (greater than 2 x ULN), and serum lipase (greater than 2 x ULN) have been reported in up to 5%, up to 2%, and up to 1% of patients, respectively. Elevated serum amylase (greater than 175 units/L) was reported in 8% of patients.

Gastroenteritis was only reported in pediatric patients.[Ref]

Metabolic

Very common (10% or more): Elevated fasting cholesterol (22%)

Common (1% to 10%): Hypertriglyceridemia, hyperglycemia, elevated triglycerides, increased/decreased serum glucose, elevated fasting triglycerides

Frequency not reported: Lactic acidosis

Antiretroviral therapy:

-Frequency not reported: Increased blood lipid levels, increased glucose levels[Ref]

Elevated fasting cholesterol (greater than 240 mg/dL) and fasting triglycerides (greater than 750 mg/dL) were reported in 22% and 4% of patients, respectively. Elevated triglycerides (greater than 750 mg/dL [greater than 8.47 mmol/L]) and increased/decreased serum glucose (less than 40 or greater than 250 mg/dL [less than 2.2 or greater than 13.9 mmol/L]) have been reported in up to 10% and up to 3% of patients, respectively. Elevated triglycerides (greater than 750 mg/dL) and hyperglycemia (greater than 250 mg/dL) were reported in 5% and 2% of patients, respectively.

Lactic acidosis and severe hepatomegaly with steatosis (including fatal cases) have been reported with the use of nucleoside analogs.[Ref]

Respiratory

Grades 2 to 4 sinusitis, upper respiratory tract infections, and nasopharyngitis were reported in 8%, 8%, and 5% of patients, respectively.

Pneumonia was only reported in pediatric patients.[Ref]

Very common (10% or more): Rhinitis (up to 18%), increased cough (up to 14%)

Common (1% to 10%): Sinusitis, upper respiratory tract infections, nasopharyngitis

Frequency not reported: Pneumonia[Ref]

Psychiatric

Grades 2 to 4 depression, insomnia, and abnormal dreams were reported in 9%, 5%, and 4% of patients, respectively.[Ref]

Very common (10% or more): Insomnia (up to 16%), abnormal dreams (up to 11%)

Common (1% to 10%): Depressive disorders, depression[Ref]

Other

Grades 2 to 4 fatigue was reported in 9% of patients.

Elevated alkaline phosphatase (greater than 550 units/L) was reported in 1% of patients.

Infection, otitis media, and fever were only reported in pediatric patients.[Ref]

Very common (10% or more): Asthenia (up to 16%)

Common (1% to 10%): Pain, fatigue, elevated alkaline phosphatase

Frequency not reported: Infection, otitis media, fever

Antiretroviral therapy:

-Frequency not reported: Increased weight[Ref]

Musculoskeletal

Very common (10% or more): Elevated creatine kinase (up to 12%)

Common (1% to 10%): Myalgia, arthralgia

Frequency not reported: Osteonecrosis[Ref]

Elevated creatine kinase (greater than 4 x ULN) has been reported in up to 12% of patients. Elevated creatine kinase (greater than 990 units/L in males and 845 units/L in females) was reported in 9% of patients.[Ref]

Hepatic

Common (1% to 10%): Elevated serum AST, elevated serum ALT, hyperbilirubinemia

Uncommon (0.1% to 1%): Elevated bilirubin

Frequency not reported: Posttreatment exacerbation of hepatitis B, liver failure, liver decompensation, severe hepatomegaly with steatosis, elevated GGT[Ref]

Elevated AST (greater than 5 x ULN), ALT (greater than 5 x ULN), and bilirubin (greater than 2.5 x ULN) have been reported in up to 6%, up to 5%, and up to 1% of patients, respectively. Elevated AST (greater than 180 units/L in males and 170 units/L in females) and ALT (greater than 215 units/L in males and 170 units/L in females) were reported in 3% and 2% of patients, respectively.

Elevated AST and ALT was reported more often in patients coinfected with HIV and hepatitis B virus (HBV) than in those only infected with HIV.

Severe acute exacerbations of hepatitis B (including fatalities) have been reported in patients coinfected with HIV-1 and HBV after discontinuation of this drug and were associated with liver failure and liver decompensation in some patients.

Lactic acidosis and severe hepatomegaly with steatosis (including fatal cases) have been reported with the use of nucleoside analogs.

Elevated GGT was only reported in a pediatric patient.[Ref]

Hematologic

Decreased neutrophils (less than 750/mm3) have been reported in up to 5% of patients.

Anemia was common in pediatric patients. Decreased hemoglobin (less than 7 g/dL) was only reported in a pediatric patient.[Ref]

Common (1% to 10%): Neutropenia, decreased neutrophils

Uncommon (0.1% to 1%): Anemia

Frequency not reported: Decreased hemoglobin[Ref]

Genitourinary

Common (1% to 10%): Hematuria

Frequency not reported: Glycosuria[Ref]

Hematuria (greater than 75 RBC/high power field) and glycosuria (3 plus) were reported in 3% and less than 1% of patients, respectively.[Ref]

Hypersensitivity

Common (1% to 10%): Allergic reaction[Ref]

Immunologic

Frequency not reported: Immune reconstitution/reactivation syndrome, autoimmune disorders in the setting of immune reconstitution (e.g., Graves' disease, polymyositis, Guillain-Barre syndrome)[Ref]

References

1. Molina JM, Journot V, Morand-Joubert L, et al. "Simplification Therapy with Once-Daily Emtricitabine, Didanosine, and Efavirenz in HIV-1-Infected Adults with Viral Suppression Receiving a Protease Inhibitor-Based Regimen: A Randomized Trial." J Infect Dis 191 (2005): 830-9

2. "Product Information. Emtriva (emtricitabine)." Gilead Sciences, Foster City, CA.

3. Warnke D, Barreto J, Temesgen Z "Antiretroviral drugs." J Clin Pharmacol 47 (2007): 1570-9

4. Piacenti FJ "An update and review of antiretroviral therapy." Pharmacotherapy 26 (2006): 1111-33

5. Frampton JE, Perry CM "Emtricitabine: A Review of its Use in the Management of HIV Infection." Drugs 65 (2005): 1427-48

6. Benson CA, van der Horst C, Lamarca A, et al. "A randomized study of emtricitabine and lamivudine in stably suppressed patients with HIV." AIDS 18 (2004): 2269-2276

7. Panel on Antiretroviral Therapy and Medical Management "Guidelines for the use of antiretroviral agents in pediatric HIV infection. Available from: URL: https://aidsinfo.nih.gov/contentfiles/lvguidelines/pediatricguidelines.pdf." ([2017, Apr 27]):

8. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents – A Working Group of the Office of AIDS Research Advisory Council (OARAC) "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available from: URL: https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf." ([2017, Oct 17]):

9. Borras-Blasco J, Navarro-Ruiz A, Borras C, Castera E "Adverse cutaneous reactions associated with the newest antiretroviral drugs in patients with human immunodeficiency virus infection." J Antimicrob Chemother 62 (2008): 879-88

10. Cerner Multum, Inc. "Australian Product Information." O 0

11. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

12. "Drugs for HIV infection." Treat Guidel Med Lett 7 (2009): 11-22

13. Blum MR, Chittick GE, Begley JA, Zong J "Steady-state pharmacokinetics of emtricitabine and tenofovir disoproxil fumarate administered alone and in combination in healthy volunteers." J Clin Pharmacol 47 (2007): 751-9

14. Lim SG, Ng TM, Kung N, et al. "A Double-blind Placebo-Controlled Study of Emtricitabine in Chronic Hepatitis B." Arch Intern Med 166 (2006): 49-56

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

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