Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide (Oral route)

Pronunciation:

dar-UE-na-vir, koe-BIK-i-stat, em-trye-SYE-ta-been, ten-OF-oh-vir al-a-FEN-a-mide

Brand Names:

  • Symtuza

Dosage Forms:

  • Tablet

Warnings:

Oral route(Tablet)

Warning: Post treatment acute exacerbation of hepatitis BSevere acute exacerbations of hepatitis B (HBV) have been reported in patients who are coinfected with HIV-1 and HBV and have discontinued products containing emtricitabine and/or tenofovir disoproxil fumarate (TDF), and may occur with discontinuation of darunavir/cobicistat/emtricitabine/tenofovir alafenamide. Closely monitor hepatic function with both clinical and laboratory follow-up for at least several months in patients who are coinfected with HIV-1 and HBV and discontinue darunavir/cobicistat/emtricitabine/tenofovir alafenamide. If appropriate, anti-hepatitis B therapy may be warranted .

Classifications:

Therapeutic—

Antiretroviral Agent

Pharmacologic—

Protease Inhibitor

Uses of This Medicine:

Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide combination is used to treat human immunodeficiency virus (HIV) infection. HIV is the virus that causes acquired immune deficiency syndrome (AIDS). This medicine is usually given to patients who have yet not received any medicine for HIV infection.

Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide combination will not cure or prevent HIV infection or AIDS. It helps keep HIV from reproducing and appears to slow down the destruction of the immune system. This may help delay problems that are usually related to AIDS or HIV disease from occurring. This medicine will not keep you from spreading HIV to other people. People who receive this medicine may continue to have other problems usually related to AIDS or HIV disease.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of darunavir, cobicistat, emtricitabine, and tenofovir alafenamide combination in children. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of darunavir, cobicistat, emtricitabine, and tenofovir alafenamide combination in the elderly. However, elderly patients are more likely to have age-related liver problems, which may require caution in patients using this medicine.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Alfuzosin
  • Astemizole
  • Carbamazepine
  • Cisapride
  • Colchicine
  • Conivaptan
  • Crizotinib
  • Dihydroergotamine
  • Domperidone
  • Doxorubicin
  • Doxorubicin Hydrochloride Liposome
  • Dronedarone
  • Eletriptan
  • Eliglustat
  • Eplerenone
  • Ergonovine
  • Ergotamine
  • Fosphenytoin
  • Grazoprevir
  • Isavuconazonium Sulfate
  • Ivabradine
  • Lomitapide
  • Lovastatin
  • Lurasidone
  • Maraviroc
  • Methylergonovine
  • Midazolam
  • Naloxegol
  • Pazopanib
  • Phenobarbital
  • Phenytoin
  • Pimozide
  • Primidone
  • Ranolazine
  • Rifampin
  • Riociguat
  • Romidepsin
  • Sildenafil
  • Silodosin
  • Simvastatin
  • St John's Wort
  • Terfenadine
  • Tolvaptan
  • Triazolam
  • Venetoclax

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acalabrutinib
  • Ado-Trastuzumab Emtansine
  • Afatinib
  • Alfentanil
  • Alprazolam
  • Amineptine
  • Amiodarone
  • Amitriptyline
  • Amitriptylinoxide
  • Amobarbital
  • Amoxapine
  • Amprenavir
  • Apalutamide
  • Apixaban
  • Aprepitant
  • Aprobarbital
  • Aripiprazole
  • Atazanavir
  • Atomoxetine
  • Atorvastatin
  • Avanafil
  • Bedaquiline
  • Benzhydrocodone
  • Betrixaban
  • Boceprevir
  • Bosentan
  • Bosutinib
  • Brigatinib
  • Bromocriptine
  • Budesonide
  • Buprenorphine
  • Buspirone
  • Butabarbital
  • Butalbital
  • Cabazitaxel
  • Cabozantinib
  • Calcifediol
  • Cariprazine
  • Ceritinib
  • Cilostazol
  • Clarithromycin
  • Clomipramine
  • Cobimetinib
  • Codeine
  • Conivaptan
  • Copanlisib
  • Cyclophosphamide
  • Cyclosporine
  • Dabigatran Etexilate
  • Dabrafenib
  • Daclatasvir
  • Dasabuvir
  • Dasatinib
  • Deflazacort
  • Delamanid
  • Delavirdine
  • Desipramine
  • Desogestrel
  • Dexamethasone
  • Dextromethorphan
  • Diazepam
  • Dibenzepin
  • Didanosine
  • Dienogest
  • Digoxin
  • Dihydrocodeine
  • Disopyramide
  • Docetaxel
  • Domperidone
  • Donepezil
  • Doxepin
  • Doxorubicin
  • Doxorubicin Hydrochloride Liposome
  • Drospirenone
  • Duloxetine
  • Duvelisib
  • Efavirenz
  • Elagolix
  • Elbasvir
  • Elvitegravir
  • Encorafenib
  • Erlotinib
  • Erythromycin
  • Eslicarbazepine Acetate
  • Estazolam
  • Estradiol Cypionate
  • Estradiol Valerate
  • Eszopiclone
  • Ethinyl Estradiol
  • Ethynodiol Diacetate
  • Etonogestrel
  • Etravirine
  • Everolimus
  • Fentanyl
  • Flecainide
  • Fluoxetine
  • Fluticasone
  • Fluvastatin
  • Fosamprenavir
  • Fosaprepitant
  • Fosnetupitant
  • Gestodene
  • Glasdegib
  • Glecaprevir
  • Grazoprevir
  • Haloperidol
  • Horsetail
  • Hydrocodone
  • Hydrocortisone
  • Ibrutinib
  • Idelalisib
  • Ifosfamide
  • Iloperidone
  • Imipramine
  • Irinotecan
  • Irinotecan Liposome
  • Itraconazole
  • Ivacaftor
  • Ivosidenib
  • Ketoconazole
  • Lapatinib
  • Larotrectinib
  • Levomilnacipran
  • Levonorgestrel
  • Lidocaine
  • Lofepramine
  • Lopinavir
  • Lorlatinib
  • Lumacaftor
  • Macitentan
  • Manidipine
  • Medroxyprogesterone Acetate
  • Melitracen
  • Meperidine
  • Mephobarbital
  • Mestranol
  • Methadone
  • Methohexital
  • Mexiletine
  • Midostaurin
  • Mifepristone
  • Modafinil
  • Morphine
  • Morphine Sulfate Liposome
  • Nafcillin
  • Naloxegol
  • Nelfinavir
  • Neratinib
  • Netupitant
  • Nevirapine
  • Nifedipine
  • Nilotinib
  • Nimodipine
  • Nisoldipine
  • Norelgestromin
  • Norethindrone
  • Norgestimate
  • Norgestrel
  • Nortriptyline
  • Olaparib
  • Ombitasvir
  • Ondansetron
  • Opipramol
  • Orlistat
  • Oxcarbazepine
  • Oxycodone
  • Palbociclib
  • Panobinostat
  • Paritaprevir
  • Pentazocine
  • Pentobarbital
  • Perphenazine
  • Pibrentasvir
  • Pimavanserin
  • Piperaquine
  • Pitavastatin
  • Pixantrone
  • Ponatinib
  • Pravastatin
  • Prednisolone
  • Prednisone
  • Primidone
  • Propafenone
  • Propranolol
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Reboxetine
  • Regorafenib
  • Retapamulin
  • Ribociclib
  • Rifabutin
  • Rifapentine
  • Ritonavir
  • Rivaroxaban
  • Rosuvastatin
  • Ruxolitinib
  • Salmeterol
  • Saquinavir
  • Secobarbital
  • Simeprevir
  • Sirolimus
  • Sonidegib
  • Sufentanil
  • Sunitinib
  • Suvorexant
  • Tacrolimus
  • Tadalafil
  • Tamoxifen
  • Tamsulosin
  • Telaprevir
  • Telithromycin
  • Temsirolimus
  • Tezacaftor
  • Thiopental
  • Thiotepa
  • Tianeptine
  • Ticagrelor
  • Tipranavir
  • Tolvaptan
  • Topotecan
  • Toremifene
  • Trabectedin
  • Tramadol
  • Trazodone
  • Trimipramine
  • Valbenazine
  • Vardenafil
  • Vemurafenib
  • Venlafaxine
  • Vilanterol
  • Vilazodone
  • Vinblastine
  • Vincristine
  • Vincristine Sulfate Liposome
  • Vinflunine
  • Vorapaxar
  • Voriconazole
  • Warfarin
  • Zolpidem

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aripiprazole Lauroxil
  • Atazanavir
  • Atorvastatin
  • Clarithromycin
  • Cobicistat
  • Darunavir
  • Digoxin
  • Indinavir
  • Ketoconazole
  • Nelfinavir
  • Tenofovir Disoproxil Fumarate

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Diabetes or
  • Fanconi syndrome (kidney disease), history of or
  • Hepatitis B infection, history of or
  • Hemophilia (bleeding problem) or
  • Kidney failure, history of or
  • Sulfa allergy—Use with caution. May make these conditions worse.
  • Kidney disease, severe or
  • Liver disease, severe—Use is not recommended in patients with these conditions.

Proper Use of This Medicine:

Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine comes with a patient information leaflet. Read and follow these instructions carefully. Read it again each time you refill your prescription in case there is new information. You should talk to your doctor if you have any questions.

Do not change the dose or stop using this medicine without checking first with your doctor. When your supply of this medicine is running low, contact your doctor or pharmacist ahead of time. Do not allow yourself to run out of this medicine.

Take this medicine with food.

If you cannot swallow the tablet whole, you may cut it into two using a tablet cutter. Take both halves of the tablet right away.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For treatment of HIV infection:
      • Adults—1 tablet once a day. Each tablet contains 800 milligrams (mg) of darunavir, 150 mg of cobicistat, 200 mg of emtricitabine, and 10 mg of tenofovir alafenamide.
      • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits, especially during the first few weeks that you take this medicine, to make sure this medicine is working properly. Blood and urine tests may be needed to check for any unwanted effects.

This medicine should not be used together with alfuzosin (Uroxatral®), carbamazepine (Tegretol®), cisapride (Propulsid®), dronedarone (Multaq®), elbasvir/grazoprevir (Zepatier®), ivabradine (Corlaonor®), lovastatin (Mevacor®), lurasidone (Latuda®), midazolam (Versed®), naloxegol (Movantik®, Moventig®), phenobarbital (Luminal®), phenytoin (Dilantin®), pimozide (Orap®), ranolazine (Ranexa®), rifampin (Rifadin®, Rimactane®), sildenafil (Revatio®), simvastatin (Zocor®), St. John's wort, triazolam (Halcion®), or ergot medicines (eg, dihydroergotamine, ergotamine, methylergonovine, Cafergot®, Ergomar®, Wigraine®). Do not use this medicine together with colchicine (Colcrys®) if you have kidney or liver disease.

Using this medicine while you are pregnant can harm your unborn baby. Birth control pills may not work as well to prevent pregnancy when used with this medicine. Use another form of birth control (eg, condoms, spermicide) along with your pills. If you think you have become pregnant while using this medicine, tell your doctor right away.

Serious skin reactions can occur with this medicine. Check with your doctor right away if you have any of the following symptoms: severe rash, blistering, peeling, or loosening of the skin, chills, cough, diarrhea, itching, joint or muscle pain, red skin lesions, often with a purple center, skin rash, sore throat, sores, ulcers, or white spots in the mouth or on the lips, or unusual tiredness or weakness.

Your immune system may get stronger when you start taking HIV medicines. Tell your doctor right away if you notice any changes in your health. Sometimes the immune system will start to fight infections that were hidden in your body, such as pneumonia, herpes, or tuberculosis. Autoimmune disorders (eg, Graves' disease, polymyositis, and Guillain-Barré syndrome) may also occur.

A decrease in frequency or amount of urine, an increase in blood pressure, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, troubled breathing, unusual tiredness or weakness, vomiting, or weight gain. These could be symptoms of a serious kidney problem.

Two rare but serious reactions to this medicine are lactic acidosis (too much acid in the blood) and liver toxicity. These reactions are more common if you are female, obese, or have been taking anti-HIV medicines for a long time. Call your doctor right away if you have abdominal or stomach pain, nausea, vomiting, decreased appetite, muscle cramping or pain, unusual tiredness or weakness, trouble breathing, or yellow skin or eyes.

This medicine may increase blood sugar levels. Check with your doctor if you notice a change in the results of your blood or urine sugar tests.

This medicine may cause you to have excess body fat. Tell your doctor if you notice changes in your body shape, such as an increased amount of fat in the upper back and neck, or around the chest and stomach area. You might also lose fat from the legs, arms, and face.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or non-prescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine 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:

More common
Rash
Less Common
Blistering, peeling, or loosening of the skin
bloating
blurred vision
chills
constipation
cough
dark urine
diarrhea
dry mouth
fast heartbeat
fever
flushed, dry skin
fruit-like breath odor
general tiredness and weakness
heavy jaw feeling
increased hunger
increased thirst
increased urination
indigestion
itching
joint or muscle pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
light-colored stools
loosening of a tooth
loss of appetite
loss of consciousness
nausea
pain, swelling, or numbness in the mouth or jaw
pains in the stomach, side, or abdomen, possibly radiating to the back
red skin lesions, often with a purple center
red, irritated eyes
sore throat
sores, ulcers, or white spots in the mouth or on the lips
stomachache
sweating
troubled breathing
unexplained weight loss
unusual tiredness or weakness
upper right abdominal pain
vomiting
yellow eyes or skin
Incidence not known
Muscle cramps, spasms, or stiffness
swollen, painful, or tender lymph glands in the neck, armpit, or groin

Some side effects 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:

Less common
Abnormal dreams
belching
difficulty in moving
excess air or gas in the stomach or bowels
headache
heartburn
passing gas
redistribution or accumulation of body fat
stomach discomfort, upset, or pain
swelling of the breasts or breast soreness in both females and males
swollen joints
weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 8/2/2019

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.
All rights reserved.

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