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Efavirenz, Lamivudine, and Tenofovir

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WARNING

Hepatitis B virus infection (HBV; an ongoing liver infection) should not be treated with efavirenz, lamivudine, or tenofovir. If you have HBV or believe you might have it, let your doctor know. Before starting your efavirenz, lamivudine, and tenofovir treatment, your doctor may perform a test to see if you have HBV. If you have HBV and take efavirenz, lamivudine, and tenofovir, your condition could quickly get worse if you suddenly stop taking these medications. After you stop taking efavirenz, lamivudine, and tenofovir, your doctor will continue to check on you and place lab testing to see whether your HBV has gotten worse for a few months.

Keep all of your appointments with your physician and the lab. To monitor your body’s reaction to efavirenz, lamivudine, and tenofovir, your doctor will prescribe specific tests both before and during your therapy.

Why is this medication prescribed?

HIV in adults and children is treated with efavirenz, lamivudine, and tenofovir together. Efavirenz belongs to a group of drugs known as NNRTIs, or non-nucleoside reverse transcriptase inhibitors. A class of drugs known as nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs) includes lamivudine and tenofovir. They function by lowering the body’s HIV concentration. Despite the fact that efavirenz, lamivudine, and tenofovir do not treat HIV, they may lessen your risk of getting AIDS and other HIV-related conditions including serious infections or cancer. The risk of contracting or spreading the HIV virus to others may be reduced by taking these medications, engaging in safer sexual behaviour, and changing other aspects of one’s lifestyle.

How should this medicine be used?

Efavirenz, lamivudine, and tenofovir are available as a tablet for oral use. On an empty stomach (at least 1 hour before or 2 hours after a meal), it is typically taken once daily. Efavirenz, Lamivudine, and Tenofovir should be taken every day at roughly the same time. Some adverse effects may be less irritating if efavirenz, lamivudine, and tenofovir are taken before night. Ask your doctor or chemist to explain any instructions on your prescription label that you are unsure about following. Follow the directions on the label for efavirenz, lamivudine, and tenofovir. Never take it in larger or less amounts or more frequently than directed by your doctor.

Even if you feel better, you should continue taking efavirenz, lamivudine, and tenofovir. Stop taking efavirenz, lamivudine, and tenofovir only after seeing your physician. The virus may develop drug resistance and become more difficult to treat if you stop taking efavirenz, lamivudine, and tenofovir for even a brief period of time or skip doses.

The brand names Symfi and Symfi Lo refer to the combination of efavirenz, lamivudine, and tenofovir. These two brands cannot be switched for one another because they each contain different dosages of the same drug. Make sure you only get the brand of efavirenz, lamivudine, and tenofovir that your doctor prescribed for you. If you have any concerns regarding the brand of efavirenz, lamivudine, or tenofovir that you were prescribed, consult your chemist.

For a copy of the manufacturer’s information for the patient, ask your chemist or doctor.

Other uses for this medicine

Ask your doctor or chemist for more details if you believe this drug should be used for something else.

What special precautions should I follow?

Before taking efavirenz, lamivudine, and tenofovir,

  • If you have any allergies to efavirenz, lamivudine, tenofovir, other drugs, or any of the chemicals in efavirenz, lamivudine, and tenofovir tablets, let your doctor and chemist know right away. Request a list of the ingredients from your chemist.
  • It’s important to be aware that efavirenz, lamivudine, and tenofovir are also offered separately under the brand names Sustiva, Epivir, Epivir-HBV (used to treat hepatitis B), and Tenofovir, vemlidy (used to treat hepatitis B), Viread, and other drugs under the brand names Atripla, Biktarvy, Combivir, Complera, Descovy, Epzicom, Genvoya, Odefsey, Stribild, Symfi, Triumeq, Trizivir, and Truvada are examples of combinations. To ensure that you don’t receive the same medication more than once, let your doctor know if you’re taking any of these drugs.
  • If you take Zepatier (elbasvir/grazoprevir), let your doctor know. If you are taking this drug, your doctor will probably advise you to avoid taking efavirenz, lamivudine, and tenofovir.
  • Inform your doctor and chemist about any other prescription and over-the-counter drugs, vitamins, or dietary supplements you are currently taking or intend to take. Be certain to bring up any of the following: gentamicin, aminoglycosides such acyclovir (Sitavig, Zovirax), artemether/lumefantine (Coartem), adefovir (Hepsera), and adefovir; aspirin, additional nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), atorvastatin (Lipitor, in Caduet); bupropion (Forfivo, Wellbutrin, Zyban, and other brands); atovaquone/proguanil (Malarone); calcium channel blockers such verapamil (Calan, Verelan, in Tarka), felodipine, nicardipine (Cardene), and diltiazem (Cardizem, Cartia, Diltzac, and others); cyclosporine (Gengraf, Neoral, Sandimmune); ganciclovir (Cytovene); glecaprevir/pibrentasvir (Mavynet); carbamazepine (Carbatrol, Equetro, Tegretol, among others); cidofovir; macrolide antibiotics such clarithromycin (Biaxin, in Prevpac); methadone (Dolophine, Methadose); itraconazole (Sporanox, Onmel); ketoconazole; ledipasvir/sofosbuvir (Harvoni); phenobarbital, phenytoin (Dilantin, in Phenytek), posaconazole (Noxafil), pravastatin (Pravachol), rifampin (Rimactane, in Rifamate, Rifater), sertraline (Zoloft), rifabutin (Mycobutin), and rifampin (Rimactane); simvastatin (Flolopid, Zocor, and Vytorin), simeprevir (Olyslo), sirolimus (Rapamune), sofosbuvir/velpatasvir/voxilaprevir (Epculsa), and sofosbuvir/velpatasvir/voxilaprevir (Vosevi); tacrolimus (Astagraf, Envarsus, Prograf), trimethoprim (Primsol, in Bactrim, Septra), or drugs that contain sorbitol as a sweetener; valganciclovir (Valcyte), warfarin (Coumadin, Jantoven), and valacyclovir (Valtrex). Your doctor might need to adjust your medication doses or keep a close eye out for any negative side effects. Efavirenz, lamivudine, and tenofovir may interact with a variety of other drugs as well. As a result, it is important to inform your doctor about all the drugs you are taking, even ones that are not on this list.
  • Please let your doctor know if you are taking any herbal supplements, especially St. John’s wort.
  • Inform your doctor if you have or have ever had any of the conditions listed in the IMPORTANT WARNING section, a prolonged QT interval (a rare heart condition that may cause irregular heartbeat, fainting, or sudden death), a low level of potassium or magnesium in your blood, bone issues such as osteoporosis (a condition in which the bones become brittle and break easily), seizures, hepatitis C or another liver disease, kidney disease, or any other health issues. Additionally, let your doctor know if you regularly consume significant amounts of alcohol or have ever done so in the past, use street drugs or have done so in the past, abuse prescription medicines or have ever done so, or currently suffer from depression or another mental disorder. whether your kid is taking this medication, let your doctor know whether they have ever experienced pancreatitis or have previously been treated with a nucleoside analogue drug, such as a NRTI.
  • If you are pregnant or plan to become pregnant, inform your doctor right away. During therapy, you shouldn’t get pregnant. Before starting this medicine, you must have a negative pregnancy test. You must also use reliable birth control while undergoing therapy if you are capable of getting pregnant. You shouldn’t use efavirenz, lamivudine, or tenofovir as your sole method of birth control throughout therapy since they may interfere with the effects of hormonal contraceptives (birth control pills, patches, rings, implants, or injections). Throughout your treatment and for 12 weeks following your last dose, you must use a barrier form of birth control in addition to any other method you have selected. To select a birth control technique that will work for you, consult your doctor. While using efavirenz, lamivudine, or tenofovir, call your doctor right away if you become pregnant.
  • If you have HIV or are taking efavirenz, lamivudine, or tenofovir, you should not breastfeed.
  • You need to be aware that your body fat may expand or shift to several regions, including your upper back, neck (the “buffalo hump”), breasts, and the area surrounding your abdomen. Your face, legs, and arms may show a reduction of body fat.
  • You should be aware that while you use medications to treat your HIV infection, your immune system could become stronger and start to fight other infections you previously have in your body or trigger the development of other illnesses. You might start to exhibit signs of certain illnesses as a result of this. Tell your doctor right away if you experience any new or worsening symptoms while taking efavirenz, lamivudine, or tenofovir.
  • You should be aware that efavirenz, lamivudine, and tenofovir may cause you to feel lightheaded, tired, unable to focus, have difficulties falling or staying asleep, have strange dreams, or experience hallucinations (the perception of unreal objects or sounds). 2 to 4 weeks after the commencement of treatment, these adverse effects typically disappear. If you also drink alcohol or use certain other medications like antidepressants, anxiety meds, mental illness medications, seizures medications, sedatives, sleeping pills, or tranquillizers, these side effects could get worse. Prior to understanding how this drug affects you, avoid using machinery or driving a car.
  • You should be aware that the drugs efavirenz, lamivudine, and tenofovir may alter your mood or mental state. If you experience any of the following symptoms while taking efavirenz, lamivudine, or tenofovir, call your doctor right away: depression, suicidal thoughts, plans, or attempts, irrational anger or aggressive behaviour, hallucinations (hearing voices or seeing things that are not there), strange thoughts, loss of awareness of reality, or inability to move or speak normally. Make sure your family is aware of any potentially critical symptoms so they can contact your doctor on your behalf if you are unable to get help on your own.
  • You should be aware that months or years after starting to use efavirenz, lamivudine, and tenofovir, it may still result in very serious nervous system issues, such as encephalopathy (a serious and sometimes fatal brain illness). It’s critical for you to understand that efavirenz may contribute to nervous system issues, even if they might not manifest until after you’ve taken efavirenz, lamivudine, and tenofovir for a while. At any point while taking efavirenz, lamivudine, and tenofovir, if you develop balance or coordination issues, confusion, memory issues, or any other issues brought on by aberrant brain function, call your doctor immediately away. Your physician might advise you to stop taking lamivudine, tenofovir, and efavirenz.

What special dietary instructions should I follow?

Keep eating normally unless your doctor instructs you otherwise.

What should I do if I forget a dose?

If you miss a dosage, take it as soon as you recall. If the next dose is soon due, skip the missed one and carry on with your regular dosing plan. To make up for a missing dose, do not take a second one.

What side effects can this medication cause?

There could be negative effects from efavirenz, lamivudine, and tenofovir. If any of these symptoms are severe or do not go away, let your doctor know right once:

  • Headache
  • Abdomen ache
  • Diarrhea
  • Heartburn
  • Nausea
  • Vomiting
  • Joint, muscular, or back pain
  • Not enough energy
  • Feeling of stinging, burning, or discomfort in the arms or legs

Some adverse effects can be very harmful. Call your doctor right away or seek emergency medical attention if you have any of these symptoms or any of those listed in the SPECIAL PRECAUTIONS section:

  • Hives, hoarseness, swelling of the face, throat, tongue, lips, or eyes, difficulty breathing or swallowing
  • Irritation, fever, swelling of the cheeks, sores in the mouth, red or swollen eyes, peeling or blistering skin, and rash
  • Unusual chest pain, difficulty breathing, stomach pain, nausea, and vomiting, as well as feeling chilly, especially in your arms or legs, being extremely exhausted or weak, and a rapid or irregular heartbeat
  • Yellowing of the skin or eyes, dark urine, pale faeces, vomiting, nausea, lack of appetite, soreness or pain in the upper right part of the stomach, bloated stomach, excessive fatigue, weakness, and confusion
  • Reduced urination and leg edoema
  • Joint pain, muscle pain, bone pain, pain in the arms or legs, and bone fracture
  • Seizures
  • Feeling dizzy or weak; having an irregular or rapid heartbeat
  • Persistent stomach ache that starts in the upper left or middle but may move to the back, a queasy stomach

Other adverse effects could be brought on by efavirenz, lamivudine, and tenofovir. If you experience any strange issues while taking this medicine, contact your doctor right away.

You or your doctor can submit a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting programme online at http://www.fda.gov/Safety/MedWatch or by phone at 1-800-332-1088 if you suffer a serious side event.

What should I know about storage and disposal of this medication?

Keep this medication tightly closed in the original container and out of the reach of children. Keep it at room temperature and out of the bathroom and other places with excessive heat and moisture.

As many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and are simple for young children to open, it is crucial to keep all medications out of sight and out of reach of children. Always lock safety caps and promptly stash medication up and away from young children where it is out of their sight and reach to prevent poisoning.http://www.upandaway.org

Unused prescriptions must be disposed of carefully to prevent pets, kids, and other people from ingesting them. You should not, however, dispose of this medication in the toilet. Instead, utilising a medicine take-back programme is the ideal approach to get rid of your medicines. To find out about take-back programmes in your area, speak with your chemist or the garbage/recycling department in your city. If you do not have access to a take-back programme, visit the FDA’s Safe Disposal of Medicines website at http://goo.gl/c4Rm4p for additional information.

In case of emergency/overdose

Call the poison control hotline at 1-800-222-1222 in the event of an overdose. Additionally, information can be found online at https://www.poisonhelp.org/help. Call 911 right once if the person has collapsed, experienced a seizure, is having difficulty breathing, or cannot be roused.

Overdose signs could include the following:

  • Dizziness
  • Difficulty concentrating
  • Sleepiness
  • Having trouble falling or staying asleep
  • Strange dreams
  • Being aware of or hearing something that is not there
  • Uncontrollable trembling or muscle movements

What other information should I know?

Inform the lab staff and your doctor that you are taking efavirenz, lamivudine, and tenofovir prior to any laboratory test.

No one else should take your medication. Any queries you may have regarding prescription refills should be directed to your chemist.

Efavirenz, lamivudine, and tenofovir should always be available. Do not put off getting a refill on your prescription until you are out of medicine.

You should keep a written record of every medication you take, including any over-the-counter (OTC) items, prescription drugs, and dietary supplements like vitamins and minerals. This list should be brought with you whenever you see a doctor or are admitted to the hospital. You should always have this information with you in case of emergencies.

Brand names

  • Symfi®
  • Symfi Lo®
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