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Headache, and Nausea, and Fatigue. Oh, My!

A Look at the Possible Side Effects That Can Result From HIV Medications

March/April 2012

Click on the name of each drug for further details, or refer to the manufacturer's package insert for a comprehensive list of potential drug side effects. Remember that side effects may or may not occur. Some are more common than others, and individuals react differently to the same drug. A drug regimen cannot be chosen solely on the basis of minimal potential for side effects. Discuss any symptoms, however minor, with your health care providers, including your pharmacist, since small reactions may become serious. There may also be management techniques for side effects.


Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Potential drug class side effects Rare but potentially serious toxicity with all NRTIs: enlarged, fatty liver (hepatomegaly with steatosis) and lactic acidosis (accumulation of lactate in the blood and abnormal acid-base balance). Lactic acidosis may cause persistent fatigue, abdominal pain or distension, nausea/vomiting, difficulty breathing or shortness of breath, and enlarged liver.
Combivir (lamivudine/zidovudine)

See Epivir and Retrovir.

Emtriva (emtricitabine, or FTC) A very tolerable drug, but side effects may include headache, diarrhea, nausea, and rash. Darkening of the skin on the palms and the soles of the feet has also been reported.
Epivir (lamivudine, or 3TC) A very tolerable drug, but side effects may include headache, nausea, vomiting, diarrhea, fever, fatigue, hair loss, insomnia, malaise, nasal symptoms, and cough.
Epzicom (abacavir/lamivudine)

See Epivir and Ziagen.

Retrovir (zidovudine, AZT, or ZDV) Headaches, fever, chills, muscle soreness and/or damage, fatigue, nausea, lipodystrophy, fingernail discoloration, anemia (low red blood cell count), and neutropenia (low white blood cell count).
Trizivir (abacavir/lamivudine/zidovudine) See Epivir, Retrovir, and Ziagen.
Truvada (emtricitabine/ tenofovir)

See Viread and Emtriva. Abdominal distension/pain.

Videx EC and Videx (didanosine, or ddI)

Peripheral neuropathy, upset stomach, diarrhea, headache, pancreatitis (inflammation of the pancreas), eye changes and optic neuritis, increased uric acid levels, insomnia, and body fat redistribution.

Viread (tenofovir DF, or TDF)

Overall fairly well tolerated; however, side effects may include nausea, diarrhea, vomiting, flatulence (gas), bone changes, kidney toxicities, decreased bone mineral density, and low blood phosphate.

Zerit (stavudine, or d4T)

Headache, diarrhea, nausea, rash, peripheral neuropathy, lipoatrophy (including facial wasting), mitochondrial toxicities (a variety of symptoms caused by cell damage), and elevated cholesterol levels.

Ziagen (abacavir, or ABC)

Hypersensitivity reaction, nausea, vomiting, diarrhea, fatigue, headache, fever, rash, and loss of appetite.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Potential drug class side effects Rash. Immune Reconstitution Inflammatory Syndrome (IRIS) may occur as the immune system regains strength; signs and symptoms of inflammation from previous infections may occur soon after anti-HIV treatment is initiated. Report symptoms of illness, such as shingles and TB, to a health care provider.
Edurant (rilpivirine, or RPV) Insomnia, headache, rash, and depressive disorders.
Intelence (etravirine, or ETR)

Rash, diarrhea, nausea, nasopharyngitis (symptoms like a common cold), headache, hypersensitivity, and increased liver enzyme levels.

Rescriptor (delavirdine, or DLV) Increased liver enzyme levels and itchy skin or rash.
Sustiva (efavirenz, or EFV)

Central nervous system (CNS) and psychiatric symptoms. Rash, nausea, vomiting, diarrhea, fever, insomnia, and increases in triglycerides, bad cholesterol (LDL), good cholesterol (HDL), and liver enzyme levels. False positive tests for marijuana. Birth defects.

Viramune XR and Viramune (nevirapine, or NVP)

Headache, nausea, vomiting, fever, rash, Stevens-Johnson syndrome, increased liver enzyme levels, liver damage, and drug-induced hepatitis.

Protease Inhibitors (PIs)
Potential drug class side effects Seen with protease inhibitors (except unboosted Reyataz) are increased levels of cholesterol and triglycerides, which may be associated with an increased risk of heart disease. Other possible side effects are lipodystrophy (body fat changes, including thinning of the face, arms, and legs, with or without fat accumulation in the stomach, breasts, and upper back), onset of new cases or worsening of diabetes (see your doctor promptly), and increased bleeding in hemophiliacs. Immune Reconstitution Inflammatory Syndrome (IRIS) may occur as the immune system regains strength; signs and symptoms of inflammation from previous infections may occur soon after anti-HIV treatment is initiated. Report symptoms of illness, such as shingles and TB, to a health care provider.
Aptivus (tipranavir, or TPV)
(must be taken with Norvir)

Mild diarrhea, nausea, vomiting, and abdominal pain. Headaches, fever, fatigue, dry mouth, rash (including sensitivity to sun), dizziness, liver toxicity, and bleeding in the brain. Aptivus has a sulfa component; use with caution in patients with allergies to sulfa drugs. Also see Norvir.

Crixivan (indinavir sulfate, or IDV)

Headache, fatigue or weakness, malaise, nausea, diarrhea, stomach pain, loss of appetite, yellowing of skin/eyes, changed skin color, dry mouth/sore throat, taste changes, painful urination, indigestion, joint pain, hives, liver toxicity, kidney stones, increased bilirubin, itchy/dry skin, ingrown toenails, and hair loss.

Invirase (saquinavir, or SQV)
(must be taken with Norvir)
Diarrhea, abdominal discomfort, vomiting, and nausea. Also see Norvir.
Kaletra (lopinavir/ritonavir, or LPV/r)

Rash, diarrhea, nausea, vomiting, stomach pain, headache, muscle weakness, increased cholesterol and triglycerides, and increased liver enzyme levels. Also see Norvir.

Lexiva (fosamprenavir calcium, or FPV) Nausea, rash, diarrhea, headache, vomiting, fatigue, and abdominal pain. Lexiva has a sulfa component; use with caution in patients with allergies to sulfa drugs.
Norvir (ritonavir, or RTV)

Weakness, stomach pain, upset stomach, tingling/numbness around the mouth, hands or feet, loss of appetite, taste changes, weight loss, headache, dizziness, pancreatitis, alcohol intolerance, liver problems, increased muscle enzyme levels, and uric acid.

Prezista (darunavir, or DRV)
(must be taken with Norvir)

Rash, diarrhea, nausea, headache, abdominal pain, and increased liver enzyme levels. Prezista has a sulfa component; use with caution in patients with allergies to sulfa drugs. Also see Norvir.

Reyataz (atazanavir sulfate, or ATV)

Dizziness, lightheadedness, rash, kidney stones, and elevated liver enzyme levels, including elevated levels of unconjugated bilirubin.

Viracept (nelfinavir, or NFV)

Diarrhea, stomach discomfort, nausea, gas, weakness, and rash.

Integrase Inhibitors (INSTIs)
Potential drug class side effects

Immune Reconstitution Inflammatory Syndrome (IRIS) may occur as the immune system regains strength; signs and symptoms of inflammation from previous infections may occur soon after anti-HIV treatment is initiated. Report symptoms of illness, such as shingles and TB, to a health care provider.

Isentress (raltegravir, or RAL)

A very tolerable drug, but side effects may include diarrhea, nausea, vomiting, headache, fever, abdominal pain, fatigue, weakness, dizziness, lipodystrophy, increased levels of liver enzymes and creatine kinase, allergic reaction, and cerebellar ataxia.

dolutegravir (or DTG) (investigational drug)

Seen in clinical study: nausea, diarrhea, headache, dizziness, fatigue, weakness, and upset stomach or indigestion. Available data is limited due to investigational status at press time.

elvitegravir (or EVG) (investigational drug)

Seen in clinical study: diarrhea, upper respiratory tract infection, bronchitis, back pain, depression, sinusitis, joint pain, nausea, and urinary tract infection. Available data is limited due to investigational status at press time.

Entry Inhibitors
Potential drug class side effects

Immune Reconstitution Inflammatory Syndrome (IRIS) may occur as the immune system regains strength; signs and symptoms of inflammation from previous infections may occur soon after anti-HIV treatment is initiated. Report symptoms of illness, such as shingles and TB, to a health care provider.

Fuzeon (enfuvirtide, T-20, ENF)

Injection site reactions (ISRs), pneumonia, diarrhea, nausea, and fatigue. Hypersensitivity reactions are possible.

Selzentry (maraviroc, or MVC)

Cough, fever, cold, rash, muscle and joint pain, stomach pain, dizziness, liver toxicity, allergic reaction, low blood pressure, and possible increased risk of infections and cancer.

Single-Tablet Regimens (STRs)
Atripla (efavirenz/emtricitabine/tenofovir)

See Sustiva and Truvada (Emtriva and Viread). Atripla dose cannot be adjusted for people with kidney problems. Nausea, diarrhea, rash, insomnia, abnormal dreams, and depressive disorders.

Complera (rilpivirine/emtricitabine/tenofovir)

See Edurant and Truvada (Emtriva and Viread). Complera dose cannot be adjusted for people with kidney problems. Insomnia, headache, nausea, dizziness, rash, abnormal dreams, and depressive disorders.

The "Quad" (elvitegravir/cobicistat/emtricitabine/tenofovir) (investigational drug)

See elvitegravir, cobicistat, and Truvada (Emtriva and Viread). The Quad dose cannot be adjusted for people with kidney problems. Nausea, diarrhea, and rash. Available data is limited due to investigational status at press time.

PK Enhancer
Cobicistat (or COBI) (investigational drug)

Seen in clinical study: diarrhea, nausea, lipid elevations (increases in cholesterol and triglycerides), creatine kinase, red blood cells in urine, increased serum creatinine, and decreased estimated glomerular filtration rate (e-GFR). Available data is limited due to investigational status at press time.


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This article was provided by Positively Aware. It is a part of the publication Positively Aware. Visit Positively Aware's website to find out more about the publication.
 
See Also
The 16th Annual HIV Drug Guide
More on HIV Medication Side Effects

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