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The Body

Once- and Twice-a-Day HIV Medications

Part of HIV Medications: When to Start and What to Take

March 2009

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Once-a-Day NRTIs
DrugFood RestrictionsKey Considerations
EmtrivaEmtriva™ (FTC, emtricitabine)No food restrictions

  • Should not be taken with Combivir, Epivir, Epzicom, Trizivir or Truvada

  • Resistance can develop quickly if doses are missed

  • Specific side effects*: diarrhea, nausea, nasal allergies, rash, skin hyperpigmentation, cough
EpivirEpivir® (3TC, lamivudine)No food restrictions

  • Has better overall safety and effectiveness than other NRTIs -- fewer interactions and side effects

  • Resistance can develop quickly if doses are missed

  • Should not be taken with Combivir, Emtriva, Epzicom, Trizivir or Truvada

  • Specific side effects*: headache, nausea, fatigue, nasal problems, sore muscles
EpzicomEpzicom™ (combination of Ziagen + Epivir)No food restrictions
TruvadaTruvada® (combination of Viread + Emtriva)No food restrictions
Videx ECVidex® EC (ddI, didanosine)Take on an empty stomach

  • Videx dose should be reduced when taken with Viread or Truvada

  • Should not be taken with Zerit

  • Specific side effects*: neuropathy, diarrhea, pancreatitis
VireadViread® (TDF, tenofovir)No food restrictions

  • Videx dose should be reduced when taken with Viread or Truvada

  • Specific side effects*: headache, diarrhea, nausea, vomiting, loss of appetite, bone problems; risk of severe kidney or liver problems
ZiagenZiagen® (ABC, abacavir)No food restrictions

  • One of the meds in the combination pills Epzicom and Trizivir

  • Specific side effects*: Up to 8 percent of people may have a severe allergic reaction within 2 to 6 weeks of starting Ziagen. If this happens, Ziagen should be stopped immediately and never taken again; the reaction could be fatal if ignored. Ziagen should be used cautiously in people with liver disease. Other side effects include rash, fatigue, vomiting and diarrhea.
Once-a-Day NNRTIs
DrugFood RestrictionsKey Considerations
SustivaSustiva® (EFV, efavirenz)Take on an empty stomach, preferably at bedtime

  • Don't take when pregnant or if thinking about getting pregnant

  • Resistance can develop quickly if doses are missed

  • Some marijuana tests will be positive while taking this drug

  • May make PIs less effective, requiring doctors to increase their dosage

  • Many people may be resistant to Sustiva before they begin any treatment

  • Specific side effects*: rash, dizziness, trouble concentrating, insomnia, strange dreams, severe depression, diarrhea, fever, mild increase in cholesterol
ViramuneViramune® (NVP, nevirapine)No food restrictions

  • Should not be started in women who have a T-cell count over 250 or men starting a new regimen with a T-cell count over 400

  • Approved as a twice-a-day drug, though some doctors prescribe it once a day

  • Resistance can develop quickly if doses are missed

  • Frequent liver tests recommended during first 2-3 months

  • Specific side effects*: the potential for severe, life-threatening liver problems may be increased if taken once a day; other side effects include rash, nausea, headache
Once-a-Day PIs
DrugFood RestrictionsKey Considerations
KaletraKaletra® (combination of lopinavir + Norvir)Take with or without food. Side effects may be lessened with food.

  • Once-daily Kaletra is not recommended for treatment-experienced people

  • Gastrointestinal (i.e., gut) side effects may increase with once-a-day dosing

  • Resistance to Kaletra develops very slowly, and usually doesn't cause cross-resistance

  • Avoid taking Norvir separately when already taking Kaletra

  • Specific side effects*: headache, vomiting, diarrhea, fatigue, nausea, elevated lipid levels
LexivaLexiva® (FPV, fosamprenavir)No food restrictions

  • Needs to be taken with Norvir if used as a once-a-day medication

  • Specific side effects*: rash (may be severe), diarrhea, nausea, vomiting, headache; when taken with Norvir, possible elevations of cholesterol/triglycerides
ReyatazReyatazTM (ATV, atazanavir)Must be taken with food

  • Must be boosted with Norvir when given with Viread or Truvada

  • Must not be taken with proton pump inhibitors or antacids

  • Specific side effects*: jaundice, headache, nausea, rash
Once-a-Day NNRTI plus NRTIs
DrugFood RestrictionsKey Considerations
AtriplaAtriplaTM (combination of Sustiva + Viread + Emtriva)Take on an empty stomach

  • First fixed-dose combination pill to contain meds from two different drug classes (one NNRTI and two NRTIs)

  • Specific side effects*: see Emtriva, Sustiva and Viread
* Typical Side Effects of Different Medication Classes

  1. NNRTI side effects include, with Sustiva, nervous system and psychiatric side effects, diarrhea, rash, fever. With Viramune, rash and liver complications can be seen. NNRTIs lower effectiveness of birth control pills, so other contraceptives should be used.

  2. Possible side effects for NRTIs: pancreatitis, lactic acidosis and mitochondrial toxicity, which can cause neuropathy and wasting. Some NRTIs also contribute to high cholesterol and triglycerides.

  3. Possible side effects of protease inhibitors include: high cholesterol and triglycerides, lipodystrophy (body fat changes), high blood sugar with development or worsening of diabetes and increases in liver function tests. PIs also lower effectiveness of birth control pills, so other contraceptives should be used.

Copyright © 2006 Body Health Resources Foundation. All rights reserved.

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This article was provided by The Body. It is a part of the publication HIV Medications: When to Start and What to Take -- A Roadmap to Success.
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