Once- and Twice-a-Day HIV Medications

Once-a-Day NRTIs
Drug		Food Restrictions	Key Considerations
	Emtriva™ (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
	Epivir® (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
	Epzicom™ (combination of Ziagen + Epivir)	No food restrictions	Should not be taken with Combivir, Emtriva, Epivir, Trizivir, Truvada or Ziagen Specific side effects*: potential for allergic reaction to Ziagen; see Epivir and Ziagen
	Truvada® (combination of Viread + Emtriva)	No food restrictions	Should not be taken with Combivir, Emtriva, Epivir, Epzicom, Trizivir, Viread or Ziagen Specific side effects*: see Emtriva and Viread
	Videx® 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
	Viread® (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
	Ziagen® (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
Drug		Food Restrictions	Key Considerations
	Sustiva® (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
	Viramune® (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
Drug		Food Restrictions	Key Considerations
	Kaletra® (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
	Lexiva® (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
	Reyataz^TM (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
Drug		Food Restrictions	Key Considerations
	Atripla^TM (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 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. 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. 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.

Twice-a-Day NRTIs
Drug		Food Restrictions	Key Considerations
	Combivir® (combination of Epivir + Retrovir)	No food restrictions	Should not be taken with Epivir, Retrovir or Zerit Specific side effects*: see Epivir and Retrovir
	Retrovir® (AZT, zidovudine)	No food restrictions	One of the meds used in the combination pills Combivir and Trizivir (see note for Ziagen above) First anti-HIV drug approved; studied more than any other drug Should not be taken with Zerit Reduces mother-to-child transmission of HIV in pregnancy Specific side effects*: headache, nausea, anemia, fatigue, lipoatrophy (wasting)
	Trizivir® (combination of Epivir + Retrovir + Ziagen)	No food restrictions	Should not be taken with Epivir, Retrovir or Ziagen More likely to cause side effects than Combivir For a complete initial regimen, strengthen with an additional PI or NNRTI Specific side effects*: severe allergic reaction to Ziagen; also see Epivir and Retrovir
	Videx® (ddI, didanosine)	Take on an empty stomach	See Videx EC, above
	Zerit® (d4T, stavudine)	No food restrictions	Should not be taken with Retrovir or Videx Specific side effects*: neuropathy, lipoatrophy (wasting), hypertension, elevated cholesterol/triglycerides
Twice-a-Day NNRTIs
Drug		Food Restrictions	Key Considerations
	Viramune® (NVP, nevirapine)	No food restrictions	See Viramune, above
Twice-a-Day PIs
Drug		Food Restrictions	Key Considerations
	Aptivus® (TPV, tipranavir)	Take with food	Must be taken with Norvir Only recommended for use in treatment-experienced people Liver function should be monitored continually Specific side effects*: serious liver problems, elevations in cholesterol/triglycerides, rash, diarrhea, nausea, vomiting, unusual tiredness
	Crixivan® (IDV, indinavir)	No food restrictions when taken boosted with Norvir When not boosted, don't take with high calorie or high-fat meal or drink	Should not be taken with Reyataz; avoid Crixivan if pregnant Normally a three-times-daily med, can be twice-daily when "boosted" with Norvir Specific side effects*: kidney stones, anemia, upset stomach, bloating, skin rash, lipid and glucose disorders
	Invirase® (SQV-HGC, saquinavir)	Take within two hours after a meal	Almost always "boosted" with Norvir Specific side effects*: bloating, diarrhea, nausea; fewer lipid problems than other older PIs
	Kaletra® (combination of lopinavir + Norvir)	Must be taken with food	See Kaletra, above
	Lexiva® (FPV, fosamprenavir)	No food restrictions	See Lexiva, above
	Norvir® (RTV, ritonavir)	Take with high-fat food if possible Refrigeration is preferred, although it can also be kept at room temperature for up to 30 days	Used primarily to "boost" the effectiveness of other PIs Norvir-boosted PIs are associated with increases in triglycerides and cholesterol Specific side effects*: nausea, diarrhea, vomiting, gas
	Prezista® (TMC114, darunavir)	Take with food	Must be taken with Norvir Primarily used by people who have already taken other treatment regimens Specific side effects*: diarrhea, nausea, headache, skin rashes
	Viracept® (NFV, nelfinavir)	Should be taken with food	Weaker than boosted PIs or NNRTIs Specific side effects*: diarrhea, headache, nausea
Twice-a-Day FIs
Drug		Food Restrictions	Key Considerations
	Fuzeon® (T-20, enfuvirtide)	No food restrictions	Primarily used in people who have already taken a lot of HIV drug regimens It is a powder that needs to be mixed with sterile water and injected under the skin Specific side effects*: most people get a skin reaction where the shot is given
* Typical Side Effects of Different Medication Classes 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. 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. 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.

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