Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide Advanced Patient Information - Drugs.com

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

Medically reviewed by Drugs.com. Last updated on Oct 8, 2022.

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 .

## Commonly used brand name(s)

In the U.S.

- Symtuza

Available Dosage Forms:

- Tablet

Therapeutic Class: Antiretroviral Agent

Pharmacologic Class: Protease Inhibitor

## Uses for darunavir, cobicistat, emtricitabine, and tenofovir alafenamide

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). Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide 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. Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide will not keep you from spreading HIV to other people. People who receive darunavir, cobicistat, emtricitabine, and tenofovir alafenamide may continue to have other problems usually related to AIDS or HIV disease.

Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide is available only with your doctor's prescription.

## Before using darunavir, cobicistat, emtricitabine, and tenofovir alafenamide

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 darunavir, cobicistat, emtricitabine, and tenofovir alafenamide, the following should be considered:

### Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to darunavir, cobicistat, emtricitabine, and tenofovir alafenamide 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.

### Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of darunavir, cobicistat, emtricitabine, and tenofovir alafenamide combination in children weighing at least 40 kilograms (kg). Safety and efficacy have not been established in children weighing less than 40 kg.

### Geriatric

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 darunavir, cobicistat, emtricitabine, and tenofovir alafenamide.

### Breastfeeding

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.

### Interactions with 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 darunavir, cobicistat, emtricitabine, and tenofovir alafenamide, 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 darunavir, cobicistat, emtricitabine, and tenofovir alafenamide 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
- Alprazolam
- Astemizole
- Carbamazepine
- Cisapride
- Colchicine
- Conivaptan
- Crizotinib
- Dihydroergotamine
- Domperidone
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Dronedarone
- Eletriptan
- Eliglustat
- Eplerenone
- Ergonovine
- Ergotamine
- Finerenone
- Fosphenytoin
- Grazoprevir
- Isavuconazonium Sulfate
- Ivabradine
- Levoketoconazole
- Lomitapide
- Lovastatin
- Lurasidone
- Maraviroc
- Mavacamten
- Methylergonovine
- Midazolam
- Naloxegol
- Pacritinib
- Pazopanib
- Phenobarbital
- Phenytoin
- Pimozide
- Primidone
- Ranolazine
- Rifampin
- Riociguat
- Romidepsin
- Sildenafil
- Silodosin
- Simvastatin
- St John's Wort
- Terfenadine
- Tolvaptan
- Triazolam
- Ubrogepant
- Venetoclax
- Voclosporin

Using darunavir, cobicistat, emtricitabine, and tenofovir alafenamide 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.

- Abametapir
- Acalabrutinib
- Ado-Trastuzumab Emtansine
- Afatinib
- Alfentanil
- Alprazolam
- Amineptine
- Amiodarone
- Amitriptyline
- Amitriptylinoxide
- Amobarbital
- Amoxapine
- Amphetamine
- Amprenavir
- Apalutamide
- Apixaban
- Aprepitant
- Aprobarbital
- Aripiprazole
- Atazanavir
- Atogepant
- Atomoxetine
- Atorvastatin
- Avacopan
- Avanafil
- Avapritinib
- Bedaquiline
- Belzutifan
- Benzhydrocodone
- Benzphetamine
- Berotralstat
- Betamethasone
- Betrixaban
- Boceprevir
- Bosentan
- Bosutinib
- Brigatinib
- Bromocriptine
- Budesonide
- Buprenorphine
- Buspirone
- Butabarbital
- Butalbital
- Cabazitaxel
- Cabotegravir
- Cabozantinib
- Calcifediol
- Capmatinib
- Cariprazine
- Ceritinib
- Ciclesonide
- Cilostazol
- Clarithromycin
- Clomipramine
- Clopidogrel
- Clozapine
- Cobimetinib
- Codeine
- Conivaptan
- Copanlisib
- Cyclophosphamide
- Cyclosporine
- Dabigatran Etexilate
- Dabrafenib
- Daclatasvir
- Daridorexant
- Darolutamide
- Dasabuvir
- Dasatinib
- Deflazacort
- Delamanid
- Delavirdine
- Desipramine
- Desogestrel
- Dexamethasone
- Dextroamphetamine
- Dextromethorphan
- Diazepam
- Dibenzepin
- Didanosine
- Dienogest
- Digoxin
- Dihydrocodeine
- Disopyramide
- Docetaxel
- Domperidone
- Donepezil
- Doxepin
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Drospirenone
- Duloxetine
- Duvelisib
- Efavirenz
- Elagolix
- Elbasvir
- Elexacaftor
- Elvitegravir
- Enasidenib
- Encorafenib
- Entrectinib
- Erlotinib
- Erythromycin
- Eslicarbazepine Acetate
- Estazolam
- Estradiol
- Eszopiclone
- Ethinyl Estradiol
- Ethynodiol
- Etonogestrel
- Etravirine
- Everolimus
- Fedratinib
- Fentanyl
- Fesoterodine
- Fexinidazole
- Finerenone
- Flecainide
- Fluoxetine
- Fluticasone
- Fluvastatin
- Fosamprenavir
- Fosaprepitant
- Fosnetupitant
- Futibatinib
- Gestodene
- Gilteritinib
- Glasdegib
- Glecaprevir
- Grazoprevir
- Haloperidol
- Horsetail
- Hydrocodone
- Hydrocortisone
- Hydroxyamphetamine
- Ibrexafungerp
- Ibrutinib
- Idelalisib
- Ifosfamide
- Iloperidone
- Imipramine
- Infigratinib
- Irinotecan
- Irinotecan Liposome
- Istradefylline
- Itraconazole
- Ivacaftor
- Ivosidenib
- Ixabepilone
- Ketoconazole
- Lapatinib
- Larotrectinib
- Lefamulin
- Leflunomide
- Lemborexant
- Levoketoconazole
- Levomilnacipran
- Levonorgestrel
- Lidocaine
- Lisdexamfetamine
- Lofepramine
- Lopinavir
- Lorlatinib
- Lumacaftor
- Lumateperone
- Lurbinectedin
- Macitentan
- Manidipine
- Medroxyprogesterone
- Melitracen
- Meperidine
- Mephobarbital
- Mestranol
- Methadone
- Methamphetamine
- Methohexital
- Methylprednisolone
- Mexiletine
- Midostaurin
- Mifepristone
- Mirtazapine
- Mirvetuximab Soravtansine-gynx
- Mitapivat
- Mobocertinib
- Modafinil
- Mometasone
- Morphine
- Morphine Sulfate Liposome
- Nafcillin
- Nelfinavir
- Neratinib
- Netupitant
- Nevirapine
- Nifedipine
- Nilotinib
- Nimodipine
- Nisoldipine
- Nomegestrol
- Norelgestromin
- Norethindrone
- Norgestimate
- Norgestrel
- Nortriptyline
- Olaparib
- Ombitasvir
- Ondansetron
- Opipramol
- Orlistat
- Osilodrostat
- Oxcarbazepine
- Oxycodone
- Pacritinib
- Palbociclib
- Panobinostat
- Paritaprevir
- Pemigatinib
- Pentazocine
- Pentobarbital
- Perphenazine
- Pexidartinib
- Pibrentasvir
- Pimavanserin
- Piperaquine
- Pitavastatin
- Pixantrone
- Ponatinib
- Pralsetinib
- Pravastatin
- Prednisolone
- Prednisone
- Primidone
- Propafenone
- Propranolol
- Protriptyline
- Quetiapine
- Quinidine
- Reboxetine
- Regorafenib
- Relugolix
- Retapamulin
- Ribociclib
- Rifabutin
- Rifapentine
- Rimegepant
- Ritonavir
- Rivaroxaban
- Rosuvastatin
- Ruxolitinib
- Salmeterol
- Saquinavir
- Secobarbital
- Segesterone
- Selpercatinib
- Selumetinib
- Simeprevir
- Sirolimus
- Sirolimus Protein-Bound
- Sonidegib
- Sufentanil
- Sunitinib
- Suvorexant
- Tacrolimus
- Tadalafil
- Tafamidis
- Tamoxifen
- Tamsulosin
- Tazemetostat
- Telaprevir
- Telithromycin
- Temsirolimus
- Teriflunomide
- Tezacaftor
- Thiopental
- Thiotepa
- Tianeptine
- Ticagrelor
- Tipranavir
- Topotecan
- Toremifene
- Trabectedin
- Tramadol
- Trazodone
- Triamcinolone
- Trimipramine
- Ulipristal
- Upadacitinib
- Valbenazine
- Vardenafil
- Vemurafenib
- Venlafaxine
- Vilanterol
- Vilazodone
- Vinblastine
- Vincristine
- Vincristine Sulfate Liposome
- Vinflunine
- Vorapaxar
- Voriconazole
- Warfarin
- Zanubrutinib
- Zolpidem

Using darunavir, cobicistat, emtricitabine, and tenofovir alafenamide 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.

- Amlodipine
- Aripiprazole Lauroxil
- Atazanavir
- Atorvastatin
- Clarithromycin
- Cobicistat
- Darunavir
- Digoxin
- Eltrombopag
- Indinavir
- Ketoconazole
- Nelfinavir
- Tenofovir Disoproxil Fumarate

### Interactions with food/tobacco/alcohol

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 darunavir, cobicistat, emtricitabine, and tenofovir alafenamide. 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.

## Related/similar drugs

Biktarvy, Genvoya, Stribild, Triumeq, Truvada, tenofovir, Atripla

## Proper use of darunavir, cobicistat, emtricitabine, and tenofovir alafenamide

Take darunavir, cobicistat, emtricitabine, and tenofovir alafenamide 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.

Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide 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 darunavir, cobicistat, emtricitabine, and tenofovir alafenamide without checking first with your doctor. When your supply of darunavir, cobicistat, emtricitabine, and tenofovir alafenamide is running low, contact your doctor or pharmacist ahead of time. Do not allow yourself to run out of darunavir, cobicistat, emtricitabine, and tenofovir alafenamide.

Take darunavir, cobicistat, emtricitabine, and tenofovir alafenamide 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 darunavir, cobicistat, emtricitabine, and tenofovir alafenamide 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 darunavir, cobicistat, emtricitabine, and tenofovir alafenamide. 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 and children weighing at least 40 kilograms (kg)—1 tablet once a day with food. Each tablet contains 800 milligrams (mg) of darunavir, 150 mg of cobicistat, 200 mg of emtricitabine, and 10 mg of tenofovir alafenamide.
    - Children weighing less than 40 kilograms—Use and dose must be determined by your doctor.

### Missed dose

If you miss a dose of darunavir, cobicistat, emtricitabine, and tenofovir alafenamide, 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.

Detailed Cobicistat / darunavir / emtricitabine / tenofovir alafenamide dosage information

## Precautions while using darunavir, cobicistat, emtricitabine, and tenofovir alafenamide

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

Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide should not be used together with alfuzosin (Uroxatral®), carbamazepine (Tegretol®), dronedarone (Multaq®), elbasvir/grazoprevir (Zepatier®), ivabradine (Corlaonor®), lomitapide (Juxtapid®), 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 darunavir, cobicistat, emtricitabine, and tenofovir alafenamide together with colchicine (Colcrys®) if you have kidney or liver disease.

Using darunavir, cobicistat, emtricitabine, and tenofovir alafenamide while you are pregnant can harm your unborn baby. Birth control pills may not work as well to prevent pregnancy when used with darunavir, cobicistat, emtricitabine, and tenofovir alafenamide. Use another form of birth control (eg, condoms, spermicide) along with your pills to keep from getting pregnant during treatment with darunavir, cobicistat, emtricitabine, and tenofovir alafenamide. If you think you have become pregnant while using darunavir, cobicistat, emtricitabine, and tenofovir alafenamide, tell your doctor right away.

Serious skin reactions (eg, Stevens-Johnson syndrome) can occur with darunavir, cobicistat, emtricitabine, and tenofovir alafenamide. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, chills, cough, diarrhea, itching, joint or muscle pain, red irritated eyes, 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, trouble breathing, unusual tiredness or weakness, vomiting, or weight gain. These could be symptoms of a serious kidney problem.

Two rare but serious reactions to darunavir, cobicistat, emtricitabine, and tenofovir alafenamide 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 nausea, vomiting, decreased appetite, muscle cramping or pain, stomach pain, unusual tiredness or weakness, trouble breathing, or yellow skin or eyes.

Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide may increase blood sugar levels. Check with your doctor if you notice a change in the results of your blood or urine sugar tests.

Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide 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 (eg, St John's wort) or vitamin supplements.

## Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide side effects

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
- trouble breathing
- unexplained weight loss
- unusual tiredness or weakness
- upper right abdominal or stomach 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.

Cobicistat / darunavir / emtricitabine / tenofovir alafenamide side effects (more detail)

## Frequently asked questions

- What drugs are contained in the HIV treatment Symtuza?

## More about cobicistat / darunavir / emtricitabine / tenofovir alafenamide

- Check interactions
- Reviews (4)
- Side effects
- Dosage information
- During pregnancy
- Drug class: antiviral combinations
- En español

### Patient resources

- Drug Information

#### Other brands

Symtuza

### Professional resources

- Prescribing Information

### Related treatment guides

- HIV Infection

## Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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