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Stribild
Stribild is a combination medication used to treat HIV-1 infection in adults and certain adolescents. It contains four active ingredients: elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate. This fixed-dose regimen is designed for patients who have never been treated with HIV medications or whose viral load is well-controlled on other HIV treatments. Stribild works by suppressing the replication of the HIV virus, helping to reduce the amount of virus in the body, boost the immune system, and slow the progression of the disease.
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Frequently Asked Questions
Can I take Stribild with other HIV medications?
No, Stribild is a complete regimen for the treatment of HIV-1 infection and should not be combined with other HIV medications unless directed by your healthcare provider.
What should I do if I miss a dose of Stribild?
If you miss a dose of Stribild and it is within 12 hours of your scheduled time, take it as soon as you remember. If more than 12 hours have passed, skip the missed dose and take the next dose at your regular time.
Can Stribild cure HIV?
No, Stribild does not cure HIV. It helps control the infection, reduces the viral load in the body, and allows the immune system to function more effectively, but it must be taken as prescribed to maintain these effects.
How long will I need to take Stribild?
HIV treatment is typically lifelong, and Stribild will need to be taken every day to keep the virus under control. Your healthcare provider may adjust your regimen over time based on your health and viral load.
Can I drink alcohol while taking Stribild?
It is generally advisable to avoid or limit alcohol consumption while taking Stribild, as both alcohol and Stribild can affect liver function. Discuss with your healthcare provider if you consume alcohol regularly.
Comprehensive Drug Guide
How Does Stribild Work?
- Elvitegravir: An integrase strand transfer inhibitor (INSTI) that blocks the HIV integrase enzyme, preventing the virus from integrating its genetic material into the host’s DNA.
- Cobicistat: A pharmacokinetic enhancer that boosts the levels of elvitegravir by inhibiting liver enzymes, allowing elvitegravir to remain in the body longer.
- Emtricitabine and Tenofovir disoproxil fumarate: Both are nucleotide reverse transcriptase inhibitors (NRTIs) that block the reverse transcriptase enzyme, which the virus uses to replicate its genetic material.
Together, these actions prevent the HIV virus from replicating and help control the viral load in the body.
Common Dosages
- 150 mg of elvitegravir
- 150 mg of cobicistat
- 200 mg of emtricitabine
- 300 mg of tenofovir disoproxil fumarate
Typical Dosing
- The recommended dose is one tablet taken orally once daily, with food.
- Stribild should be taken at the same time every day to maintain consistent drug levels in the body and maximize its effectiveness.
Typical Dosing
FDA Approved Indications
- The treatment of HIV-1 infection in adults and adolescents aged 12 years and older who weigh at least 35 kg and have not received prior antiretroviral therapy or are virologically suppressed on a stable antiretroviral regimen.
Who Shouldn't Take Stribild?
- Severe renal impairment (estimated creatinine clearance less than 30 mL/min)
- Concurrent use of drugs that are highly dependent on CYP3A for clearance or are potent inducers of CYP3A (such as rifampin, St. John’s Wort, and certain anticonvulsants), as these can significantly reduce the effectiveness of Stribild.
Advice From The Pharmacist
- Take Stribild with food to ensure proper absorption of the medication and to reduce gastrointestinal side effects.
- Make sure to take Stribild at the same time each day to maintain effective drug levels and prevent missed doses, which can lead to drug resistance.
- Do not stop taking Stribild without consulting your healthcare provider, as this can lead to an increase in viral load and the development of resistance.
- Avoid taking over-the-counter medications or supplements that may interact with Stribild (e.g., St. John’s Wort) without consulting a healthcare provider.
Side Effects of Stribild
Common Side Effects
- Nausea or vomiting
- Diarrhea
- Fatigue
- Headache
- Insomnia
Uncommon/Severe Side Effects
- Lactic acidosis: Symptoms include muscle pain, trouble breathing, stomach pain, or dizziness. This is a rare but serious condition.
- Kidney problems: Stribild can cause or worsen kidney issues, so kidney function should be monitored regularly.
- Bone density loss: Stribild may reduce bone mineral density, increasing the risk of fractures.
- Liver problems: Severe liver problems, including hepatotoxicity, can occur. Patients with pre-existing liver conditions (such as hepatitis B or C) should be monitored closely.
Risks and Warnings of Stribild
- Renal Impairment: Stribild can cause or exacerbate kidney issues, including a decrease in kidney function. Regular monitoring of kidney function is recommended, especially in patients with pre-existing kidney conditions.
- Lactic Acidosis and Hepatomegaly: Although rare, Stribild can cause lactic acidosis (buildup of lactic acid in the blood) and enlarged liver (hepatomegaly), which may be fatal if untreated. Patients experiencing unusual symptoms should seek medical attention.
- Bone Density Loss: Tenofovir disoproxil fumarate, one of the components of Stribild, is associated with reductions in bone mineral density. Patients should be monitored for signs of bone loss, particularly if they are at risk for osteoporosis.
Interactions with Stribild
Common Drug Interactions
- CYP3A inducers and inhibitors: Medications that induce CYP3A (such as rifampin and certain anticonvulsants) can reduce the effectiveness of Stribild, while CYP3A inhibitors (like ketoconazole) may increase the risk of side effects.
- NSAIDs (non-steroidal anti-inflammatory drugs): These can increase the risk of kidney damage when taken with Stribild.
- Antacids: Should be taken at least 2 hours apart from Stribild, as antacids containing aluminum, magnesium, or calcium may interfere with the absorption of the medication.
Alternatives to Stribild
- Genvoya: A similar combination HIV medication that contains tenofovir alafenamide instead of tenofovir disoproxil fumarate, which may have fewer side effects on kidney function and bone density.
- Biktarvy: A newer single-tablet regimen for HIV-1 that contains bictegravir, emtricitabine, and tenofovir alafenamide, providing a more convenient alternative for some patients.
- Triumeq: A combination HIV treatment containing dolutegravir, abacavir, and lamivudine, used in patients without resistance to the components.
