What Atripla is used for and how to use it
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Atripla - Consumer Medicine Information

Manufacture: Bristol-Myers Squibb and Gilead Sciences, LLC
Country: Angola
Condition: HIV Infection, Nonoccupational Exposure, Occupational Exposure
Class: Antiviral combinations
Form: Tablets
Ingredients: efavirenz, emtricitabine, tenofovir disoproxil fumarate (tenofovir DF), croscarmellose sodium, hydroxypropyl cellulose, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate, black iron oxide, polyethylene glycol, polyvinyl alcohol, red iron oxide, talc and titanium dioxide

(Efavirenz / Emtricitabine / Tenofovir Disoproxil Fumarate Tablets)

About this medication

What the medication is used for

ATRIPLA contains 3 medicines, SUSTIVA (efavirenz), EMTRIVA (emtricitabine) and VIREAD (tenofovir DF), combined in one pill. EMTRIVA and VIREAD are HIV (human immunodeficiency virus) nucleoside/nucleotide analog reverse transcriptase inhibitors (NRTI) and SUSTIVA is an HIV non-nucleoside analog reverse transcriptase inhibitor (NNRTI). VIREAD and EMTRIVA are components of TRUVADA . ATRIPLA can be used alone as a complete regimen, or in combination with other medications to treat people with HIV infection. ATRIPLA is for adults age 18 and older. ATRIPLA has not been studied in children under age 18 or adults over age 65.

What it does

ATRIPLA helps block HIV reverse transcriptase, a chemical in your body (enzyme) that is needed for HIV to multiply. ATRIPLA lowers the amount of HIV in the blood (viral load). Lowering the amount of HIV in the blood lowers the chance of infections that happen when your immune system is weak (opportunistic infections).

HIV infection destroys CD4 (T) cells, which are important to the immune system. The immune system helps fight infection. After a large number of T cells are destroyed, acquired immune deficiency syndrome (AIDS) develops. ATRIPLA may also help to increase the number of T cells (CD4 cells).

ATRIPLA does not cure HIV infection or AIDS. The long-term effects of ATRIPLA are not known at this time. People taking ATRIPLA may still get opportunistic infections or other conditions that happen with HIV infection. Opportunistic infections are infections that develop because the immune system is weak. Some of these conditions are pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC) infections. It is very important that you see your doctor regularly while taking ATRIPLA.

ATRIPLA has not been shown to reduce the risk of passing HIV to others through sexual contact or blood contamination. Continue to practice safe sex and do not use or share dirty needles.

When it should not be used

Together with your doctor, you need to decide whether ATRIPLA is right for you.

Do not take ATRIPLA if:

  • you are taking any medication that is listed in this pamphlet under “Drugs that should not be taken with ATRIPLA” (see INTERACTIONS WITH THIS MEDICATION).
  • you have or are at known risk for any type of bone disease or bone related problems and have not discussed this with your doctor.
  • you are allergic to ATRIPLA or any of its ingredients. The medicinal ingredients are efavirenz, emtricitabine and tenofovir DF (see: What the important nonmedicinal ingredients are).

What the medicinal ingredients are

tenofovir disoproxil fumarate (tenofovir DF)

What the important nonmedicinal ingredients are

croscarmellose sodium, hydroxypropyl cellulose, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate, black iron oxide, polyethylene glycol, polyvinyl alcohol, red iron oxide, talc and titanium dioxide.

What dosage forms it comes in

ATRIPLA is available as tablets. Each tablet contains 600 mg of efavirenz, 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate (which is equivalent to 245 mg of tenofovir disoproxil), as active ingredients. The tablets are pink, modified capsule- shaped, film-coated, debossed with “123” on one side and plain-faced on the other side. Each bottle contains 30 tablets and a silica gel desiccant and is closed with a child-resistant closure.

Warnings and precautions

Serious Warnings and Precautions
— The class of medicines to which emtricitabine and tenofovir DF, two of the components of ATRIPLA, belongs (NRTI) can cause a condition called lactic acidosis, together with an enlarged liver. This rare but serious side effect has occasionally been fatal

         — The symptoms that may lactic acidosis include: feeling very weak, tired or          uncomfortable; unusual or unexpected stomach discomfort; feeling cold; feeling dizzy          or lightheaded; suddenly developing an irregular heartbeat. Lactic acidosis occurs          more often in women, particularly if they are very overweight. You should consult your          doctor immediately if such symptoms occur while you are receiving ATRIPLA.

         — Non-specific symptoms of liver problems may include nausea, vomiting, stomach          pain and yellowing of the skin and eyes.

 If you notice these symptoms of lactic acidosis or liver problems, stop taking ATRIPLA and consult a doctor immediately.

“Flare-ups” of Hepatitis B Virus infection, in which the disease suddenly returns in a worse way than before, can occur if you stop taking ATRIPLA. Do not stop taking ATRIPLA without your doctor’s advice. If you stop taking ATRIPLA, tell your doctor immediately about any new, unusual or worsening symptoms that you notice after stopping treatment. After you stop taking ATRIPLA, your doctor will still need to check your health and take blood tests to check your liver. ATRIPLA is not approved for the treatment of hepatitis B virus infection.

— The most serious possible side effect is harm to the kidneys, including damage to kidney cells, kidney tissue inflammation and kidney failure. Your doctor may monitor your kidney function before beginning and while receiving ATRIPLA. Some patients treated with tenofovir DF (a component of ATRIPLA) have had kidney problems. Your doctor may need to perform additional blood tests if you have had kidney problems in the past or need to take another drug that can cause kidney problems.
  • Tenofovir DF, a component of ATRIPLA, caused harm to the bones of animals. If you notice bone pain, suffer a bone fracture, or other bone problem, consult your doctor. If you have bone problems, you may wish to discuss calcium and/or vitamin D supplementation with your doctor. The effect of supplementation with calcium and/or vitamin D is unknown.
  • Patients who experience dizziness, trouble concentrating or drowsiness should avoid driving or operating machinery.
  • Women should not become pregnant while taking ATRIPLA and for 12 weeks after stopping it. Serious birth defects have been seen in animals and women treated with efavirenz (a component of ATRIPLA) during pregnancy. It is not known whether efavirenz caused these defects. A reliable form of barrier contraception must always be used even if you or your partner are using other methods of contraception such as the pill or other hormonal therapy (e.g. implants, injections). ATRIPLA may remain in your blood for a time after therapy is stopped. Therefore, you should continue use of a reliable form of contraception for 12 weeks after stopping treatment with ATRIPLA. If you are pregnant or become pregnant while taking ATRIPLA, your doctor may register you in the Antiretroviral Pregnancy Registry. The Registry monitors fetal outcomes in pregnant women using antiretroviral medicines.
  • A small number of patients taking efavirenz, one of the components of ATRIPLA, have had severe depression, strange thoughts, or angry behavior. Some patients have had thoughts of suicide and a few patients have actually committed suicide. These problems tend to occur more often in patients with a history of mental illness. You should contact your doctor immediately if you think you are having these symptoms, so your doctor can decide whether you should continue to take ATRIPLA.
  • Consult your doctor if you have a rash since some rashes may be serious.

BEFORE you use ATRIPLA (efavirenz/ emtricitabine/tenofovir DF) talk to your doctor or pharmacist:

If you have ever had a previous life threatening skin reaction (e.g. Stevens-Johnson syndrome).

If you are breast- feeding or plan to breast-feed

Do not breast- feed if you have HIV or are taking ATRIPLA. HIV can be passed to your baby in your breast milk. All components of ATRIPLA, efavirenz, emtricitabine and tenofovir DF, can be passed to your baby in your breast milk and may cause harm to your baby. Talk to your doctor about the best way to feed your baby. 

If you have other medical conditions

Let your doctor know if you have other medical conditions, especially liver, kidney problems, pancreatitis (inflammation of the pancreas), seizures or mental illness, or have or are at risk for bone disease or bone-related problems.

If you are taking other medicines

Some medicines can interact when taken together, including prescription and non-prescription medicines, herbal products and dietary supplements (see INTERACTIONS WITH THIS MEDICATION).

Interactions with this medication

No drug interaction studies have been done with ATRIPLA.

Drugs that must not be taken with ATRIPLA:

  • Propulsid (cisapride)*, Versed (midazolam), Halcion (triazolam), ergot medications (for example Wigraine and Cafergot), Hismanal (astemizole)*, Seldane (terfenadine)*, Vascor (bepridil)* or Orap (pimozide). Taking these medications with ATRIPLA could create the potential for serious or life-threatening side effects.
  • Vfend (voriconazole) since it may lose its effect or may increase the chance of having side effects from ATRIPLA.
  • Do not take ATRIPLA if you are taking St. John’s wort (Hypericum perforatum), or products containing St. John’s wort. St. John’s wort is an herbal product sold as a dietary supplement. Taking St. John’s wort may decrease ATRIPLA levels and may lead to increased viral load and possible resistance to efavirenz or resistance to the class of non-nucleoside reverse transcriptase inhibitors (NNRTIs).

*Not marketed in Canada.

It is also important to tell your doctor if you are taking any of the following:

  • ATRIPLA should not be used with Combivir, COMPLERA, EMTRIVA, 3TC, Heptovir, HEPSERA, Kivexa, Triumeq,Trizivir, TRUVADA, STRIBILD or VIREAD. ATRIPLA also should not be used with SUSTIVA unless your doctor decides a dose adjustment is needed (e.g. with rifampin).
  • Do not take ATRIPLA if you are on other medications that may affect your kidneys and have not discussed this with your doctor.
  • Reyataz (atazanavir sulfate), Fortovase or Invirase (saquinavir), or Biaxin (clarithromycin); these medicines need to be replaced with another medicine when taken with ATRIPLA. If your doctor does prescribe Reyataz and ATRIPLA together, you may need to be monitored more carefully for side effects.
  • Celsentri (maraviroc)
  • Crixivan (indinavir), methadone, Mycobutin (rifabutin), Zoloft (sertraline), Wellbutrin SR, Wellbutrin XL, or Zyban (bupropion); these medicines may need to have their dose changed when taken with ATRIPLA.
  • Videx or Videx EC (didanosine); Tenofovir DF (a component of ATRIPLA) may increase the amount of didanosine in your blood, which could result in more side effects. You may need to be monitored more carefully if you are taking ATRIPLA and didanosine together. Also, the dose of didanosine may need to be changed.
  • Kaletra (lopinavir/ritonavir); these medicines may increase the amount of tenofovir DF (a component of ATRIPLA) in your blood, which could result in more side effects. You may need to be monitored more carefully if you are taking ATRIPLA and Kaletra together. Also, the dose of Kaletra may need to be changed.
  • Medicines for seizures [for example, Dilantin (phenytoin), Tegretol (carbamazepine), or phenobarbital]; your doctor may want to switch you to another medicine or check drug levels in your blood from time to time.
  • Sporanox (itraconazole) and Posanol (posaconazole) may need to be replaced by another medicine when taken with ATRIPLA.
  • The cholesterol-lowering medicines Lipitor (atorvastatin), Pravachol (pravastatin sodium), and Zocor (simvastatin).
  • Rifadin (rifampin) or the rifampin-containing medicines Rofact and Rifater.
  • Calcium channel blockers such as Cardizem, or Tiazac (diltiazem), Covera HS, Isoptin SR or Tarka (verapamil), and others.
  • Immunosuppressants such as Neoral (cyclosporine), Advagraf or Prograf (tacrolimus), Rapamune or Torisel (sirolimus).
  • Hepatitis C antiviral agents such as Victrelis (boceprevir), Galexos (simeprevir) and Incivek (telaprevir)
  • Antimalarials such as Coartem* and Riamet* (artemether/lumefantrine), and Malarone (atovaquone/proguanil)
  • The effect of combining alcohol or recreational (street, illicit) drugs with efavirenz has not been studied. Because they may interact with each other, speak with your doctor before you combine ATRIPLA with these drugs.

*Drug is not marketed in Canada

These are not all the medicines that may cause problems if you take ATRIPLA. Be sure to tell your doctor about all the medicines you take.

Keep a complete list of all the prescription and nonprescription medicines as well as any herbal medicines that you are taking, how much you take and how often you take them. Make a new list when medicines or herbal medicines are added or stopped, or if the dose changes. Give copies of this list to all your doctors and pharmacists every time you visit them or fill a prescription. This will give your doctor a complete picture of the medicines you use. Then he or she can decide the best approach for the situation.

Proper use of this medication

Stay under a doctor’s care when taking ATRIPLA. Do not change your treatment or stop treatment without first talking with your doctor.

Take ATRIPLA every day exactly as your doctor prescribed it. Follow the directions from your doctor, exactly as written on the label. Set up a dosing schedule and follow it carefully.

When your ATRIPLA supply starts to run low, get more from your doctor or pharmacy. This is very important because the amount of virus in your blood may increase if the medicine is stopped for even a short time. The virus may develop resistance to ATRIPLA and become harder to treat.

Only take medicine that has been prescribed specifically for you. Do not give ATRIPLA to others or take medicine prescribed for someone else.

Do not use if seal over bottle opening is broken or missing.

Usual Adult Dose

  • The usual dose of ATRIPLA is one tablet orally (by mouth) once a day.
  • ATRIPLA should be taken on an empty stomach. Taking ATRIPLA at bedtime may make some side effects less bothersome.


In case of drug overdose, contact your healthcare practitioner (e.g. doctor), hospital emergency department or regional poison control centre, even if there are no symptoms.

Missed Dose

It is important that you do not miss any doses. If you miss a dose of ATRIPLA, take it as soon as you remember that day. Do not take more than 1 dose of ATRIPLA in a day. Do not take 2 doses at the same time. Call your doctor or pharmacist if you are not sure what to do.

Side effects and what to do about them

The most common side effects of SUSTIVA, EMTRIVA and VIREAD are:

  • Nervous system symptoms such as dizziness, trouble sleeping, drowsiness, trouble concentrating, unusual dreams
  • Headache
  • Diarrhea
  • Nausea
  • Vomiting
  • Rash
  • Flatulence (intestinal gas)
  • Tiredness
  • Itching
  • Allergic reaction (including swelling of the face, lips, tongue or throat)
  • Abdominal pain

Other side effects may include pancreatitis (inflammation of the pancreas) and shortness of breath.

Skin discoloration (small spots or freckles) may also happen with ATRIPLA.

A small number of patients taking efavirenz, one of the components of ATRIPLA, have had severe depression, strange thoughts, or angry behavior. Some patients have had thoughts of suicide and a few patients have actually committed suicide. These problems tend to occur more often in patients with a history of mental illness. Contact your doctor immediately if you think you are having these symptoms so your doctor can decide whether you should continue to take ATRIPLA.

Changes in body fat have been seen in some patients taking antiretroviral therapy. These changes may include increased amounts of fat in the upper back and neck (“buffalo hump”), breast, and around the trunk. Loss of fat from the legs, arms and face may also happen. The cause and long-term health effects of these conditions are not known at this time.

Some patients have experienced serious liver problems including liver failure resulting in transplantation or death. Most of these serious side effects occurred in patients with a chronic liver disease such as a hepatitis infection, but there have also been a few reports in patients without any existing liver disease.

Changes in your immune system (Immune Reconstitution Inflammatory Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time, or you could develop an autoimmune disease in which your immune system reacts against your own body [e.g. Grave's disease (which affects the thyroid gland), Guillain-Barre syndrome (which affects the nervous system) or polymyositis (which affects the muscles)] and it may develop at any time, sometimes months later after the start of HIV therapy. Sometimes symptoms can be severe, so if you develop high temperature (fever), joint or muscle pain, redness, rash, swelling or fatigue, or any new symptoms, contact your doctor right away.

Serious side effects, how often they happen and what to do about them

Symptom/effectTalk with your doctor or pharmacistStop taking
drug and
call your
doctor or
Only if
In all
CommonEffect: Serious psychiatric events

—Severe depression
—Thoughts of suicide
—Strange thoughts
—Angry behavior

UncommonSevere skin rash

—Blisters or peeling of the skin
—Blisters or peeling of the mouth, lips and throat
—Fever and general ill feeling.

RareEffect:Lactic acidosis

—Feeling very weak or tired
—Unusual muscle pain
—Stomach pain with nausea and vomiting
—Feeling cold especially in arms and legs
—Feeling dizzy or lightheaded
—Irregular heartbeat

RareEffect:Hepatotoxicity(severe liver problems) with hepatomegaly (liver enlargement) and steatosis (fat in the liver)

—Jaundice (skin or the white part of eyes turn yellow)
—Urine turns dark
—Bowel movements (stools) turn light in color
—Loss of appetite for several days or longer
—Feeling sick to your stomach (nausea)
—Lower stomach pain

Very RareEffect: Flare-ups of hepatitis B virus infection following drug discontinuation

—Jaundice (skin or the white part of eyes turn yellow)
—Urine turns dark
—Bowel movements (stools) turn light in color
—Loss of appetite for several days or longer
—Feeling sick to your stomach (nausea)
—Lower stomach pain

RareEffect: Kidney problems

—You may have increased or decreased urination as well as increased thirst
—You may have swelling of your legs and feet
—You may feel listless and tired

Lactic acidosis is a medical emergency and must be treated in the hospital. You may be more likely to get lactic acidosis or serious liver problems if you are very overweight (obese) or have been taking nucleoside analog medicines, like ATRIPLA, for a long time.

Muscle pain, muscle weakness, bone pain and softening of the bone (infrequently contributing to fractures) have also been reported due to tenofovir DF (a component of ATRIPLA).

There have been other side effects in patients taking SUSTIVA, EMTRIVA or VIREAD. This is not a complete list of side effects. If you have questions about side effects, ask your doctor, nurse, or pharmacist. You should report any new or continuing symptoms to your doctor right away. Your doctor may be able to help you manage these side effects.

How to store it

  • Keep ATRIPLA and all other medications out of reach and sight of children.
  • ATRIPLA should be stored at 15–30 °C (59– 86 °F). It should remain stable until the expiration date printed on the label.
  • Do not keep your medicine in places that are too hot or cold.
  • Do not keep medicine that is out of date or that you no longer need. If you throw any medicines away make sure that children will not find them.
  • Keep ATRIPLA in its original container and keep the container tightly closed.

Reporting suspected side effects

You can report any suspected adverse reactions associated with the use of health products to the Canada Vigilance Program by one of the following 3 ways:

  • Report online at www.healthcanada.gc.ca/medeffect
  • Call toll-free at 1-866-234-2345
  • Complete a Canada Vigilance Reporting Form and:
    • Fax toll-free to 1-866-678-6789, or
    • Mail to: Canada Vigilance Program
                     Health Canada
                     Postal Locator 0701E
                     Ottawa, ON K1A 0K9

Postage paid labels, Canada Vigilance Reporting Forms and the adverse reaction reporting guidelines are available on the MedEffect™ Canada Web site at www.healthcanada.gc.ca/medeffect.

NOTE: Should you require information related to the management of side effects, contact your health professional. The Canada Vigilance Program does not provide medical advice.

More information

This document plus the full Product Monograph, prepared for health professionals can be found at:


or by contacting the sponsor, Gilead Sciences Canada, Inc., at: