Darunavir Cobicistat Emtricitabine Tenofovir alafenamide Brand Name– Symtuza
What is Darunavir Cobicistat Emtricitabine Tenofovir alafenamide
Darunavir cobicistat emtricitabine tenofovir alafenamide is a complete antiretroviral regimen approved for the treatment of HIV-1 infection in adults and pediatric patients weighing at least 40 kg.
The drug is indicated for use in antiretroviral-naive patients and patients who are virologically suppressed (HIV-1 RNA less than 50 copies per mL) on a stable antiretroviral regimen for at least 6 months and have no known substitutions associated with resistance to darunavir or tenofovir.
The tablets are administered once daily with food, and each tablet contains a protease inhibitor (darunavir), 2 nucleoside reverse transcriptase inhibitors (emtricitabine, tenofovir alafenamide), and a pharmacokinetic enhancer (cobicistat).
The FDA-approved package labeling contains a Black Box Warning regarding the potential for acute exacerbations of hepatitis B in HIV and HBV coinfected patients after treatment discontinuation.
Indications
- human immunodeficiency virus (HIV)
- human immunodeficiency virus (HIV) infection
NOTE: HIV guidelines recommend consideration be given to avoiding use of tenofovir alafenamide-containing regimens in patients coinfected with tuberculosis and receiving a rifamycin.
Side Effects
- abdominal pain
- abnormal dreams
- acute generalized exanthematous pustulosis (AGEP)
- angioedema
- anorexia
- bleeding
- breast enlargement
- Cushingoid features
- diabetes mellitus
- diabetic ketoacidosis
- diarrhea
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
- dyspepsia
- elevated hepatic enzymes
- erythema
- Fanconi syndrome
- fatigue
- fever
- flatulence
- gynecomastia
- headache
- hematoma
- hepatic decompensation
- hepatic failure
- hepatitis
- hepatitis B exacerbation
- hepatomegaly
- hypercholesterolemia
- hyperglycemia
- hypertriglyceridemia
- hypophosphatemia
- lactic acidosis
- lipodystrophy
- maculopapular rash
- myalgia
- nausea
- osteonecrosis
- osteopenia
- osteoporosis
- pancreatitis
- photosensitivity
- pruritus
- rash
- renal failure (unspecified)
- rhabdomyolysis
- steatosis
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- urticaria
- vomiting
- weight gain
Monitoring Parameters
- blood glucose
- CBC with differential
- CD4+ T cell count
- hepatitis B serology
- LFTs
- plasma hepatitis C RNA
- plasma HIV RNA
- pregnancy testing
- serum bilirubin (total and direct)
- serum cholesterol
- serum creatinine/BUN
- serum lipid profile
- serum triglycerides
- urinalysis
Contraindications
- alcoholism
- autoimmune disease
- Black patients
- bleeding
- breast-feeding
- children
- diabetes mellitus
- diabetic ketoacidosis
- females
- Graves’ disease
- Guillain-Barre syndrome
- hemophilia
- hepatic disease
- hepatitis
- hepatitis B and HIV coinfection
- hepatitis B exacerbation
- hepatitis C and HIV coinfection
- hepatomegaly
- hepatotoxicity or lactic acidosis
- Hispanic patients
- human immunodeficiency virus (HIV) infection resistance
- hypercholesterolemia
- hyperglycemia
- hyperlipidemia
- hypertriglyceridemia
- immune reconstitution syndrome
- infants
- jaundice
- neonates
- obesity
- pancreatitis
- pregnancy
- renal failure
- renal impairment
- serious rash
- sulfonamide hypersensitivity
Interactions
- Abacavir; Dolutegravir; Lamivudine
- Abacavir; Lamivudine, 3TC
- Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
- Abemaciclib
- Acalabrutinib
- Acarbose
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Diphenhydramine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Tramadol
- Acyclovir
- Adefovir
- Ado-Trastuzumab emtansine
- Afatinib
- Aldesleukin, IL-2
- Alfentanil
- Alfuzosin
- Aliskiren
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Aliskiren; Valsartan
- Almotriptan
- Alogliptin
- Alogliptin; Metformin
- Alogliptin; Pioglitazone
- Alosetron
- Alpelisib
- Alpha-glucosidase Inhibitors
- Alprazolam
- Amikacin
- Aminoglycosides
- Aminosalicylate sodium, Aminosalicylic acid
- Amiodarone
- Amitriptyline
- Amitriptyline; Chlordiazepoxide
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amobarbital
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amphotericin B
- Amphotericin B cholesteryl sulfate complex (ABCD)
- Amphotericin B lipid complex (ABLC)
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- Apalutamide
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- Asenapine
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atazanavir
- Atazanavir; Cobicistat
- Atomoxetine
- Atorvastatin
- Atorvastatin; Ezetimibe
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Avanafil
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- Axitinib
- Azelastine; Fluticasone
- Bacitracin
- Barbiturates
- Barium Sulfate
- Bedaquiline
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Benzhydrocodone; Acetaminophen
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- Bepridil
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- Boceprevir
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- Bromocriptine
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- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Budesonide
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- Bupivacaine
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- Buprenorphine
- Buprenorphine; Naloxone
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- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carboplatin
- Cariprazine
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- Celecoxib
- Cenobamate
- Ceritinib
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- Cevimeline
- Chloramphenicol
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chlorpheniramine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
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- Ciclesonide
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- Clozapine
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- Cobimetinib
- Cocaine
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- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Colchicine
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- Conivaptan
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- Copanlisib
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- Dabigatran
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- Daclatasvir
- Dalfopristin; Quinupristin
- Danazol
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- Dapagliflozin; Metformin
- Dapagliflozin; Saxagliptin
- Dapsone
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- Darolutamide
- Darunavir; Cobicistat
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Dasatinib
- Deflazacort
- Delavirdine
- Desipramine
- Desvenlafaxine
- Dexamethasone
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexlansoprazole
- Dextromethorphan
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Diazepam
- Dichlorphenamide
- Diclofenac
- Diclofenac; Misoprostol
- Didanosine, ddI
- Dienogest; Estradiol valerate
- Diethylstilbestrol, DES
- Diflunisal
- Digoxin
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dihydroergotamine
- Diltiazem
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Disopyramide
- Disulfiram
- Docetaxel
- Dofetilide
- Dolasetron
- Dolutegravir
- Dolutegravir; Lamivudine
- Dolutegravir; Rilpivirine
- Donepezil
- Donepezil; Memantine
- Doravirine
- Doravirine; Lamivudine; Tenofovir disoproxil fumarate
- Dorzolamide; Timolol
- Doxazosin
- Doxepin
- Doxercalciferol
- Doxorubicin
- Dronabinol
- Dronedarone
- Drospirenone
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Duloxetine
- Dutasteride
- Dutasteride; Tamsulosin
- Duvelisib
- Echinacea
- Edoxaban
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elagolix
- Elagolix; Estradiol; Norethindrone acetate
- Elbasvir; Grazoprevir
- Eletriptan
- Elexacaftor; tezacaftor; ivacaftor
- Eliglustat
- Eluxadoline
- Elvitegravir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Empagliflozin
- Empagliflozin; Linagliptin
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Emtricitabine; Tenofovir disoproxil fumarate
- Enalapril; Felodipine
- Encainide
- Encorafenib
- Enfortumab vedotin
- Entrectinib
- Enzalutamide
- Eplerenone
- Erdafitinib
- Ergoloid Mesylates
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- Ergotamine
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- Ertugliflozin; Metformin
- Erythromycin
- Erythromycin; Sulfisoxazole
- Escitalopram
- Eslicarbazepine
- Esomeprazole
- Esomeprazole; Naproxen
- Estazolam
- Esterified Estrogens
- Esterified Estrogens; Methyltestosterone
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Estradiol; Progesterone
- Estropipate
- Eszopiclone
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Ethosuximide
- Etodolac
- Etonogestrel
- Etravirine
- Everolimus
- Ezetimibe; Simvastatin
- Famotidine; Ibuprofen
- Fedratinib
- Felbamate
- Felodipine
- Fenoprofen
- Fentanyl
- Fesoterodine
- Fexofenadine
- Fexofenadine; Pseudoephedrine
- Flecainide
- Flibanserin
- Fluconazole
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurazepam
- Flurbiprofen
- Flutamide
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Fluvastatin
- Fluvoxamine
- food
- Formoterol; Mometasone
- Fosamprenavir
- Foscarnet
- Fosphenytoin
- Fostamatinib
- Gadobutrol
- Gadoversetamide
- Ganciclovir
- Gefitinib
- Gentamicin
- Gilteritinib
- Glasdegib
- Glecaprevir; Pibrentasvir
- Glipizide; Metformin
- Glyburide
- Glyburide; Metformin
- Granisetron
- grapefruit juice
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guanfacine
- Halofantrine
- Haloperidol
- Homatropine; Hydrocodone
- Hydrochlorothiazide, HCTZ; Losartan
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrochlorothiazide, HCTZ; Valsartan
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydroxyprogesterone
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibrutinib
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Idelalisib
- Ifosfamide
- Iloperidone
- Imatinib
- Imipramine
- Incretin Mimetics
- Indacaterol
- Indacaterol; Glycopyrrolate
- Indinavir
- Indomethacin
- Insulins
- Interferon Alfa-2b; Ribavirin
- Interferons
- Irinotecan
- Irinotecan Liposomal
- Isavuconazonium
- Isoniazid, INH
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Isradipine
- Istradefylline
- Itraconazole
- Ivabradine
- Ivacaftor
- Ivosidenib
- Ixabepilone
- Kanamycin
- Ketoconazole
- Ketoprofen
- Ketorolac
- Lamivudine, 3TC
- Lamivudine, 3TC; Zidovudine, ZDV
- Lamivudine; Tenofovir Disoproxil Fumarate
- Lansoprazole
- Lansoprazole; Naproxen
- Lanthanum Carbonate
- Lapatinib
- Larotrectinib
- Ledipasvir; Sofosbuvir
- Lefamulin
- Lemborexant
- Letermovir
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- Levobupivacaine
- Levomethadyl
- Levomilnacipran
- Levonorgestrel
- Lidocaine
- Lidocaine; Prilocaine
- Linagliptin
- Linagliptin; Metformin
- Lomitapide
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Lorcaserin
- Lorlatinib
- Losartan
- Lovastatin
- Lovastatin; Niacin
- Lumacaftor; Ivacaftor
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- Lumateperone
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- Maprotiline
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- Mefenamic Acid
- Mefloquine
- Meloxicam
- Meperidine; Promethazine
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- Metformin
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- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methadone
- Methamphetamine
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- Methylergonovine
- Methylprednisolone
- Methysergide
- Metoclopramide
- Metoprolol
- Mexiletine
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- Midostaurin
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- Miglitol
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- Mitomycin
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- Modafinil
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- Morphine
- Morphine; Naltrexone
- Nabumetone
- Nafcillin
- Naldemedine
- Naloxegol
- Naloxone
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- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Nateglinide
- Nebivolol
- Nebivolol; Valsartan
- Nefazodone
- Neratinib
- Netupitant, Fosnetupitant; Palonosetron
- Nevirapine
- Niacin; Simvastatin
- Nicardipine
- Nicotine
- Nifedipine
- Nilotinib
- Nimodipine
- Nintedanib
- Nisoldipine
- Nitisinone
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- Nonsteroidal antiinflammatory drugs
- Norethindrone
- Norgestrel
- Nortriptyline
- Obeticholic Acid
- Octreotide
- Olanzapine
- Olaparib
- Ombitasvir; Paritaprevir; Ritonavir
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole
- Omeprazole; Amoxicillin; Rifabutin
- Omeprazole; Sodium Bicarbonate
- Ondansetron
- Oritavancin
- Orlistat
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- Osimertinib
- Ospemifene
- Oxaliplatin
- Oxaprozin
- Oxcarbazepine
- Oxybutynin
- Oxycodone
- Ozanimod
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- Palbociclib
- Palonosetron
- Pamidronate
- Panobinostat
- Paricalcitol
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- Pentamidine
- Pentazocine; Naloxone
- Pentobarbital
- Perampanel
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- Perindopril; Amlodipine
- Perphenazine
- Perphenazine; Amitriptyline
- Pexidartinib
- Phenobarbital
- Phentermine; Topiramate
- Phenylephrine; Promethazine
- Phenytoin
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- Pirfenidone
- Piroxicam
- Pitavastatin
- Plazomicin
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- Polymyxins
- Ponatinib
- Posaconazole
- Pramlintide
- Pravastatin
- Prednisone
- Primidone
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- Progesterone
- Promethazine
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- Propranolol
- Protriptyline
- Quazepam
- Quetiapine
- Quinidine
- Quinine
- Rabeprazole
- Ramelteon
- Ranitidine
- Ranolazine
- Red Yeast Rice
- Regorafenib
- Repaglinide
- Retapamulin
- Revefenacin
- Ribavirin
- Ribociclib
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Rifapentine
- Rifaximin
- Rilpivirine
- Rimegepant
- Ripretinib
- Risperidone
- Ritonavir
- Rivaroxaban
- Rofecoxib
- Roflumilast
- Rolapitant
- Romidepsin
- Ropivacaine
- Rosuvastatin
- Ruxolitinib
- Sacubitril; Valsartan
- Salicylates
- Salmeterol
- Salsalate
- Sapropterin
- Saquinavir
- Saxagliptin
- Secobarbital
- Segesterone Acetate; Ethinyl Estradiol
- Selective serotonin reuptake inhibitors
- Selegiline
- Selpercatinib
- Selumetinib
- Sertraline
- Sibutramine
- Sildenafil
- Silodosin
- Simeprevir
- Simvastatin
- Simvastatin; Sitagliptin
- Siponimod
- Sirolimus
- Sitagliptin
- Sofosbuvir
- Sofosbuvir; Velpatasvir
- Sofosbuvir; Velpatasvir; Voxilaprevir
- Solifenacin
- Somatropin, rh-GH
- Sonidegib
- Sorafenib
- St. John’s Wort, Hypericum perforatum
- Streptogramins
- Streptomycin
- Sufentanil
- Sulfonylureas
- Sulindac
- Sunitinib
- Suvorexant
- Tacrolimus
- Tadalafil
- Tafamidis
- Talazoparib
- Talimogene Laherparepvec
- Tamsulosin
- Tasimelteon
- Tazemetostat
- Tedizolid
- Telaprevir
- Telithromycin
- Telotristat Ethyl
- Temsirolimus
- Teniposide
- Tenofovir Alafenamide
- Tenofovir, PMPA
- Terbinafine
- Terfenadine
- Testosterone
- Tetrabenazine
- Tezacaftor; Ivacaftor
- Theophylline, Aminophylline
- Thiazolidinediones
- Thiopental
- Thioridazine
- Thiotepa
- Tiagabine
- Ticagrelor
- Timolol
- Tinidazole
- Tipranavir
- Tobramycin
- Tofacitinib
- Tolmetin
- Tolterodine
- Tolvaptan
- Topiramate
- Topotecan
- Toremifene
- Trabectedin
- Tramadol
- Trandolapril; Verapamil
- Trazodone
- Triamcinolone
- Triazolam
- Tricyclic antidepressants
- Trimetrexate
- Trimipramine
- Trospium
- Tucatinib
- Ubrogepant
- Ulipristal
- Umeclidinium
- Umeclidinium; Vilanterol
- Upadacitinib
- Valacyclovir
- Valbenazine
- Valdecoxib
- Valganciclovir
- Valproic Acid, Divalproex Sodium
- Valsartan
- Vancomycin
- Vardenafil
- Vemurafenib
- Venetoclax
- Venlafaxine
- Verapamil
- Vilazodone
- Vinblastine
- Vincristine
- Vincristine Liposomal
- Vinorelbine
- Vorapaxar
- Voriconazole
- Voxelotor
- Warfarin
- Yohimbine
- Zafirlukast
- Zaleplon
- Zanubrutinib
- Zileuton
- Ziprasidone
- Zoledronic Acid
- Zolmitriptan
- Zolpidem
- Zonisamide
