TM Owner Gilead Sciences
Stribild 150mg/150mg/200mg/245mg Tablet (Film-Coated)
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Indications & Clinical Uses
- Stribild is a once-daily, single-tablet regimen combining four medicines - elvitegravir (an integrase strand transfer inhibitor), cobicistat (a pharmacokinetic booster with no antiviral activity of its own), emtricitabine, and tenofovir disoproxil fumarate (two nucleoside/nucleotide reverse transcriptase inhibitors) - manufactured by Gilead Sciences and approved as a complete regimen for HIV-1 infection in antiretroviral treatment-naive adults, and in some virologically suppressed patients switching from a stable regimen as defined on the label.
- Because tenofovir disoproxil fumarate is an older prodrug of tenofovir, Stribild should not be confused with newer single-tablet regimens that use tenofovir alafenamide, such as Genvoya, which shares the same first three active ingredients but has largely replaced Stribild for many patients because of better bone and kidney safety; a healthcare provider decides which is appropriate.
- Stribild is taken by mouth at home, once daily with food.
Side Effects
- The most common side effects of Stribild are nausea, affecting around 1 in 6 people, and diarrhoea; headache, unusual dreams, and fatigue are also reported.
- Stribild carries a boxed warning: nucleoside analogues such as tenofovir and emtricitabine have caused lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, usually in women, obesity, or with prolonged use, and Stribild is not approved for chronic hepatitis B - stopping Stribild in a patient who also has hepatitis B can cause severe flare-ups of hepatitis, so liver function must be monitored closely for several months after stopping.
- New or worsening kidney problems, decreased bone density, and changes in body fat distribution have also been reported.
- Seek urgent care for unusual muscle pain, difficulty breathing, yellowing skin or eyes, or severe abdominal pain.
Precautions & Warnings
- Kidney function should be checked before starting Stribild and periodically during treatment; the medicine should not be started in patients with a creatinine clearance below 70 mL/min and should be stopped if it falls below 50 mL/min, because cobicistat and tenofovir disoproxil fumarate can affect the kidneys.
- All patients should be tested for hepatitis B before starting, since stopping Stribild abruptly can trigger a serious hepatitis B flare.
- Bone mineral density can decrease during treatment, so patients with fracture risk factors need extra monitoring, and calcium and vitamin D supplementation may be considered.
- Stribild should not be started in pregnancy because reduced elvitegravir levels in later pregnancy can raise the risk of treatment failure and mother-to-child transmission; a pregnancy test and discussion of alternatives is recommended before starting in anyone who could become pregnant.
- Stribild is for adults only on the US label.
Avoid Interactions
- Cobicistat, one of the four components of Stribild, strongly inhibits the CYP3A enzyme, so Stribild must not be combined with drugs that depend heavily on CYP3A clearance and have a narrow safety margin, including certain ergot derivatives, the sedative triazolam or oral midazolam, the antiarrhythmic drug dronedarone, and statins such as lovastatin and simvastatin.
- Strong inducers of CYP3A, such as rifampin, carbamazepine, phenytoin, and St John's wort, reduce levels of elvitegravir and cobicistat and can cause treatment failure, so they must also be avoided.
- Stribild should not be combined with other medicines containing tenofovir, emtricitabine, or lamivudine, to avoid double dosing.
- Antacids and multivitamins containing calcium, iron, magnesium, or aluminium can reduce elvitegravir absorption and should be taken at a different time of day.
- Tell the healthcare provider about all other medicines, including herbal products, before starting Stribild.
References
Frequently Asked Questions
Stribild is a once-daily HIV-1 treatment combining elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate in one tablet. It is approved for adults starting antiretroviral therapy for the first time, and for some patients switching from another regimen. It fully suppresses the virus without needing extra HIV medicines.
Take one Stribild tablet by mouth once a day, with food, at about the same time each day. Do not skip doses or stop suddenly, because interrupting treatment in someone who also has hepatitis B can trigger a serious flare-up of that infection.
Nausea and diarrhoea are the most common side effects. Stribild carries a boxed warning for lactic acidosis and severe liver problems (hepatomegaly with steatosis), which can be fatal, and for serious hepatitis B flares if the medicine is stopped in someone with that coinfection. Report abdominal pain or yellowing skin urgently.
Avoid rifampin, St John's wort, and certain seizure medicines, which stop Stribild from working properly. Avoid triazolam, oral midazolam, and some statins like simvastatin, which can build up to dangerous levels with Stribild. Take antacids or calcium/iron supplements at a different time, as they reduce absorption.
Stribild uses an older form of tenofovir (disoproxil fumarate), while Genvoya uses the same three other ingredients plus a newer form, tenofovir alafenamide, which is gentler on bone and kidneys. The two are not interchangeable without medical advice, and many patients on Stribild are now switched to newer regimens.
Stribild should not be started during pregnancy because elvitegravir levels drop in later pregnancy, which can let the virus rebound and raise the risk of passing HIV to the baby. Anyone who could become pregnant should discuss contraception and alternative regimens with their HIV specialist before starting.
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