Question
Why does Truvada & Atripla have different food restrictions?
21 May 2012. Related: Adherence, All topics.
Why does Truvada need to be taken with or after food and Atripla when the stomach is empty or two hours after food or one hour before?
They both contain the same drugs emtricitabine and tenofovir, so does Truvada really need to be taken with food at all? It would make my life easier if it didn’t.
Answer
Some ARVs (antiretroviral treatments for HIV), need to be taken with food. This is so that their concentration reaches the levels necessary to suppress the virus.
Recommendations for taking Truvada differ in for Europe and the US. Although in the US you can take Truvada with or without food, in Europe, the recommendation is still to take with food. This difference comes because the food interaction (food increases the levels of tenofovir by 30%), was only discovered after the main trials were well underway. US and European regulatory agencies interpreted the results differently. Please follow this link to an earlier question where this has been answered in more detail.
As regards Atripla, when the drug instructions say take Atripla on an empty stomach, it does not mean that you have to feel physically empty or hungry. That is why the recommendation is to take your medication after about 2 hours without eating. A cup of tea and a biscuit an hour before you take your medication should be fine.
One of the reasons they recommend taking it on an empty stomach is because a high fat meal can increase the drug levels of efavirenz to 60%. Efavirenz is one of the drugs contained in Atripla).Nearly all other foods are fine, just leave a couple of hours when the meal is high fat.
Hi Elle,
What does the doctor say about this? Was there a reason why your son can’t eat or drink anything with calcium in it?
Some HIV meds can interact with some herbs or supplements. Please see this link to the HIV drug interactions website. But please check with the doctor about why your son was given this advice.
My son was told do not drink or eat anything with calcium so I’d like to know what he can eat that doesn’t have calcium he is on PEP after being exposed one time to HIV
Hi David,
Fat loss like this is usually associated with older HIV drugs such as d4T and AZT. But is also possibly linked to efavirenz. But Truvada on its own is used as PrEP. Are taking Atripla, which is a tablet that has both Truvada and efavirenz in it? if so, you can talk to your doctor about changing to other meds. Please see information about fat loss here.
I have been taking Truvada for some years now am experiencing loss of weight specially on my face, legs, buttocks and hands. Now my question is, which better medication i should take to gain weight.
Hi Chris,
You’re right, all of this can get very confusing.
The 60% potential increase in efavirenz levels caused by taking it with a high fat meal has been decided to be ‘clinically relevant’. This is because this increase has the potential to be noticeable in terms of increasing side effects.
With tenofovir it is more that taking it without food means that it is not boosted by 30%, rather than it is being reduced. The original results were from a study where people took tenofovir with or without food. Here the 30% increase would be a potential benefit because the drug would be more active but without additional side effects.
However this 30% increase is not considered clinically significant. Without the 30% boost the drug levels remain high enough for tenofovir to be effective. You might like to take it with food if you are just starting treatment or if you viral load is still detectable.
Otherwise, if your viral load is less than 50 it won’t make a difference if you take tenofovir without food and it is up to you and what is best for your lifestyle. The breakfast you describe should be plenty to see the 30% boost.
With tenofovir it is more that taking it without food means that it is not boosted by 30%, rather than it is being reduced. The origional results were from a study where people took tenofovir with or without food. Here the 30% increase would be a potential benefit because the drug would be more active but without additional side effects.
However this 30% increase is not considered clinically significant. Without the 30% boost
I’ve now read the reply to the earlier question and that says that a light meal has no effect on levels of tenofovir and it should be a high fat meal. Well, what is a high fat meal. I take mine with breakfast and have full fat milk on the cereal and butter on my toast. Would that be high fat?
But if you take Atripla on an empty stomach so as not to boost the efavirenz levels by 60% as you say above, then you will also at the same time reduce the tenofovir levels by 30%. So which is more important?
It’s all very confusing.