bictegravir-emtricitabine-tenofovir AF

Bictegravir-emtricitabine-tenofovir AF is a combination medication used to treat the symptoms of the human immunodeficiency virus (HIV) infection. 

• Bictegravir-emtricitabine-tenofovir AF is available under the following different brand names: Biktarvy

Contraindications

• Coadministration with dofetilide and/or rifampin

Effects of drug abuse

• None

Cautions

• Patients with HIV-1 infection should be tested for the presence of chronic hepatitis B virus (HBV) before initiating antiretroviral therapy (ART); not approved for the treatment of chronic HBV infection (see Black Box Warnings)
• Immune reconstitution syndrome is reported in patients treated with combination ART therapy; autoimmune disorders (.g, Graves’ disease, polymyositis, Guillain-Barré syndrome, autoimmune hepatitis) may occur in the setting of immune reconstitution; time to onset varies and can occur many months after initiation of treatment
• Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, reported with use; suspend treatment if a patient develops signs or symptoms of lactic acidosis or pronounced hepatotoxicity (which may include hepatomegaly and steatosis, even in absence of marked transaminase elevations)

New-onset or worsening renal impairment

• Cases of acute renal failure and Fanconi syndrome (renal tubular injury with severe hypophosphatemia) reported with the use of tenofovir prodrugs
• Discontinue drug if clinically significant decreases in renal function or evidence of Fanconi syndrome develop
• Avoid concurrent or recent use of the nephrotoxic drug, including nonsteroidal anti-inflammatory drugs, owing to the increased risk of developing renal-related adverse reactions

Drug interactions overview

• Bictegravir inhibits OCT2 and MATE1; coadministration with drugs that are OCT2 and MATE1 substrates may increase their plasma concentrations (also see Contraindications)
• Strong CYP3A inducers that also induce UGT1A1 can substantially decrease raltegravir plasma concentrations, which may lead to loss of therapeutic effect of Bictegravir-Emtricitabine-Tenofovir AF and development of resistance (also see Contraindications)
• Strong CYP3A4 inhibitors that also inhibit UGT1A1 may significantly increase bictegravir plasma concentrations
• Coadministration of drugs that bit of P-glycoprotein (P-GP) and breast cancer resistance protein (BCRP) may increase the absorption and plasma concentrations of tenofovir AF
• Coadministration of drugs that induce P-positivity is expected to decrease the absorption of tenofovir AF, resulting in reduced plasma concentration of tenofovir AF, which may lead to loss of therapeutic effect of treatment and development of resistance
• Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase concentrations of emtricitabine and tenofovir, thereby increasing the risk of adverse effects

Common side effects of bictegravir-emtricitabine-tenofovir AF include:

• Diarrhea,
• Nausea,
• Headache,
• Fatigue,
• Abnormal dreams
• Dizziness, and
• Insomnia

Serious side effects of bictegravir-emtricitabine-tenofovir AF include:

• Change in the amount of urine,
• Pink or bloody urine,
• Nausea,
• Vomiting,
• Loss of appetite,
• Stomach pain,
• Yellowing of the eyes and skin (jaundice),
• Dark urine,
• Unusual tiredness,
• Dizziness,
• Severe drowsiness,
• Chills,
• Blue or cold skin,
• Muscle pain,
• Fast or shallow breathing,
• Slow or irregular heartbeat,
• Diarrhea,
• Unexplained weight loss,
• Severe tiredness,
• Muscle aches or weakness,
• Severe headaches,
• Joint pain,
• Numbness or tingling of the hands, feet, arms, or legs,
• Vision changes,
• Fever,
• Swollen lymph nodes,
• Trouble breathing,
• Coughing,
• Non-healing skin sores,
• Irritability,
• Nervousness,
• Heat intolerance,
• Fast, pounding, or irregular heartbeat,
• Bulging eyes,
• Unusual growth in the neck (goiter),
• Difficulty swallowing,
• Difficulty moving the eyes,
• Dropping face,
• Paralysis,
• Trouble speaking,
• Rash,
• Itching,
• Swelling of the face, tongue, or throat, and
• Severe dizziness

Rare side effects of bictegravir-emtricitabine-tenofovir AF include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult and pediatric dosage

Tablet

• 50 mg/200 mg/25 mg
• 30 mg/120 mg/15 mg

Human immunodeficiency virus (HIV) infection

Adult dosage

• 1 tablet orally once a day

Pediatric dosage

• Children below 14 kg: Safety and efficacy not established
• Children above 14 to 25 kg: 1 tablet (30 mg/120 mg/15 mg) orally once a day
• Children above 25 kg: 1 tablet (50 mg/200 mg/25 mg) orally once a day

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Bictegravir-emtricitabine-tenofovir AF has severe interactions with the following drugs:
  • Dofetilide
  • Elvitegravir/cobicistat/emtricitabine/tenofovir df
  • Lamivudine
  • Rifampin
• Bictegravir-emtricitabine-tenofovir AF has serious interactions with the following drugs:
  • betibeglogene autotemcel
  • cabotegravir
  • carbamazepine
  • elivaldogene autotemcel
  • elivaldogene autotemcel
  • Retrovirir
  • oxcarbazepine
• Bictegravir-emtricitabine-tenofovir AF has moderate interactions with at least 88 other drugs.
• Bictegravir-emtricitabine-tenofovir AF has minor interactions with the following drug:
  • nirmatrelvir/ritonavir

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. 

Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

• There is insufficient human data on the use of bictegravir-emtricitabine-tenofovir AF during pregnancy to inform a drug-associated risk of birth defects and miscarriage
• Bictegravir: Data from an observational study in Botswana showed that dolutegravir, another integrase inhibitor, was associated with an increased risk of neural tube defects when administered at the time of conception and in early pregnancy; data available to date from other sources including the pregnancy registry, clinical trials, and postmarketing data are insufficient to address this risk with raltegravir
• Bictegravir and tenofovir AF use in women during pregnancy has not been evaluated
• Emtricitabine (FTC) use during pregnancy in a limited number of women reported to the APR showed no difference in the overall risk of major birth defects for FTC compared with the background rate for major birth defects

Pregnancy registry

• Registry monitors pregnancy outcomes in women exposed to bictegravir-emtricitabine-tenofovir AF during pregnancy
• Healthcare providers are encouraged to register patients by calling the Antiretroviral Pregnancy Registry (APR) at 1-800-258-4263

Lactation

• The Centers for Disease Control and Prevention do not recommend HIV-infected mothers breastfeed their infants owing to the potential risk for postnatal transmission of HIV
• Unknown whether bictegravir-emtricitabine-tenofovir AF or all of the components of the drug are present in human breast milk affects human milk production, or has effects on the breastfed infant; emtricitabine is present in human breast milk
• Owing to the potential for HIV transmission (in HIV-negative infants), developing viral resistance (in HIV-positive infants), and adverse reactions in a breastfed infant similar to those seen in adults, instruct mothers not to breastfeed while taking this medication