HIV Drug Information on Atripla

(tenofovir + emtricitabine + efavirenz)

Photo credit: National Library of Medicine/National Institutes of Health


Atripla is single-pill, fixed dose combination (FDC) drug comprised of three antiretroviral agents: tenofovir, emtricitabine and efavirenz.

Tenofovir and emtricitabine are both classified as nucleotide reverse transcriptase inhibitors and are independently marketed as Viread (tenofovir), Emtriva (emtricitabine, FTC), and the co-formulated FDC Truvada (tenovfovir + emtricitabine). Efavirenz is, by contrast, is a non-nucleoside reverse transcriptase inhibitor and is commercially marketed as Sustiva (efavirenz).

Atripla was licensed by the U.S. Food and Drug Administration (FDA) on June 12, 2012 and was the first once-daily, three-in-one drug approved for use in the treatment of HIV for adults and  children ages 12 years and older.

Atripla Formulation:

Atripla is a co-formulated tablet comprised of 300mg tenofovir disoproxil fumarate, 200mg emtricitabine, and 600mg of efavirenz. The pink, oblong tablet is film coated and embossed on one side with the number "123."

Atripla Dosage:

For adults and children 12 years or older who weigh at least 87 lbs (40kg): one tablet taken orally on an empty stomach, ideally at bedtime.

For patients taking rifampin (used frequently in the treatment of tuberculosis coinfection) who weigh at least 110 lbs (50kg): one Atripla tablet and one tablet of Sustiva (efavirenz) taken orally, again on an empty stomach and ideally at bedtime.

Atripla Common Side Effects:

The most common side effects associated with Atripla use (occurring in 5% or less of cases) include:

  • Nausea
  • Diarrhea
  • Fatigue
  • Sinusitis
  • Headache
  • Dizziness
  • Depression
  • Insomnia
  • Abnormal dreams
  • Rash

Most of the symptoms are generally short-lasting, often resolving themselves within a week or two. Some of the central nervous system disturbances, like dizziness, may sometimes take longer to resolve, although taking the pills at night, just before bedtime, tends to alleviate the symptoms significantly.


  • Antifungal medication: Vrend (voriconazole)
  • Hepatitis B medication: Hepsera (adefovir)

Treatment Considerations:

Patients who have had experienced previous, strong hypersensitivity reactions to Sustiva (including severe or eruptive rash) should not be prescribed Atripla.

Atripla should be used with care in patients with a history of renal (kidney) impairment. Always assess estimated creatinine clearance before initiating treatment. In patients with a risk of renal dysfunction, include estimated creatinine clearance, serum phosphorus, urine glucose and urine protein when monitoring. Atripla should not be used in patients with an estimated creatinine clearance below 50mL/minute.

Monitor liver function tests in hepatic patients with underlying liver disease, including hepatitis B and hepatitis C. Atripla is not recommended in patients with moderate to severe liver impairment. Use with caution in patients with mild liver impairment.

The efavirenz component in Atripla has been associated with fetal abnormalities in a number of animal studies.

While there is still contention as to whether efavirenz poses any real risk in human, it is recommended Atripla be avoided during pregnancy), particularly during the first trimester. Mothers are also advised not to breastfeed while taking Atripla.


U.S. Food and Drug Administration (FDA). "FDA Approves the First Once-a-Day, Three Drug Combination for Treatment of HIV-1." Silver Spring, Maryland; press release issued August 2, 2004.

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