Generic Name: elvitegravir + cobicistat + tenofovir disoproxil fumarate + emtricitabine

Pronunciation: STRY-build

Abbreviation: Quad

Other Market Name: N/A

Drug Class: Single-Tablet Regimens

Pharmaceutical Company: Gilead Sciences

Approval Status: Approved

Generic Version Available: No

Experimental Code: N/A


Drug Recommendation

A recommended regimen for antiretroviral-naive people living with HIV, as indicated by the U.S. Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults and Adolescents. Visit https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/0 for the full DHHS guidelines.


General Info

Stribild is a single-tablet regimen for HIV. It contains two different types of HIV drugs: one integrase inhibitor and two nucleotide/nucleoside reverse transcriptase inhibitors. It also contains a pharmacokinetic enhancer, a drug that has no activity against HIV, but it boosts the blood levels and effectiveness of other drugs. Stribild was approved by the U.S. Food and Drug Administration in August 2012 for people starting HIV treatment for the first time.

Stribild is a combination of Vitekta (elvitegravir), Tybost (cobicistat), Viread (tenofovir disoproxil fumarate) and Emtriva (emtricitabine). All four drugs can be purchased individually for use in combination with other HIV drugs.


Dosage

Adult Dose: One tablet once a day. Each tablet contains 150 mg elvitegravir, 150 mg cobicistat, 300 mg tenofovir disoproxil fumarate and 200 mg emtricitabine.

Pediatric Dose: N/A

Dosing Info: This is a complete one-pill, once-daily drug regimen. Take with food.


Side Effects

Common side effects include nausea and diarrhea.

Stribild can cause minor increases in serum creatinine, a potential sign of kidney toxicity. These increases do not appear to affect creatinine clearance (CrCl), an even better indicator of kidney health. However, Stribild should not be used by people with CrCL below 70 mL/min. CrCl should be tested before and during treatment with Stribild.

Stribild may lead to bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones.

If you also have hepatitis B virus (HBV) and take Stribild, your hepatitis may become worse if you stop taking Stribild. Do not stop taking Stribild without first talking to your healthcare provider.


Drug Interactions

The following medications should not be taken while you are being treated with Stribild:
Acid reflux/heartburn medications: Propulsid (cisapride)
Antibiotics: Rifadin (rifampin)
Antimigraine medications: Ergostat, Cafergot, Ercaf, Wigraine (ergotamine) or D.H.E. 45 (dihydroergotamine)
Pulmonary hypertension medications: sildenafil (Revatio; used to treat pulmonary hypertension)
Cholesterol-lowering drugs (statins): Zocor (simvastatin) and Mevacor (lovastatin)
Antipsychotics: Orap (pimozide)
Sedatives: Versed (midazolam) and Halcion (triazolam)
Enlarged prostate: Uroxatral (alfuzosin)
Antivirals: Hepsera (adefovir)

Stribild should not be combined with any HIV medications that contain any of the active ingredients in Stribild. These include: Atripla, Complera, Emtriva, EvoTaz, Genvoya, Prezcobix, Tybost, Viread, or Vitekta. Combining Stribild with HIV medications containing active ingredients similar to those in Stribild should also be avoided. These include: Combivir, Epivir, Epzicom, Isentress, Norvir, Tivicay, Triumeq, and Trizivir.

Stribild should not be taken at the same time as common antacids, particularly those containing aluminum, magenesium hydroxide, or calcium carbonate; they should be taken at least two hours before or after Stribild. Stribild can, however, be taken at the same time as acid-reducing H2-receptor antagonists and proton pump inhibitors.

Blood levels of fluticasone, one of the drugs in inhalable medications like Advair, Flonase, and Flovent, can become increased if used with Stribild. Careful monitoring for Cushing’s syndrome, a side effect of corticosteroids like fluticasone, is advised.

Important hepatitis C treatment drug-drug interactions: Stribild can be combined with Sovaldi (sofosbuvir), ribavirin, and pegylated interferon alfa. Do not use Stribild with Harvoni (ledipasvir/sofosbuvir), Olysio/Sovriad (simeprevir) or Viekira Pak (ombitasvir/paritaprevir/ritonavir/dasabuvir).

Caution is also necessary when combining commonly used anti-seizure medications, erectile dysfunction drugs, heart rhythm medications, anti-depressants, immune suppressants, hormonal contraceptives, and some other drugs. Consult the Stribild package insert for details: http://www.gilead.com/~/media/Files/pdfs/medicines/hiv/stribild/stribild_pi.pdf


Other Info

Before taking this medication, tell your doctor if you have kidney disease or liver disease (including hepatitis B). In addition, tell your doctor if you are pregnant or planning to become pregnant; if you are breast feeding, and all your medical conditions, including all prescription and over-the-counter medications and supplements you are taking.


For More Info: http://www.gilead.com/~/media/Files/pdfs/medicines/hiv/stribild/stribild_pi.pdf

Co-Pay Program Info: https://www.poz.com/basics/hiv-basics/drug-assistance-programs

Patient Assistance Program Info: https://www.poz.com/basics/hiv-basics/drug-assistance-programs

Last Revised: July 15, 2016