Generic Name: efavirenz + tenofovir disoproxil fumarate + lamivudine

Pronunciation: N/A

Abbreviation: EFV + TDF + 3TC

Other Market Name: N/A

Drug Class: Single-Tablet Regimens

Company: Mylan Pharmaceuticals

Approval Status: Approved

Generic Version Available: No

Experimental Code: N/A


Drug Recommendation

Symfi and Symfi Lo have not yet been reviewed for inclusion in the DHHS list of recommended HIV treatments. Visit https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/0 for the full DHHS guidelines.


General Info

Symfi and Symfi Lo are each single-tablet regimens for HIV. Both contain three different types of HIV drugs: one non-nucleoside reverse transcriptase inhibitor and two nucleoside/nucleotide reverse transcriptase inhibitors. Symfi Lo was approved by the U.S. Food and Drug Administration for use by people living with HIV in February 2018; Symfi was approved in March 2018.

Symfi and Symfi Lo are each a combination of three drugs: efavirenz, tenofovir disoproxil fumarate andlamivudine. All three drugs can be purchased separately for use in combination with other HIV drugs.


Dosage

Adult Dose: One tablet of either Symfi or Symfi Lo once a day. Each tablet of Symfi contains 600mg efavirenz + 300mg tenofovir disoproxil fumarate + 300mg lamivudine. Each tablet of Symfi Lo contains 400mg efavirenz + 300mg tenofovir disoproxil fumarate + 300mg lamivudine.

Pediatric Dose: Symfi: One tablet of once a day for those weighing at least 88lbs (40kg).
Symfi Lo: One tablet of once a day for those weighing at least 77lbs (35kg).

Dosing Info: This is a complete one-pill, once-daily drug regimen. Take on an empty stomach. Dose should be taken at bedtime to minimize dizziness, drowsiness and impaired concentration.


Side Effects

Many patients have dizziness, headache, trouble sleeping, drowsiness, trouble concentrating, and/or unusual dreams after starting treatment with Symfi or Symfi Lo. These feeling may be less noticeable if you take Symfi or Symfi Lo at bedtime on an empty stomach. They also tend to go away after you’ve taken the medicine for a few weeks. Tell your doctor promptly if any of these side effects continue or if they bother you.

A small number of patients have had severe depression, strange thoughts, or angry behavior while taking efavirenz, one of the drugs in Symfi and Symfi Lo. Some patients have had thoughts of suicide and a few patients have actually committed suicide. These problems tend to occur more often in patients with a history of mental illness. You should contact your doctor immediately if you think you are having these symptoms, so your doctor can decide whether you should continue to take efavirenz.

Rash is another common side effect of Symfi and Symfi Lo. These rashes usually go away without any change in treatment. In a small number of patients, rash may be serious. If you develop rash, call your doctor as soon as possible.

Symfi and Symfi Lo may lead to new or worsening kidney problems, including kidney failure. Your healthcare provider may do blood tests to check your kidneys before and during treatment with Symfi and Symfi Lo. If you develop kidney problems, your healthcare provider may need to make changes to your treatment regimen.

Symfi and Symfi Lo may lead to new or worsening liver problems. Your healthcare provider may check your liver function before and during treatment with Symfi and Symfi Lo. Contact your doctor immediately if you experience yellowing of the skin or eyes, dark-colored-urine, light-colored bowel movements, confusion, weakness or tiredness, loss of appetite, nausea, stomach swelling or pain on the right side of your stomach area.

Symfi and Symfi Lo can also cause lactic acidosis, a buildup of lactic acid in the blood.  Contact your doctor immediately if you experience nausea, vomiting, or unusual or unexpected stomach discomfort; weakness or tiredness; shortness of breath; weakness in the arms and legs; yellowing of the skin or eyes; or pain in the upper stomach area.

Symfi and Symfi Lo 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 Symfi and Symfi Lo, your hepatitis may become worse if you stop taking it. Do not stop taking Symfi and Symfi Lo without first talking to your healthcare provider.

If you also have hepatitis C virus (HCV) and take Symfi and Symfi Lo, your liver disease can worsen if your HCV is being treated with interferon alfa with or without ribavirin. Talk to your health care provider if you have any new symptoms while taking Symfi and Symfi Lo and interferon alfa with or without ribavirin.


Drug Interactions

For a review of drug interactions, including prescription and over-the-counter medications and supplements that should not be taken with Symfi or Symfi Lo or may require dose adjustments, consult the Symfi or Symfi Lo package insert.


Other Info

Before taking this medication, tell your doctor if you have kidney disease, liver disease (including hepatitis B), or a history of depression/suicidal thoughts. In addition, tell your doctor if you are pregnant or planning to become pregnant, if you are breastfeeding, and all your medical conditions, including all prescription and over-the-counter medications and supplements you are taking.


For More Info: https://aidsinfo.nih.gov/drugs/594/symfi/0/patient

Last Reviewed: April 14, 0019