NRTIs Appendix B: Drug Characteristics Tables Adult and Adolescent ARV

Appendix B: Drug Characteristics Tables

Characteristics of Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Last Updated: October 25, 2018; Last Reviewed: October 25, 2018

Appendix B, Table 1. Characteristics of Nucleoside Reverse Transcriptase Inhibitors
Generic Name (Abbreviation) Trade Name	Formulations	Dosing Recommendations^a	Elimination/ Metabolic Pathway	Serum/ Intracellular Half-Lives	Adverse Events^b
Abacavir (ABC) Ziagen Note: Generic tablet formulation is available.	Ziagen: 300 mg tablet 20 mg/mL oral solution	Ziagen: 600 mg once daily, or 300 mg BID Take without regard to meals.	Metabolized by alcohol dehydrogenase and glucuronyl transferase Renal excretion of metabolites: 82% Dose adjustment for ABC is recommended in patients with hepatic insufficiency (see Appendix B, Table 8).	1.5 hours/ 12–26 hours	HSRs: Patients who test positive for HLA-B5701 are at highest risk. HLA screening should be done before initiation of ABC. For patients with a history of HSR, re-challenge is not recommended*. Symptoms of HSR may include fever, rash, nausea, vomiting, diarrhea, abdominal pain, malaise, fatigue, or respiratory symptoms such as sore throat, cough, or shortness of breath. Some cohort studies suggest increased risk of MI with recent or current use of ABC, but this risk is not substantiated in other studies.
(ABC/3TC) Epzicom Note: Generic formulation is available.	Epzicom: (ABC 600 mg plus 3TC 300 mg) tablet	Epzicom: 1 tablet once daily
(ABC/DTG/3TC) Triumeq	Triumeq: (ABC 600 mg plus 3TC 300 mg plus DTG 50 mg) tablet	Triumeq: 1 tablet once daily
(ABC/ZDV/3TC) Trizivir Note: Generic formulation is available.	Trizivir: (ABC 300 mg plus ZDV 300 mg plus 3TC 150 mg) tablet	Trizivir: 1 tablet BID
Didanosine (ddI) Videx Videx EC Note: Generic is available as delayed-release capsules; dose is the same as Videx EC.	Videx EC: 125, 200, 250, and 400 mg capsules Videx: 10 mg/mL oral solution	Body Weight ≥60 kg: ddI 400 mg once daily With TDF: ddI 250 mg once daily Body Weight <60 kg: ddI 250 mg once daily With TDF: ddI 200 mg once daily Take 1/2 hour before or 2 hours after a meal. Note: Preferred dosing with oral solution is BID (with the total daily dose divided into 2 doses).	Renal excretion: 50% Dose adjustment is recommended in patients with renal insufficiency (see Appendix B, Table 8).	1.5 hours/ >20 hours	Pancreatitis Peripheral neuropathy Retinal changes, optic neuritis Lactic acidosis with hepatic steatosis with or without pancreatitis (rare but potentially life-threatening toxicity) Nausea, vomiting Potential association with noncirrhotic portal hypertension; in some cases, patients presented with esophageal varices One cohort study suggested increased risk of MI with recent or current use of ddI, but this risk is not substantiated in other studies. Insulin resistance/diabetes mellitus
Emtricitabine (FTC) Emtriva	Emtriva: 200 mg hard gelatin capsule 10 mg/mL oral solution	Emtriva Capsule: FTC 200 mg once daily Oral Solution: FTC 240 mg (24 mL) once daily Take without regard to meals.	Renal excretion: 86% Dose adjustment is recommended in patients with renal insufficiency (see Appendix B, Table 8).	10 hours/ >20 hours	Minimal toxicity Hyperpigmentation/skin discoloration Severe acute exacerbation of hepatitis may occur in HBV coinfected patients who discontinue FTC.
(FTC/TAF) Descovy	Descovy: (FTC 200 mg plus TAF 25 mg) tablet	Descovy: 1 tablet once daily
(FTC/TDF) Truvada	Truvada: (FTC 200 mg plus TDF 300 mg) tablet	Truvada: 1 tablet once daily
(FTC/BIC/TAF) Biktarvy	Biktarvy: (FTC 200 mg plus BIC 50 mg plus TAF 25 mg) tablet	Biktarvy: 1 tablet once daily
(FTC/DRV/c/TAF) Symtuza	Symtuza: (FTC 200 mg plus DRV 800 mg plus COBI 150 mg plus TAF 10 mg) tablet	Symtuza: 1 tablet once daily with food
(FTC/EFV/TDF) Atripla	Atripla: (FTC 200 mg plus EFV 600 mg plus TDF 300 mg) tablet	Atripla: 1 tablet once daily on an empty stomach, preferably at bedtime
(FTC/EVG/c/TAF) Genvoya	Genvoya: (FTC 200 mg plus EVG 150 mg plus COBI 150 mg plus TAF 10 mg) tablet	Genvoya: 1 tablet once daily with food
(FTC/EVG/c/TDF) Stribild	Stribild: (FTC 200 mg plus EVG 150 mg plus COBI 150 mg plus TDF 300 mg) tablet	Stribild: 1 tablet once daily with food
(FTC/RPV/TDF) Complera	Complera: (FTC 200 mg plus RPV 25 mg plus TDF 300 mg) tablet	Complera: 1 tablet once daily with a meal
Lamivudine (3TC) Epivir Note: Generic is available.	Epivir: 150 and 300 mg tablets 10 mg/mL oral solution	Epivir: 3TC 300 mg once daily, or 3TC 150 mg BID	Renal excretion: 70% Dose adjustment in patients with renal insufficiency is recommended (see Appendix B, Table 8).	5–7 hours/ 18–22 hours	Minimal toxicity Severe acute exacerbation of hepatitis may occur in HBV coinfected patients who discontinue 3TC.
(3TC/ABC) Epzicom Note: Generic is available.	Epzicom: (3TC 300 mg plus ABC 600 mg) tablet	Epzicom: 1 tablet once daily
(3TC/TDF) Cimduo	Cimduo: (3TC 300 mg plus TDF 300 mg) tablet	Cimduo: 1 tablet once daily
(3TC/ZDV) Combivir Note: Generic is available.	Combivir: (3TC 150 mg plus ZDV 300 mg) tablet	Combivir: 1 tablet BID
(3TC/ABC/ZDV) Trizivir Note: Generic is available.	Trizivir: (3TC 150 mg plus ZDV 300 mg plus ABC 300 mg) tablet	Trizivir: 1 tablet BID
(3TC/DOR/TDF) Delstrigo	Delstrigo: (3TC 300 mg plus DOR 100 mg plus TDF 300 mg) tablet	Delstrigo: 1 tablet once daily
(3TC/DTG/ABC) Triumeq	Triumeq: (3TC 300 mg plus ABC 600 mg plus DTG 50 mg) tablet	Triumeq: 1 tablet once daily
(3TC/EFV/TDF) Symfi	Symfi: (3TC 300 mg plus EFV 600 mg plus TDF 300 mg) tablet	Symfi: 1 tablet once daily on an empty stomach, preferably at bedtime
(3TC/EFV/TDF) Symfi Lo	Symfi Lo: (3TC 300 mg plus EFV 400 mg plus TDF 300 mg) tablet	Symfi Lo: 1 tablet once daily on an empty stomach, preferably at bedtime
Stavudine (d4T) Zerit Note: Generic is available.	Zerit: 15, 20, 30, and 40 mg capsules 1 mg/mL oral solution	Body Weight ≥60 kg: d4T 40 mg BID Body Weight <60 kg: d4T 30 mg BID Take without regard to meals. Note: WHO recommends 30 mg BID dosing regardless of body weight.	Renal excretion: 50% Dose adjustment is recommended in patients with renal insufficiency (see Appendix B, Table 8).	1 hour/ 7.5 hours	Peripheral neuropathy Lipoatrophy Pancreatitis Lactic acidosis/severe hepatomegaly with hepatic steatosis (rare but potentially life-threatening toxicity) Hyperlipidemia Insulin resistance/diabetes mellitus Rapidly progressive ascending neuromuscular weakness (rare)
Tenofovir Alafenamide (TAF) Vemlidy Note: Available as a 25-mg tablet for the treatment of HBV.	See FDCs for HIV treatment below.	See FDCs for HIV treatment below.	Metabolized by cathepsin A. Not recommended in patients with CrCl <30 mL/min.	0.5 hours/ 150–180 hours	Renal insufficiency, Fanconi syndrome, proximal renal tubulopathy are less likely to occur with TAF than with TDF. Osteomalacia, decrease in bone mineral density are less likely to occur with TAF than with TDF. Severe acute exacerbation of hepatitis may occur in HBV coinfected patients who discontinue TAF. Diarrhea, nausea, headache
(FTC/TAF) Descovy	Descovy: (FTC 200 mg plus TAF 25 mg) tablet	Descovy: 1 tablet once daily
(TAF/BIC/FTC) Biktarvy	Biktarvy: (TAF 25 mg plus BIC 50 mg plus FTC 200 mg) tablet	Biktarvy: 1 tablet once daily
(TAF/DRV/c/FTC) Symtuza	Symtuza: (TAF 10 mg plus DRV 800 mg plus COBI 150 mg plus FTC 200 mg) tablet	Symtuza: 1 tablet once daily with food
(TAF/EVG/c/FTC) Genvoya	Genvoya: (TAF 10 mg plus EVG 150 mg plus COBI 150 mg plus FTC 200 mg) tablet	Genvoya: 1 tablet once daily with food
(TAF/RPV/FTC) Odefsey	Odefsey: (TAF 25 mg plus RPV 25 mg plus FTC 200 mg) tablet	Odefsey: 1 tablet once daily with a meal
Tenofovir Disoproxil Fumarate (TDF) Viread Note: Generic is available.	Viread: 150, 200, 250, and 300 mg tablets 40 mg/g oral powder Generic: 300 mg tablet	Viread: TDF 300 mg once daily, or 7.5 level scoops of oral powder once daily (dosing scoop dispensed with each prescription; 1 level scoop contains 1 g of oral powder). Take without regard to meals. Mix oral powder with 2–4 ounces of a soft food that does not require chewing (e.g., applesauce, yogurt). Do not mix oral powder with liquid.	Renal excretion is primary route of elimination. Dose adjustment is recommended in patients with renal insufficiency (see Appendix B, Table 8).	17 hours/ >60 hours	Renal insufficiency, Fanconi syndrome, proximal renal tubulopathy Osteomalacia, decrease in bone mineral density Severe acute exacerbation of hepatitis may occur in HBV-coinfected patients who discontinue TDF. Asthenia, headache, diarrhea, nausea, vomiting, and flatulence
(TDF/3TC) Cimduo	Cimduo: (TDF 300 mg plus 3TC 300 mg) tablet	Cimduo: 1 tablet once daily
(TDF/FTC) Truvada	Truvada: (TDF 300 mg plus FTC 200 mg) tablet	Truvada: 1 tablet once daily Take without regard to meals.
(TDF/DOR/3TC) Delstrigo	Delstrigo: (TDF 300 mg plus DOR 100 mg plus 3TC 300 mg) tablet	Delstrigo: 1 tablet once daily
(TDF/EFV/FTC) Atripla	Atripla: (TDF 300 mg plus EFV 600 mg plus FTC 200 mg) tablet	Atripla: 1 tablet once daily on an empty stomach, preferably at bedtime
(TDF/EFV/3TC) Symfi	Symfi: (TDF 300 mg plus EFV 600 mg plus 3TC 300 mg) tablet	Symfi: 1 tablet once daily on an empty stomach, preferably at bedtime
(TDF/EFV/3TC) Symfi Lo	Symfi Lo: (TDF 300 mg plus EFV 400 mg plus 3TC 300 mg) tablet	Symfi Lo: 1 tablet once daily on an empty stomach, preferably at bedtime
(TDF/EVG/c/FTC) Stribild	Stribild: (TDF 300 mg plus EVG 150 mg plus COBI 150 mg plus FTC 200 mg) tablet	Stribild: 1 tablet once daily Take with food.
(TDF/RPV/FTC) Complera	Complera: (TDF 300 mg plus RPV 25 mg plus FTC 200 mg) tablet	Complera: 1 tablet once daily Take with a meal.
Zidovudine (ZDV) Retrovir Note: Generic is available.	Retrovir: 100 mg capsule 300 mg tablet (only available as generic) 10 mg/mL intravenous solution 10 mg/mL oral solution	Retrovir: ZDV 300 mg BID, or ZDV 200 mg TID Take without regard to meals.	Metabolized to GAZT Renal excretion of GAZT Dose adjustment is recommended in patients with renal insufficiency (see Appendix B, Table 8).	1.1 hours/ 7 hours	Bone marrow suppression: macrocytic anemia or neutropenia Nausea, vomiting, headache, insomnia, asthenia Nail pigmentation Lactic acidosis/severe hepatomegaly with hepatic steatosis (rare but potentially life-threatening toxicity) Hyperlipidemia Insulin resistance/diabetes mellitus Lipoatrophy Myopathy
(ZDV/3TC) Combivir Note: Generic is available.	Combivir: (ZDV 300 mg plus 3TC 150 mg) tablet	Combivir: 1 tablet BID Take without regard to meals.
(ZDV/3TC/ABC) Trizivir Note: Generic is available.	Trizivir: (ZDV 300 mg plus 3TC 150 mg plus ABC 300 mg) tablet	Trizivir: 1 tablet BID Take without regard to meals.
^a For dose adjustments in patients with hepatic insufficiency, see Appendix B, Table 8. ^b Also see Table 15. Key to Acronyms:3TC = lamivudine; ABC = abacavir; BIC = bictegravir; BID = twice daily; COBI = cobicistat; CrCl = creatinine clearance; d4T = stavudine; ddI = didanosine; DOR = doravirine; DRV = darunavir; DTG = dolutegravir; EC = enteric coated; EFV = efavirenz; EVG = elvitegravir; FDC = fixed-dose combination; FTC = emtricitabine; GAZT = azidothymidine glucuronide; HBV = hepatitis B virus; HLA = human leukocyte antigen; HSR = hypersensitivity reaction; MI = myocardial infarction; RPV = rilpivirine; TAF = tenofovir alafenamide; TDF = tenofovir disoproxil fumarate; TID = three times a day; WHO = World Health Organization; ZDV = zidovudine

Appendix B, Table 1. Characteristics of Nucleoside Reverse Transcriptase Inhibitors

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Appendix B: Drug Characteristics Tables

Characteristics of Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

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