Bictegravir-Emtricitabine-TenofovirBictegravir/Emtricitabine/Tenofovir Alafenamide

About Bictegravir-Emtricitabine-Tenofovir

Bictegravir blocks HIV integrase, and emtricitabine and tenofovir alafenamide block reverse transcriptase, enzymes the virus needs to copy itself. Biktarvy is a complete regimen on its own. The label covers people starting HIV treatment; people already treated whose virus is not suppressed, with no known or suspected resistance to integrase inhibitors, emtricitabine or tenofovir; and people switching from a stable regimen that keeps the virus suppressed (below 50 copies per mL), with no known or suspected resistance to bictegravir or tenofovir. Adults and children weighing at least 25 kg take one 50/200/25 mg tablet once a day, with or without food; children from 14 kg to under 25 kg take the 30/120/15 mg tablet. It is not recommended in severe liver impairment or when creatinine clearance is under 30 mL per minute, except in adults on chronic hemodialysis whose virus is suppressed.

The boxed warning concerns hepatitis B: severe flares, including liver failure, have been reported after people with both infections stopped products containing emtricitabine or tenofovir disoproxil fumarate, and may occur when Biktarvy is stopped, so everyone is tested for hepatitis B before or when starting, and anyone who has it and stops Biktarvy has liver function followed closely for at least several months. Kidney function, urine glucose and urine protein are checked before starting and during treatment, since new or worsening kidney problems, including acute kidney failure, have been reported. Other warnings cover drug interactions that can cause side effects or loss of virus control, immune reconstitution syndrome (an inflammatory reaction to hidden infections as the immune system recovers), and lactic acidosis with a severely enlarged fatty liver, which can be fatal. It must not be taken with dofetilide or rifampin. Diarrhea, nausea and headache are the most common side effects.

Antacids with aluminum or magnesium lower bictegravir levels, so Biktarvy is taken at least 2 hours before or 6 hours after them; calcium or iron supplements and antacids can be taken with it together with food, but on an empty stomach Biktarvy is not taken with them or 2 hours after them. In pregnancy, someone whose virus is suppressed takes one full-strength tablet a day, with viral load watched closely because drug levels are lower; a registry tracks outcomes. All three ingredients have been found in breast milk, and the label lists the risks of breastfeeding. Even a short gap in treatment may lead to drug resistance, so refills are lined up before the bottle runs out.

Taking Bictegravir-Emtricitabine-Tenofovir

How to take it

One tablet once a day at about the same time, with or without food; never stop it without talking to the prescriber. A child who cannot swallow the lower-strength tablet whole can take it split, as long as all parts are swallowed within about 10 minutes. Adults on hemodialysis take it after dialysis on dialysis days.

If you miss a dose

Take it as soon as you can, unless the next dose is almost due; then skip the missed dose. Never take two doses at once, and refill before you run out.

Storage

Keep tablets in the original bottle, tightly closed, below 86°F (30°C), with the desiccant packet inside; blister packs are kept at room temperature. Keep out of reach of children.

Interactions to know about

Dofetilide and rifampin must not be taken with it; rifabutin, rifapentine and St. John’s wort are not recommended; and with carbamazepine, oxcarbazepine, phenobarbital or phenytoin the prescriber should consider other seizure medicines. It raises metformin levels. Take it at least 2 hours before or 6 hours after antacids with aluminum or magnesium; calcium or iron can be taken with it together with food.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Bictegravir-Emtricitabine-Tenofovir differs from pharmacy to pharmacy

Biktarvy is brand-only, so every pharmacy stocks the same Gilead product, priced as a brand, and quotes differ mainly in markup and dispensing fee. A pharmacy can fill a Biktarvy prescription only with Biktarvy; it cannot swap in other HIV medicines at the counter.

The lower-strength tablet for children is dispensed less often, so a pharmacy may need to order it. Because Biktarvy is taken every day long term, a ninety-day supply carries one dispensing fee instead of three.

Ways to pay less for Bictegravir-Emtricitabine-Tenofovir without insurance

• Ask your HIV clinic or case manager about your state’s AIDS Drug Assistance Program (ADAP), which provides HIV medicines to people with low incomes and limited or no health insurance; each state sets its own eligibility rules.
• Ask Gilead’s Advancing Access program what support may apply to you; many copay cards require commercial insurance.
• If you have insurance, Medicare or Medicaid, check your coverage before paying cash.
• Once your treatment is stable, ask for a ninety-day supply, and compare more than one pharmacy.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Bictegravir-Emtricitabine-Tenofovir

1. 1.How should I time antacids, calcium or iron supplements with my dose?
2. 2.Do my seizure medicines, rifabutin or St. John’s wort interact with it?
3. 3.Has my hepatitis B status been checked, and what happens if I need to stop?
4. 4.Can you order my refills early enough that I never run out?

Related medications