SYMFI

efavirenz/lamivudine/tenofovir DF (EFV/3TC/TDF)

Recommended initial regimen in certain clinical situations

HIV Single Trablet Regimen

Single-Tablet Regimen

Symfi Tablet

STANDARD DOSE

One tablet once daily on an empty stomach, preferably at bedtime (food increases the risk of central nervous system, or CNS, toxicities). The Symfi tablet contains 600 mg of the NNRTI efavirenz plus 300 mg lamivudine and 300 mg tenofovir DF (TDF). The Symfi Lo tablet contains a lower dose of efavirenz, 400 mg, plus 300 mg lamivudine and 300 mg tenofovir DF (TDF).

For adults and pediatric patients weighing at least 77 pounds (35 kg) for Symfi Lo and 88 pounds (40 kg) for Symfi.

Take missed dose as soon as possible, unless it is closer to the time of your next dose. Do not double up on your next dose. Do not split or crush the tablet. Dose cannot be adjusted for people with kidney problems. Symfi and Symfi Lo are not recommended for patients with CrCl less than 50 mL/min or individuals requiring dialysis. Symfi or Symfi Lo should not be used in people with moderate or severe kidney or liver impairment.

MANUFACTURER

Mylan
symfi.com
mylan.com
(877) 446-3679

PHARMACY

Drug Mart Pharmacy
shopdrugmart.com
(800) 877-0337

GET STARTED – Request To Fill Your Medication

•    See the individual drugs contained in SymFi: Sustiva, Epivir, and Viread.

•    See package insert for more complete information on potential side effects and interactions. 

The most common side effects occurring in 5% or more of studied individuals include headache (14%), body pain (13%), fever (8%), abdominal pain (7%), back pain (9%), asthenia (6%), diarrhea (11%), nausea (8%), vomiting (5%), arthralgia (joint pain, 5%), depression (11%), insomnia (5%), anxiety (6%), pneumonia (5%), and rash (18%). These side effects are most common at the start of treatment and usually diminish in two to four weeks. Bedtime dosing on an empty stomach can help reduce symptoms. Use with caution in individuals with depression or other psychiatric issues who are not under a psychiatrist’s care. Prior to initiation, people should be tested for hepatitis B (HBV) infection. Severe exacerbations of hepatitis B have been reported in people who are co-infected with hepatitis B and have discontinued the lamivudine and/or tenofovir components. Monitor liver enzymes closely in people co-infected with hepatitis B and, if appropriate, initiation of anti-hepatitis B therapy may be warranted. The efavirenz component in these medications can cause a false positive for marijuana on certain drug tests. A more specific confirmatory test can be done.

Do not take with Epivir-HBV, Hepsera, or Vemlidy (TAF), all three used for treatment of hepatitis B. Do not take with another nephrotoxic (harmful to the kidneys) medication, such as high-dose or multiple NSAIDs (non-steroidal anti-inflammatory drugs; these include aspirin, ibuprofen – Motrin, Advil, and others, and naproxen sodium – Aleve and others). Should not be taken with voriconazole, ergot derivatives, midazolam, pimozide, triazolam, bepridil, or St. John’s wort. Efavirenz should also not be taken with other medications that prolong QTc interval (a heart problem) or medications with a known risk of torsades de pointes. May affect warfarin levels. Can decrease levels of buprenorphine and methadone—monitor for withdrawal. When taken with carbamazepine, phenobarbital, or phenytoin, periodic monitoring of anticonvulsant and efavirenz levels should be done or alternative anti-seizure drugs, such as levetiracetam, should be considered. Effectiveness of birth control pills may be decreased; consider the use of other contraceptives. Closer monitoring and dose adjustments may be required with posaconazole (avoid unless benefit outweighs potential risk) and itraconazole. Monitor effectiveness of clarithromycin or consider using azithromycin instead. Levels of immunosuppressants should be monitored when starting or stopping Symfi or Symfi Lo. Cardizem, Lipitor, Pravachol, and Zocor doses may need to be adjusted. Titrate dose of bupropion and sertraline based on clinical response. Avoid use of sorbitol-containing medicines with lamivudine; there are many, such as acetaminophen liquid (Tylenol liquid and others). No dose adjustment of Symfi or Symfi Lo needed with Sovaldi. Use caution when administering with Harvoni and monitor renal function closely due to possible increased tenofovir levels. Increase dose of Daklinza to 90 mg when used with Symfi or Symfi Lo. Should not be taken with Epclusa, Olysio, Viekira Pak, or Zepatier. Not intended to be taken with other HIV medications, unless prescribed that way. See Atripla page for more potential side effects. Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not, as there are other drug interactions which are not listed here.

Symfi and Symfi Lo are basically alternative versions of Atripla, a well-established HIV medication that’s no longer in favor when starting therapy. If you can’t sleep, ask your doctor about gradually adjusting the timing of your dose until it’s taken during the day. A rare genetic trait affecting drug metabolism of Sustiva, leading to a higher rate of side effects, occurs more in African Americans. For individuals with HIV-2, commonly found in some other countries, an NNRTI would not be recommended as HIV-2 is inherently resistant to NNRTIs. Randomized clinical trial data have demonstrated the efficacy of lower dose (400 mg) efavirenz found in Symfi Lo, however this dose has not been studied in a U.S. population, in pregnant women, or in patients with TB and HIV. The U.S. guidelines therefore preferentially recommends Symfi with higher dose efavirenz (600 mg) over the reduced dose of efavirenz found in Symfi Lo (400 mg) at this time.

Symfi and Symfi Lo are listed as a “Recommended Regimen in Certain Clinical Situations” in the DHHS guidelines, just as Atripla is, due to their association with a high rate of central nervous system side effects and possible association with suicidality. Be careful when stopping these medications, so that you avoid the rapid development of HIV resistance to it—check with your provider or pharmacist first.

Symfi and Symfi Lo are once-daily single-tablet regimens that might offer powerful antiretroviral treatment at a much lower price than comparable antiretroviral treatments on the market. The difference between them is that Symfi Lo has a lower dose of efavirenz than Symfi. Research among adults living with HIV shows that treating them with tenofovir and emtricitabine was comparably effective regardless of whether they also received 400 mg or 600 mg of efavirenz. The advantage of the lower 400 mg dose vs. the 600 mg higher is that the exposure to neurotoxicities is less, therefore individuals with the lower dose report less insomnia, depression, and dizziness.

Karen T.
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"They truly care, I tell everyone to go here. I've been with them since 2008."
Yolanda P.
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"Always helpful to save money on medication and very kind."
Michael A.
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"Helpful and knowledgeable. Can't ask for better service, thank you!"
Patti E.
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"The staff at Drug Mart are exceptionally helpful. The quality of their products are top notch. I recommend Drug Mart to everyone. Am with them for life!!"
Darryl F.
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"This is the best pharmacy I have ever been to. They are caring, helpful and treat you with respect."
Anita H.
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"My daughter was able to get emergency medication after hours within half hour of making the phone call to the 800#. I can't recommend Drug Mart more highly."
Robert T.
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"I've been going here for years since my doctor recommended this pharmacy. They're busier now then when I first started but their service is still top notch. Thanks again for all your help!"
David D.
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"They are most accommodating, courteous, friendly and professional pharmacist I've ever dealt with. I'm so grateful to call this pharmacy my own."
Tonia B.
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"Always very caring when asking a question about your medication they know what they're talking about and they are very knowledgeable I've been going to them for oh my goodness since they opened up wow where did time go anyway my drug store for life thank you!"
Josh P.
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"This pharmacy is one of the best. Pharmacist has lots of knowledge and staff takes time to explain in detail. They do other half of what doctors should do. Also, no waiting like big name pharmacy. I highly recommend this pharmacy. They also deliver and ship to anywhere in USA."
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Drug Mart Pharmacy
5.0
Based on 163 reviews
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Chanice Dorsey
Chanice Dorsey
02:45 12 Mar 20
The staff at Drug Mart are truly an extension of my family. Vik offered me one of the greatest opportunities while in... nursing school, as a graduate, and as a working professional. He continues to encourage young adults to pursue their dreams and provides them with opportunities to be impactful within the community. You can’t get any better than this.read more
langston hannah
langston hannah
12:02 07 Mar 20
I am very pleased with the service that I receive from the pharmacy. The people who serve you are very helpful and... friendly and assist you in any way that they can. The pharmacist are well informed with your prescription needs, if there's a problem with anything you need they will do their best to resolve any issue you have. I recommend everyone to check them out and get their prescriptions filled at Drug Mart. I will always be a customer of Drug Mart because they are so good at what they do.read more
Yolanda Mesa
Yolanda Mesa
15:11 05 Mar 20
The best pharmacy I ever went. Staff is very polite and friendly. Very fast and they also deliver. One time I totally... forget about a medication and they went to my house.read more
tracey evans
tracey evans
16:32 03 Mar 20
Drug Mart is my family, I’ve been with them since day 1. I moved away for a few years to another state, I’ve been... back i NJ. a little over 5 years and I’m still a happy customer. They’re very friendly, knowledgeable and very helpful and understanding, prices are better then most..read more
Cassandra Hemby
Cassandra Hemby
21:33 28 Feb 20
I so appreciate the dear people @Drug Mart! I am recovering from cancer and one day while in Chemotherapy I was told I... would need a certain cream right away, but I wouldn't be able to pick it up that day.however there is this very courteous and sweet young lady named Michele that assured me it would be delivered to me in at my daughter's home in Woodbridge, NJ, because that is where I go after having treatment.The kind of caring and compassion received there have made the staff endearing to me and has restored my faith in customer service again.read more
Denise Eady
Denise Eady
20:38 24 Feb 20
I love this place. Best pharmacy around!!!. I have been using this pharmacy since it opened. Whenever I walk in,... everyone is very cordial and always pleasant and with a smile, and they always greet me by nmy name. Vic and the other Pharmacists are very knowledgeable, and the staff takes the time to explain any new medications in detail. If you are not able to pick up your prescriptions, they do HOME delivery which is great. I transferred from Walgreens pharmacy and I am so glad I did!!!read more
Jay Bhatt
Jay Bhatt
21:05 22 Feb 20
The quality of service provided by the pharmacist and the staff is excellent! I wouldn't go to any other pharmacy. They... truly care.read more
Cindy Hall
Cindy Hall
15:21 20 Feb 20
I never have to wait. This is the best pharmacy I ever went to. I highly recommend them to everyone!
Maisha Bryant
Maisha Bryant
00:32 20 Feb 20
I have known Vik and his family since they opened. They have bright back what it means to have a home town family... operated pharmacy. He remembers you, that you have had a baby etc. He is compassionate and always goes above and beyond. He trains his staff to pursue their own dreams. Some have gone on to school. My prayer is that God gives him a long healthy life and that his business continues to prosper. Oh and BTW if you move he does mail order so he can continue to be your pharmacist no need to switch!read more
Sharel E. Gordon-Love
Sharel E. Gordon-Love
19:46 19 Feb 20
My family has been with Drug Mart since they first open and we’ve received top notch service every single time. Vic... and the staff are very friendly, and we are greeted with a smileread more
Tammy Nichols
Tammy Nichols
23:23 18 Feb 20
I used to get my prescriptions at Cvs. But when Drug Mart open close to my house i figured I give then a try and have... not looked back. The staff is always kind, helpful, and considerate. LOVE THIS PLACE.❤read more
Yolanda Parker
Yolanda Parker
20:50 17 Feb 20
I enjoyed the customer service I experience when I go into this store the friendly atmosphere the warm welcome you get... upon entering and exitingread more
Mike Webb
Mike Webb
16:48 06 Feb 20
Great being able to pick up my meds at this pharmacy. They are the best!
Janet Bynum
Janet Bynum
18:21 28 Jan 20
Leaving his experience I had with Drug Mart it's coming there getting my medication and then delivering it to me very... happy who had Drug Mart in my life far as my medications is concerned I don't have to call for refills they deliver them to me I've been the drug mart play my medications concern about 7 years or more appreciate the people they appreciate me I'm happy with Drug Mart this is my the best pharmacist that I know thank youread more
james hunter
james hunter
21:25 24 Jan 20
Always ready to help! Any way possible thank you for all your years of service!
Michelle Reyes
Michelle Reyes
21:03 24 Jan 20
Awesome staff always willing to help out 🙂
cindy ortega
cindy ortega
20:41 24 Jan 20
I love this pharmacy. Everyone makes you feel like your family. Any issues with prescription they try to resolve it... asap. I recommend this pharmacy to everyone.read more
jacqueline wells
jacqueline wells
19:33 31 Dec 19
Drug mart has the most pleasant employees and the service is swift I can't say enough good things about this pharmacy... Thanks for your years of dedication and service in our communityread more
Chris Hanington
Chris Hanington
13:47 18 Jul 19
These people take great care of THEIR people. Impressive!
R Turner
R Turner
21:57 01 Jun 19
I've been going here for years since my doctor recommended this pharmacy. They're busier now then when I first started... but their service is still top notch. Thanks again for all your help!read more
John Aleksandrowicz
John Aleksandrowicz
22:21 14 Apr 19
Great pharmacy with great customer service. Vik is great. He obviously cares about people and understands the needs of... each. Thank you!read more
Karen T
Karen T
18:54 06 Jan 19
This pharmacy is the best! I left Walgreens and very glad I did. They take the time to explain my medicines and know me... by name. I recommended them to all my family and friends.read more
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