TRUVADA FOR PREP

emtricitabine/tenofovir DF (FTC/TDF)

CDC recommended for prevention of HIV for all people at risk through sex or injection drug use

PrEP drug

Pre-Exposure Prophylaxis

Truvada tablet

STANDARD DOSE

For HIV-negative adults and adolescents weighing at least 77 pounds (35 kg), one tablet once daily, without regard to food. The tablet contains 200 mg emtricitabine and 300 mg tenofovir disoproxil fumarate.

Take a 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. Truvada should not be used for prevention if eCrCl or eGFR (measures of kidney function) is less than 60 mL/min.

MANUFACTURER

Gilead Sciences, Inc.
gilead.com
truvada.com
(800) GILEAD-5 (445–3235)

PHARMACY

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

GET STARTED – Request To Fill Your Medication

No new serious side effects were seen when Truvada was studied for HIV prevention in clinical trials. Some patients may experience nausea, headache, stomach pain, or weight loss. Risk compensation (when people put themselves at greater risk for infection, such as anonymous or multiple sex partners, because they think PrEP will protect them) was not observed in clinical trials. The tenofovir DF (Viread) in Truvada is associated with long-term decreases in bone mineral density (BMD). BMD monitoring should be considered in people who have a history of bone fracture due to a disease or are at risk for osteopenia or osteoporosis. Truvada can cause kidney toxicities. In prevention studies, decreases in BMD and creatinine clearance or eGFR (a marker of kidney function) were rare, mild, and reversible upon stopping Truvada. Tell your provider about pain in extremities, persistent or worsening bone pain and fractures, with or without muscular pain or weakness, as well as any concerning changes in urinary habits as these could be signs of kidney or bone problems. If Truvada is discontinued abruptly in people with hepatitis B virus (HBV), flare-up of hepatitis may occur—talk to your provider before discontinuing. In studies, there were cases of people who had unidentified HIV infection when starting Truvada for PrEP and subsequently developed drug resistance. A negative HIV test must be confirmed immediately prior to starting Truvada for PrEP. Truvada alone is not a complete regimen to treat HIV. Continuing only with Truvada after acquiring HIV may lead to drug resistance and limit future antiviral options. Truvada contains lactose, which can cause some abdominal discomfort, especially in patients sensitive to lactose.

  • See the individual drugs contained in Truvada: Viread and Emtriva.
  • See package insert for more complete information on potential side effects and interactions.

Do not take with any other HIV or HBV drugs when used for PrEP. Avoid taking Truvada with drugs that negatively affect the kidneys, including chronic use or high doses of anti-inflammatory drugs for pain like Advil or Motrin (ibuprofen) and Aleve (naproxen). Truvada for PreP can be used with the hepatitis C drugs Daklinza, Harvoni, Sovaldi, Olysio, Viekira Pak, or Zepatier. Monitor for tenofovir toxicities if used with Epclusa. Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not.

Let’s be clear: Truvada for PrEP is almost 100% effective in preventing HIV—this is a done deal. Why aren’t more people using it to help end the epidemic? Stigma and lack of access to health care continue to fuel HIV infections. Remember, risk depends on the situation—including where you live or how much money your friends have or some such. Stigma—not sex—is the real shame. Other problems include not knowing about PrEP and inability to perceive a need for it (not realizing one may be vulnerable at all). Altogether, even doctors continue to avoid prescribing PrEP. Although PrEP should become medically routine, like HIV tests for pregnant women, until it is, we’ll tell you again: seeing an HIV specialist is the best way to obtain PrEP. They get it. It’s not about being a whore. And better yet, they care. Fortunately, new avenues for PrEP—many without HIV specialty—are opening up: pharmacist-led PrEP clinics, tele-PrEP (via video consultation), use of ERs and STD clinics, and so on. As for “just use a condom,” there are many reasons why condoms are not enough. So can we move on?

Truvada, a widely-used medication for the treatment of HIV, was approved in July 2012 by the Food and Drug Administration (FDA) to reduce the risk of HIV infection in HIV-negative individuals ”at risk” for HIV acquisition (according to the drug label – in reality, people rarely realize that they’re at risk for HIV at all). Although the drug label specifies sexually-acquired infection, U.S. HIV guidelines also recommend use for protecting against infection through injection drug use (reducing the risk of HIV by more than 70%, according to the CDC). This approach to HIV prevention is called pre-exposure prophylaxis, or PrEP (“prophylaxis” means something that prevents disease, such as a condom or a vaccine). The U.S. Public Health Service (USPHS) has issued updated guidelines for the use of Truvada for PrEP. Go to cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf. Truvada is currently the only drug approved for PrEP.

There are many considerations regarding Truvada for PrEP. Proper use is crucial. It is vital that people test HIV-negative right before being given a prescription (the label says “immediately,” the CDC says within 7 days). Patients should also be re-tested for HIV infection at least every three months while taking Truvada for PrEP. People who are already unknowingly HIV infected when starting PrEP risk developing drug-resistant virus because Truvada alone is not adequate for the treatment of HIV.  Drug resistance can only occur in HIV-positive individuals. Truvada for PrEP should not be given to people with symptoms of recent (acute) infection, such as fever, fatigue, sweating a lot (especially at night), rash, vomiting, diarrhea, joint or muscle aches, headache, sore throat, or enlarged lymph nodes (especially in the neck or groin). PrEP should not be started (or re-started) if any of these symptoms appear after a potential exposure to HIV unless evaluated by a doctor and possibly re-tested for HIV. People on PrEP who have these symptoms after a potential exposure to HIV should let their provider know immediately.

Truvada for PrEP is not a “morning-after pill” or a weekend medication. It must be taken every day to be maximally effective. In studies, greater protection was seen with greater adherence. Truvada for PrEP works if you take it as prescribed. On the other hand, there have been good results with using it around the time of sex (kudos to the IPERGAY study)—the research continues. Unlike HIV therapy, which is long-term, PrEP may be used just for periods of time when HIV-negative individuals are most vulnerable to infection.

While some people may use PrEP as their only prevention method, it was studied and approved as part of a more comprehensive HIV prevention strategy that includes the use of condoms and risk reduction counseling. That said, the CDC has changed the definition of protected sex to include sex without condoms, given new modalities such as PrEP. Although consistent condom use is an important part of a prevention plan for all people prescribed PrEP, lack of use of a barrier protection is not a reason to withhold PrEP. On the contrary, the PrEP label lists people who are unwilling or unable to use condoms as at-risk candidates for whom the drug is indicated. PrEP does not protect against other sexually transmitted infections (STDs) including hepatitis C or against pregnancy.

Other screening and monitoring requirements include measuring kidney function and checking for STIs and hepatitis B and C, treatment for STIs, and vaccination for HBV if warranted.

Although a PrEP prescription can be given to a wide range of people, the Truvada PrEP drug label states that it is indicated for those considered “at risk” for infection. The label notes that people at risk include those who engage in sexual activity in a high-prevalence area or social network and have one or more of the following: (a) inconsistent or no condom use, (b) diagnosis of sexually transmitted infections (STIs), (c) exchange of sex for commodities (money, food, shelter, or drugs), (d) use of illicit drugs or alcohol dependence, (e) history of incarceration, or (f) sexual partners of unknown HIV status with any of the above risk factors. U.S. HIV treatment guidelines state that, “Truvada has been shown to be safe and effective at preventing HIV in healthy adults who meet recommended criteria in the following populations: MSM [men who have sex with men], heterosexually active men and women, and IV drug users.”

Individuals who have used post-exposure prophylaxis (PEP) multiple times are also good candidates for PrEP because of their continuing risk for HIV. PEP is a course of HIV medications taken for 28 days after exposure to HIV to prevent infection; it must be started as soon as possible but no later than 72 hours after exposure.

Although pregnant women were not enrolled in PrEP studies, there is hope for PrEP to help serodiscordant couples (where one partner is positive and one is negative) conceive without transmitting the virus. Last year, the DHHS perinatal HIV guidelines added a section on the use of PrEP and HIV therapy to prevent transmission in sero-different couples trying to conceive; go to aidsinfo.nih.gov. The Bay Area Perinatal AIDS Center (BAPAC) is leading the charge for safer conception options, including MSM, plus a new providers list at pleaseprepme.org; go to hiveonline.org.

According to the World Health Organization, it takes Truvada for PrEP 7 days to reach protective levels, whether exposure is rectal or vaginal. The CDC notes time to steady state, or maximum intracellular concentrations of tenofovir diphospate (TFV-DP), of 7 days for the rectal tract and about 20 days for vaginal tissue. Protective levels, however, are reached much earlier, based on pharmacokinetic (PK) models.

The two studies that led to Truvada’s approval for PrEP, iPrEx (in high-risk MSM and transgender women) and Partners PrEP (in serodiscordant couples, most of them heterosexual), showed efficacy rates between 90%–92% when participants take their meds. PrEP with Truvada has also been studied in other patient populations, including younger single men and women, injection drug users, and women. In all the studies, the common theme is that PrEP is effective if you take it every day. Other drugs are being studied for use as HIV PrEP, including long-acting injection formulations requiring only one injection every 4–8 weeks.

Some providers not working in HIV are still learning about PrEP, and some continue to be reluctant to prescribe it. Read the PDF of the CDC brochure “Talk to Your Doctor about PrEP.” The brochure includes resources for providers. HIV specialists may be best for a PEP or PrEP prescription, as they are familiar with the medications and more supportive of PrEP; find providers at hivma.org and aahivm.org, as well as pleaseprepme.org. HIV specialists are generally in high demand, however, and advocates are looking to make Truvada for PrEP much more accessible. There is also a complex set of standards to use in prescribing PrEP that may cause many providers to turn away, including a call for safer sex counseling. As of July 1, 2019, however, the FDA no longer requires a REMS (Risk Evaluation and Mitigation Strategy) program for Truvada for PrEP. The National Alliance of State and Territorial AIDS Directors (NASTAD) developed a guide to help providers bill for PrEP services available at nastad.org/resource/billing-coding-guide-hiv-prevention. Two excellent websites for finding a PrEP provider are preplocator.org and aidsvu.org. All you need to do is enter your ZIP code, and a list of providers who prescribe Truvada for PrEP will appear.

Greater PrEP acceptance and use, however, appears to be increasing among communities most vulnerable to HIV. Health departments across the country are promoting PrEP as part of a strategy to end the HIV epidemic. In addition, prevention efforts are also focusing on U=U (Undetectable equals Untransmittable), promoting the awareness that people living with HIV who have undetectable viral loads do not transmit the virus to sexual partners. Go to preventionaccess.org.

Providers are reporting widespread acceptance of PrEP prescriptions by insurers. Gilead Sciences helps patients work with their insurance, including pre-authorizations, as well as provides free PrEP to uninsured patients who are eligible and co-pay assistance up to $4,800 a year; contact the patient assistance hotline at (855) 330-5479, or go to gileadadvancingaccess.com. Patients may also need to advocate on their own behalf; keeping good notes of conversations and other communication is a good idea. Also, check out prep4love.com.

PrEP Facts: Rethinking HIV Prevention and Sex is a closed Facebook group for people interested in or currently on PrEP, and their allies. Demonstration projects providing free PrEP to study its use in the real world can be found at PrEPWatch.org from AVAC and projectinform.org/prep. Providers can use V107 as a medical billing code for PrEP (exposure to infectious disease, including HIV).

Other information sources:

cdc.gov/hiv/basics/prep

nccc.ucsf.edu/clinical-resources/pep-resources/prep

whatisprep.org

truvadapreprems.com

hivinsite.com

PrEP is short for pre-exposure prophylaxis, which means protecting yourself from exposure to the HIV virus. Truvada is an HIV drug that has proven to reduce the risk of getting infected with HIV through sex. It is prescribed to be taken once a day, every day. Adherence is very important for PrEP to work. You have to be tested before using Truvada for PrEP and every three months see your health care provider who will test you for HIV and other sexually transmitted diseases (STDs). Truvada for PrEP does not reduce the risk for contracting STDs; that’s why it is strongly recommended to practice safer sex practices even if you take Truvada for PrEP. Truvada can cause serious adverse events like kidney damage and bone density loss. You should be monitored for both. Liver damage might occur, so it is important to check your liver enzymes.

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
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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