Complera (emtricitabine, rilpivirine and tenofovir disoproxil fumarate) Tablets

Complera

Generic Name: emtricitabine, rilpivirine and tenofovir disoproxil fumarate
Date of Approval: August 10, 2011
Company: Gilead Sciences, Inc.

Treatment for: HIV Infection

The U.S. Food and Drug Administration (FDA) has approved Complera (emtricitabine/rilpivirine/tenofovir disoproxil fumarate), a complete single-tablet regimen for the treatment of HIV-1 infection in treatment-naïve adults. Complera combines three antiretroviral medications in one daily tablet.

Complera Patient Information

Important: Ask your doctor or pharmacist about medicines that should not be taken with Complera. For more information, see the section Before taking Complera

Read this Patient Information before you start taking Complera and each time you get a refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or treatment.

Important information about Complera

Complera can cause serious side effects, including:

1. Build-up of an acid in your blood (lactic acidosis). Lactic acidosis can happen in some people who take Complera or similar (nucleoside analogs) medicines. Lactic acidosis is a serious medical emergency that can lead to death.
   
   Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis:
   • feeling very weak or tired
   • have unusual (not normal) muscle pain
   • have trouble breathing
   • have stomach pain with
   • nausea (feel sick to your stomach)
   • vomiting
   • feel cold, especially in your arms and legs
   • feel dizzy or lightheaded
   • have a fast or irregular heartbeat
2. Severe liver problems. Severe liver problems can happen in people who take Complera or similar medicines. In some cases these liver problems can lead to death. Your liver may become large (hepatomegaly) and you may develop fat in your liver (steatosis) when you take Complera.
   
   Call your healthcare provider right away if you have any of the following symptoms of liver problems:
   • your skin or the white part of your eyes turns yellow (jaundice).
   • dark "tea-colored" urine
   • light-colored bowel movements (stools)
   • loss of appetite for several days or longer
   • nausea
   • stomach pain
   You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking Complera or a similar medicine containing nucleoside analogs for a long time.
3. Worsening of Hepatitis B infection. If you also have hepatitis B virus (HBV) infection and you stop taking Complera, your HBV infection may become worse (flare-up). A "flare-up" is when your HBV infection suddenly returns in a worse way than before. Complera is not approved for the treatment of HBV, so you must discuss your HBV therapy with your healthcare provider.
4. Do not let your Complera run out. Refill your prescription or talk to your healthcare provider before your Complera is all gone.
5. Do not stop taking Complera without first talking to your healthcare provider.
6. If you stop taking Complera, your healthcare provider will need to check your health often and do regular blood tests to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking Complera.

What is Complera?

Complera is a prescription HIV (Human Immunodeficiency Virus) medicine that:

• is used to treat HIV-1 in adults who have never taken HIV medicines before. HIV is the virus that causes AIDS (Acquired Immunodeficiency Syndrome).
• contains 3 medicines, (rilpivirine, emtricitabine, tenofovir disoproxil fumarate) combined in one tablet. Emtriva and Viread are HIV-1 (human immunodeficiency virus) nucleoside analog reverse transcriptase inhibitors (NRTIs) and Edurant is an HIV-1 non-nucleoside analog reverse transcriptase inhibitor (NNRTI).

It is not known if Complera is safe and effective in children under the age of 18 years.

Complera may help:

• Reduce the amount of HIV in your blood. This is called your "viral load".
• Increase the number of white blood cells called CD4+ (T) cells that help fight off other infections.

Reducing the amount of HIV and increasing the CD4+ (T) cell count may improve your immune system. This may reduce your risk of death or infections that can happen when your immune system is weak (opportunistic infections).

Complera does not cure HIV infections or AIDS.

• Always practice safer sex.
• Use latex or polyurethane condoms to lower the chance of sexual contact with any body fluids such as semen, vaginal secretions, or blood.
• Never re-use or share needles.

Ask your healthcare provider if you have any questions about how to prevent passing HIV to other people.

Who should not take Complera?

• Do not take Complera if your HIV infection has been previously treated with HIV medicines.
• Do not take Complera if you are taking certain other medicines. For more information about medicines that must not be taken with Complera, see Before taking Complera

Before taking Complera

Before you take Complera, tell your healthcare provider if you:

• have liver problems, including hepatitis B or C virus infection
• have kidney problems
• have ever had a mental health problem
• have bone problems
• are pregnant or plan to become pregnant. It is not known if Complera can harm your unborn child.
  Pregnancy Registry. There is a pregnancy registry for women who take antiviral medicines during pregnancy. Its purpose is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry.
• are breast-feeding or plan to breast-feed. The Centers for Disease Control and Prevention recommends that mothers with HIV not breastfeed because they can pass the HIV through their milk to the baby. It is not known if Complera can pass through your breast milk and harm your baby. Talk to your healthcare provider about the best way to feed your baby.

Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.

Complera may affect the way other medicines work, and other medicines may affect how Complera works, and may cause serious side effects. If you take certain medicines with Complera, the amount of Complera in your body may be too low and it may not work to help control your HIV infection. The HIV virus in your body may become resistant to Complera or other HIV medicines that are like it.

Do not take Complera if you also take these medicines:

• Complera provides a complete treatment for HIV infection. Do not take other HIV medicines with Complera.
• the anti-seizure medicines carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol), oxcarbazepine (Trileptal), phenobarbital (Luminal), phenytoin (Dilantin, Dilantin-125, Phenytek)
• the anti-tuberculosis medicines rifabutin (Mycobutin), rifampin (Rifater, Rifamate, Rimactane, Rifadin) and rifapentine (Priftin)
• a proton pump inhibitor medicine for certain stomach or intestinal problems, including esomeprazole (Nexium, Vimovo), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole sodium (Protonix), rabeprazole (Aciphex)
• more than one dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate
• St. John's wort (Hypericum perforatum)

If you are taking Complera, you should not take:

• other medicines that contain tenofovir (Viread, Truvada, Atripla)
• other medicines that contain emtricitabine or lamivudine (Emtriva, Combivir, Epivir or Epivir-HBV, Epzicom, Trizivir)
• rilpivirine (Edurant)
• adefovir (Hepsera)

Also tell your healthcare provider if you take:

• an antacid medicine that contains aluminum, magnesium hydroxide, or calcium carbonate. Take antacids at least 2 hours before or at least 4 hours after you take Complera.
• a histamine-2 blocker medicine, including famotidine (Pepcid), cimetidine (Tagamet), nizatidine (Axid), or ranitidine hydrochloride (Zantac). Take these medicines at least 12 hours before or at least 4 hours after you take Complera.
• the antibiotic medicines clarithromycin (Biaxin), erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), and troleandomycin (Tao)
• an antifungal medicine by mouth, including fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil), voriconazole (Vfend)
• methadone (Dolophine)

Ask your healthcare provider or pharmacist if you are not sure if your medicine is one that is listed above.

Know the medicines you take. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. Your healthcare provider and your pharmacist can tell you if you can take these medicines with Complera. Do not start any new medicines while you are taking Complera without first talking with your healthcare provider or pharmacist. You can ask your healthcare provider or pharmacist for a list of medicines that can interact with Complera.

How should I take Complera?

• Stay under the care of your healthcare provider during treatment with Complera.
• Take Complera exactly as your healthcare provider tells you to take it.
• Always take Complera with a meal. Taking Complera with a meal is important to help get the right amount of medicine in your body. A protein drink does not replace a meal.
• Do not change your dose or stop taking Complera without first talking with your healthcare provider. See your healthcare provider regularly while taking Complera.
• If you miss a dose of Complera within 12 hours of the time you usually take it, take your dose of Complera with a meal as soon as possible. Then, take your next dose of Complera at the regularly scheduled time. f you miss a dose of Complera by more than 12 hours of the time you usually take it, wait and then take the next dose of Complera at the regularly scheduled time.
• Do not take more than your prescribed dose to make up for a missed dose.
• When your Complera supply starts to run low, get more from your healthcare provider or pharmacy. It is very important not to run out of Complera. The amount of virus in your blood may increase if the medicine is stopped for even a short time.
• If you take too much Complera, contact your local poison control center or go to the nearest hospital emergency room right away.

Complera side effects

Complera may cause the following serious side effects, including:

• See Important information about Complera
• New or worse kidney problems can happen in some people who take Complera. If you have had kidney problems in the past or take other medicines that can cause kidney problems, your healthcare provider may need to do blood tests to check your kidneys during your treatment with Complera.
• Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms:
  • feeling sad or hopeless
  • feeling anxious or restless
  • have thoughts of hurting yourself (suicide) or have tried to hurt yourself
• Bone problems can happen in some people who take Complera. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do additional tests to check your bones.
• Changes in body fat can happen in people taking HIV medicine. These changes may include increased amount of fat in the upper back and neck "buffalo hump"), breast, and around the main part of your body (trunk). Loss of fat from the legs, arms and face may also happen. The cause and long term health effect of these conditions are not known.
• Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider if you start having new symptoms after starting your HIV medicine.

The most common side effects of Complera include:

• trouble sleeping (insomnia)
• abnormal dreams
• headache
• dizziness
• diarrhea
• nausea
• rash
• tiredness
• depression

Additional common side effects include:

• vomiting
• stomach pain or discomfort
• skin discoloration (small spots or freckles)
• pain