Trustiva is a combination of three active ingredients (Efavirenz + Emtricitabine + Tenofovir) is used alone or with other antiviral drug for the treatment of HIV infection. It will not cure or prevent HIV/AIDS. Trustiva suppress the HIV replication of virus cell and despite the destruction of the immune system. Trustiva may help to delay the problems arises from AIDS/HIV diseases. The medicine allowed to purchase only with doctor’s prescription.
Tenofovir Disoproxil Fumarate + Emtricitabine+ Efavirenz
300mg + 200mg + 600mg
Trustiva is used with combination of antiretroviral drug or alone medicine in adult and children 12yrs / >12yrs for the treatment of HIV-1 infection.
An acyclic nucleoside phosphonate di ester associate of adenosine monophosphate is Tenofovir Disoproxil Fumarate (Trustiva), that hydrolyzed to Tenofovir, finally cellular enzymes phosphorylated to form Tenofovir diphosphate, arestrict chain terminator. Tenofovir involves with DNA synthesis of HIV through aggressive inhibition of reverse transcriptase and fusion into viral DNA. Tenofovir alsoprevents hepatitis B virus polymerase, resulting in blockage of viral replication.
Emtricitabine is a synthetic nucleoside coordinate of cytidine, which go through phosphorylation occurring inside a cell to emtricitabine 5'-triphosphate, then take part with deoxycytidine 5'-triphosphate and is incorporated into viral DNA which leads to chain termination. Emtricitabine activity against HIV-1, HIV-2 viruses and hepatitis B virus (HBV)
While Efavirenzis anon-nucleoside reverse transcriptase inhibitor that fight against HIV-1 and stops HIV-1 replication and RNA & DNA dependent polymerase activities.
Tenofovir (Trustiva) absorbed immediately from the GI tract, bioavailability with high fat meal is approx. 25% and duration of peak plasma concentration (PPC) is 1-2hr. In Emtricitabine (Trustiva), bioavailability is 93%(capsule) and solution 75%, PPC is 1-2 hrs. finally Efavirenz (Trustiva) , bioavailability is 42% and PPC is 3-5hr.
Tenofovir(Trustiva) volume of distribution is 1.2-1.3 L/kg and plasma protein binding is <1%, In Emtricitabine (Trustiva) independent of concentration and protein binding is <4%. Efavirenz (Trustiva) is distributed in CSF, enter into breast milk and protein bound is 99%
Tenofovir Disoproxil Fumarate (Trustiva), that hydrolyzed to Tenofovir, finally cellular enzymes phosphorylated to form Tenofovir diphosphate, an restrict chain terminator. In Emtricitabine (Trustiva) is limited metabolism. while in Efavirenz (Trustiva) mainly metabolized inCYP3A4 and CYP2B and isoenzyme to inactive hydroxyl metabolite.
Tenofovir (Trustiva) excreted through urine by active glomerular filtration and tubular secretion and half-life is 18hr. Emtricitabine (Trustiva) eliminated highly unchanged in urine and low limit in faces, half-life is 10hr. In Efavirenz (Trustiva) excreted via urine (14-34%) and faces is 16-61% while terminal half-life is 52-76hr(single dose) and 40-55hr (multiple dose).
Trustiva Dosage and administration
In adult Trustiva medicine should administrated at bedtime, one tablet orally in an empty stomach. In children, safety and efficacy of drug is not recommended at age <18yrs.
Lactic acidosis, severe hepatomegaly with steatosis
Nephritis, Nephrogenic, diabetes insipidus, renal failure
Anorexia, abdominal distention, diarrhea, dyspepsia, flatulence
vertigo, fatigue, raised liver enzyme, arthralgia,rhabdomyolysis, osteomalacia.
Patient with hepatomegaly or other serious factors for liver disease, Renal impairment, Pregnancy.
Patient Counseling: This drug may cause dizziness, if affected, do not drive or operate machinery.
Monitoring Parameters: Check the renal function and serum phosphate concentrations before start of the treatment, 4 weekly during the 1st week, and then 3 monthly. Hepatic function for several months following discontinuation. Determine HIV status in all hepatitis B virus (HBV) infected patients before the treatment.