Recommended Dosing for Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate) for PrEP
The recommended dosing for Truvada as Pre-Exposure Prophylaxis (PrEP) is one tablet daily containing tenofovir disoproxil fumarate 300 mg plus emtricitabine 200 mg. 1
Dosing Regimen Details
- Standard Daily Regimen: One tablet of Truvada (TDF 300 mg/FTC 200 mg) taken orally once daily 2, 1
- Duration of Prescription: Generally prescribe no more than a 90-day supply, renewable only after confirming negative HIV status 2
- Administration: Can be taken with or without food 3
Alternative Dosing Options
- Event-driven (2-1-1) dosing: May be considered for men who have sex with men (MSM) with infrequent sexual exposures:
- 2 pills 2-24 hours before sex
- 1 pill 24 hours after the first dose
- 1 pill 24 hours later 1
Required Monitoring
Before Starting PrEP
- Negative HIV antibody test (mandatory) 2, 1
- Creatinine clearance ≥60 mL/min (Cockcroft-Gault formula) 2, 1
- Hepatitis B screening 2, 1
- STI screening 2, 1
- Pregnancy test for women 2
While on PrEP
- HIV testing every 2-3 months 2, 1
- Creatinine level check at 3 months after initiation, then every 6 months 2, 1
- STI screening every 6 months (or more frequently if symptomatic) 2, 1
- Pregnancy testing at each visit for women 2, 1
- Adherence assessment at each follow-up visit 2
Adherence Requirements
Adherence is crucial for PrEP efficacy:
- MSM and transgender women: At least 4 of 7 doses per week
- Cisgender women, people who inject drugs, and heterosexual men: At least 6 of 7 doses per week 1
Duration of Use After Last Exposure
Truvada should be continued for at least 7 days after the last potential HIV exposure 1
Important Considerations and Precautions
Contraindications
- Active HIV infection
- Creatinine clearance <60 mL/min 1
Relative Contraindications
- Osteopenia or osteoporosis
- Chronic hepatitis B virus infection (requires careful monitoring) 1
Drug Interactions
- Avoid medications eliminated by tubular secretion 4
- No significant interactions with drugs metabolized by cytochrome P450 4
Clinical Pearls
- PrEP should be delivered as part of a comprehensive prevention package including risk-reduction counseling and condom provision 2
- Never start PrEP if acute HIV infection is suspected without ruling it out with appropriate testing, as this could lead to resistance development 1
- For patients with active hepatitis B, discontinuing Truvada requires careful monitoring due to risk of hepatic flares 1
- The efficacy of PrEP is directly related to adherence - emphasize this with all patients 1
By following these dosing and monitoring guidelines, Truvada can be an effective component of HIV prevention strategies for high-risk individuals.