Evipler
Eviplera: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Eviplera
ATX code: J05AR08
Active ingredient: emtricitabine (emtricitabine) + rilpivirine (rilpivirine) + tenofovir (tenofovir)
Producer: Gilead Science International Limited (Ireland), Pateon Inc. (Canada)
Description and photo update: 2018-27-11
Prices in pharmacies: from 22,700 rubles.
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Eviplera is a combined antiviral drug.
Release form and composition
The drug is available in the form of film-coated tablets: from pink with a violet tint to light pink, capsule-like, engraved with “GSI” on one side, the tablet core is white (30 pcs. In polyethylene bottles, in a cardboard box 1 bottle and instructions for use of Eviplera).
1 tablet contains:
- active ingredients: emtricitabine - 200 mg, rilpivirine hydrochloride - 27.5 mg (equivalent to 25 mg of rilpivirine), tenofovir - 300 mg;
- auxiliary components: lactose monohydrate, polysorbate, microcrystalline cellulose, povidone, pregelatinized starch, magnesium stearate, croscarmellose sodium;
- shell composition: lactose monohydrate, hypromellose (2910 6 mPa.s), macrogol, titanium dioxide (E171), iron oxide red dye (E172), indigo carmine dye aluminum varnish (E132), sunset dye yellow aluminum varnish (E110), triacetin …
Pharmacological properties
Pharmacodynamics
Eviplera is a fixed-dose combination antiviral drug rilpivirine, tenofovir, and emtricitabine. The mechanism of action of the drug is due to the properties of each of the active substances, which in cell culture are manifested by synergism of activity.
Rilpivirine is a diarylpyrimidine non-nucleoside non-competitive inhibitor of HIV reverse transcriptase (human immunodeficiency virus) -1, which determines its activity.
Emtricitabine is a nucleoside analogue of cytidine. Tenofovir, formed as a result of biotransformation of tenofovir disoproxil fumarate, is an analogue of the nucleoside monophosphate (nucleotide) of adenosine monophosphate. Emtricitabine and tenofovir have specific activity against hepatitis B virus, HIV-1 and HIV-2. After phosphorylation by cellular enzymes, emtricitabine is converted to emtricitabine triphosphate and tenofovir to tenofovir diphosphate. It was found that the simultaneous presence in the cell does not interfere with the full degree of their phosphorylation. Inhibition of HIV-1 reverse transcriptase with tenofovir diphosphate and emtricitabine triphosphate is carried out by a competitive mechanism and leads to termination or arrest of the synthesis of the viral DNA chain (deoxyribonucleic acid).
Emtricitabine triphosphate and tenofovir diphosphate are weak inhibitors of DNA polymerase; there is no evidence of their toxicity to mitochondria. Rilpivirine does not inhibit cellular alpha and beta DNA polymerase and mitochondrial gamma DNA polymerase.
With regard to clinical and laboratory HIV-1 isolates, the antiviral effect of emtricitabine was evaluated on peripheral blood mononuclear cells, lymphoblastoid cell lines, and MAGI-CCR5 cell lines. The 50% effective concentration (EC 50) of emtricitabine was in the range of 0.0013-0.64 µmol.
With regard to subtypes A, B, C, D, E, F, G of HIV-1, the antiviral activity of emtricitabine in cell culture is manifested in the range of 50% effective concentration (EC 50) 0.007-0.075 μmol. In addition, it was found that it exhibits specific activity against HIV-2 strains (the range of EC 50 values is 0.007–1.5 μmol).
In the study of emtricitabine in combination with abacavir, didanosine, stavudine, tenofovir, lamivudine and zidovudine (nucleoside reverse transcriptase inhibitors, or NRTIs), delavirdine, efavirenz, nevirapine and rilpivirin (non-nucleoside reverse transcriptase inhibitors, or NRTIs) with saquinavir (protease inhibitors), synergistic or additive effects have been observed.
The antiviral activity of rilpivirin is manifested against laboratory wild-type HIV-1 strains on an acutely infected T-cell line with a median HIV-1 / IIIB EC 50 of 0.27 ng / ml or 0.73 nmol. In addition, it is active against a wide range of primary isolates of group M HIV-1 strains (subtypes A, B, C, D, F, G, H) with EC 50 values in the range of 0.07–1.01 nmol or 0, 03–0.37 ng / ml and primary isolates of group O with EC 50 values of 2.88–8.45 nmol or 1.06–3.1 ng / ml.
Evaluation of the antiviral activity of tenofovir against laboratory and clinical HIV-1 isolates was carried out on lymphoblastoid cell lines (mainly macrophages or monocytes) and on peripheral blood lymphocytes. Its EC 50 values were in the range of 0.04–8.5 μmol.
In cell culture, the antiviral activity of tenofovir against subtypes A, B, C, D, E, F, G and O of HIV-1 was manifested in the range of EC 50 values from 0.5 to 2.2 μmol. In relation to strains of HIV-2, it demonstrates specific activity with an EC 50 value range of 1.6–5.5 µmol.
An additive or synergistic effect is observed when tenofovir is combined with NRTIs (emtricitabine, lamivudine, abacavir, didanosine, stavudine, zidovudine), NNRTIs (nevirapine, delavirdine, efavirenz, rilpivirine), and protease inhibitors (amprenavir, sirfacin.
According to the results obtained as a result of in vitro and in vivo studies, the activity of Eviplera in patients who have not previously received antiretroviral therapy may be influenced by the following mutations identified before treatment: E138A, E138Q, E138R, E138G, E138K, K101E, K65R, K101P, V179L, Y181I, Y181V, Y181C, M184V, MI841, M230I, M230L, H221Y, F227C. These resistance-related mutations have only been found in untreated patients, so antiretroviral therapy cannot be used to predict drug activity in virologically ineffective patients.
Treatment should be accompanied by a study of genotypic resistance.
Against the background of HIV-1 resistance to rilpivirine, the development of cross-resistance to emtricitabine or tenofovir, and vice versa, is not observed.
Pharmacokinetics
After taking the tablet by mouth during meals, the maximum concentration (C max) in plasma of emtricitabine is reached within 2.5 hours, tenofovir - 2 hours, rilpivirine - 4-5 hours. Tenofovir disoproxil fumarate is rapidly absorbed and converted to tenofovir, and its bioavailability is enhanced by concomitant intake of fat-rich foods. The absolute bioavailability of emtricitabine is approximately 93%. The exposure of rilpivirin when taking Eviplera on an empty stomach is approximately 40% lower than when taken with food, and by 50% than when taken with only a protein-rich drink. Therefore, in order to achieve an optimal level of absorption, the drug must be taken with food.
Plasma protein binding: emtricitabine - less than 4%, rilpivirine - about 99.7%, tenofovir - less than 0.7%.
Metabolism of emtricitabine occurs in part: about 9% of the dose - by oxidation of the thiol group and the formation of 3'-sulfoxide diastereomers and about 4% of the dose - by conjugation with glucuronic acid and the formation of 2'-O-glucuronide. Emtricitabine does not inhibit the enzyme responsible for glucuronidation, uridine-5-diphosphoglucuronyl transferase.
Rilpivirine hydrochloride mainly undergoes oxidative metabolism, which is mediated by the enzyme system of the cytochrome P 450 isoenzyme (CYP3A).
Tenofovir disoproxil fumarate and tenofovir are not substrates for CYP450 isoenzymes. Emtricitabine and tenofovir do not inhibit drug metabolism involving the major isoenzymes of CYP450.
Excretion of emtricitabine occurs mainly through the kidneys - about 86% (of which 13% are in the form of three metabolites), part is excreted through the intestines - about 14%. The systemic clearance of emtricitabine averages 307 ml / min, the half-life (T 1/2) is 10 hours.
On average, 25% of the taken dose of rilpivirin is excreted unchanged through the intestine. Insignificant (less than 1% of the dose) concentrations of rilpivirine are found in urine. Its final T 1/2 is 45 hours.
Tenofovir is mainly eliminated through the kidneys by filtration and by an active tubular transport system. The apparent clearance of tenofovir is 307 ml / min. Renal clearance should be approximately 210 ml / min, which is higher than the glomerular filtration rate. T 1/2 tenofovir is 12-18 hours.
Rilpivirine has no clinically significant differences in pharmacokinetic parameters in men and women, in patients with different ethnic origins, or between the ages of 18 and 78 years.
There are no recommendations for dosing Eviplera for children.
In patients over the age of 65, the efficacy and safety of the drug have not been established, therefore, patients in this group are advised to exercise caution when taking the drug.
The possibility of using Eviplera once a day in patients with mild renal impairment [creatinine clearance (CC) 50–80 ml / min] is based on limited clinical trial data. Therefore, its use is indicated only in cases where the potential benefit of therapy outweighs the possible risk.
With moderate or severe renal impairment (CC below 50 ml / min), Eviplera is contraindicated.
In case of moderate liver dysfunction, dose adjustment is not required. The use of the drug is contraindicated in severe hepatic failure.
Antiretroviral therapy in patients with chronic hepatitis B or C is associated with a high risk of developing severe adverse reactions, including death, associated with impaired liver function.
The safety and effectiveness of Eviplera in the treatment of chronic hepatitis B have not been established. In a study of emtricitabine and tenofovir (monotherapy or in combination), their activity against hepatitis B virus was established.
The results of population pharmacokinetic analysis indicate no significant effect on the level of exposure to rilpivirine in patients with co-infection with hepatitis B and / or C virus.
Indications for use
The use of Eviplera is indicated as a first-line therapy for HIV-1 infection in adult patients whose HIV-1 RNA (ribonucleic acid) values are within no more than 100,000 copies per ml.
Contraindications
- severe liver dysfunction (Child-Pugh class C);
- moderate and severe renal dysfunction (CC less than 50 ml / min);
- lactase deficiency, glucose-galactose malabsorption syndrome, lactose intolerance;
- concomitant use of medicines containing rilpivirine hydrochloride, tenofovir disoproxil fumarate or emtricitabine;
- concomitant therapy with the following drugs or soon after its withdrawal: NNRTIs, anticonvulsants (oxcarbazepine, carbamazepine, phenobarbital, or phenytoin), dexamethasone (systemic glucocorticosteroid), anti-tuberculosis drugs (rifampicin, rifapentin, inhibitori omrazone) esomeprazole, rabeprazole, pantoprazole), didanosine, St. John's wort, adefovir dipivoxil, nephrotoxic drugs (vancomycin, foscarnet, aminoglycosides, ganciclovir, amphotericin B, pentamidine, cidofovir, or interleuidleutidine-2) (cidofovir-2 analogs);
- breast-feeding;
- age up to 18 years;
- hypersensitivity to the components of the drug.
Care must be taken when assigning Eviplera tablets patients with moderately impaired liver function (class B classification Child - Pugh) with impaired renal function (creatinine clearance of 50-80 ml / min), while the use of blockers of H 2 histamine receptors, antacids (including aluminum or magnesium hydroxide, calcium carbonate), inhibitors of P 450 isoenzymes, P-glycoprotein substrates (metformin, dabigatran, digoxin), drugs that promote the development of polymorphic ventricular tachycardia of the "pirouette" type, over the age of 65 years.
During pregnancy, the use of the drug is contraindicated, except in cases where the expected therapeutic effect for the mother, according to the doctor, exceeds the possible threat to the fetus.
Eviplera, instructions for use: method and dosage
Eviplera should be treated by a physician experienced in HIV therapy.
The tablets are taken orally, swallowed whole, with meals. Violation of the integrity of the film membrane can affect the absorption of the drug.
Recommended dosage: 1 pc. per day at the set time.
If, within 4 hours after taking the pill, the patient has vomiting, then taking Eviplera with food should be repeated. If vomiting occurs more than 4 hours after taking the drug, then there is no need to take a reimbursement dose.
If you are late in taking the next dose up to 12 hours, the tablet should be taken with food as soon as possible and the usual dosing regimen should be continued. If the delay is more than 12 hours, then the next pill must be taken at the usual time.
If a change in the dose of one of the components or the cancellation of Eviplera is required, the patient should be transferred to monotherapy with individual dosage forms of emtricitabine, rilpivirine hydrochloride or tenofovir disoproxil fumarate.
When discontinuing the drug in HIV-infected patients with concomitant hepatitis B, careful monitoring of their condition is required to detect signs of exacerbation of hepatitis.
Side effects
- from the nervous system: very often - headache, dizziness; often - drowsiness;
- on the part of the lymphatic system and blood: often - a decrease in the level of hemoglobin concentration, neutropenia, a decrease in the number of leukocytes, a decrease in the number of platelets; infrequently - anemia;
- on the part of metabolism and nutrition: very often - an increase in the level of total cholesterol concentration (on an empty stomach), an increase in the content of low density lipoproteins (LDL) (on an empty stomach), hypophosphatemia (in the form of a complication of proximal tubulopathy); often - decreased appetite, hyperglycemia, increased triglyceride concentration, hypertriglyceridemia; infrequently - hypokalemia; rarely - lactic acidosis;
- on the part of the musculoskeletal system and connective tissue: very often - an increase in the activity of creatine kinase; infrequently - rhabdomyolysis, muscle weakness; rarely - osteomalacia (sometimes contributes to the appearance of fractures, symptoms - bone pain), myopathy;
- mental disorders: often - sleep disturbance, insomnia, depressed mood, unusual dreams, depression;
- from the gastrointestinal tract: very often - nausea, vomiting, diarrhea, increased activity of pancreatic amylase; often - pain and / or discomfort in the abdomen, dry mouth, dyspepsia, bloating, flatulence, increased amylase activity, increased serum lipase activity; infrequently - pancreatitis;
- from the hepatobiliary system: very often - an increase in the activity of alanine aminotransferase (ALT) and / or aspartate aminotransferase (AST); often - increased concentration of bilirubin, hyperbilirubinemia; rarely - hepatitis, fatty liver;
- from the immune system: often - allergic reactions; infrequently - immune recovery syndrome;
- from the skin and subcutaneous tissues: very often - a rash; often - itching, pustular rash, vesicular-bullous rash, maculopapular rash, urticaria, increased pigmentation (discoloration of the skin); infrequently - angioedema;
- from the urinary system: infrequently - increased creatinine levels, proteinuria; rarely - acute and chronic renal failure, Fanconi syndrome, proximal tubulopathy, acute tubular necrosis, nephritis, nephrogenic diabetes insipidus, acute interstitial nephritis;
- on the part of the body as a whole: very often - asthenia; often - fatigue, pain.
Overdose
Symptoms: signs of toxicity.
Treatment: the appointment of standard supportive therapy. There is no specific antidote, therefore, the patient's clinical condition must be carefully monitored, which includes monitoring the basic functional parameters of the body and the length of the QT interval on the electrocardiogram (ECG). The use of hemodialysis is ineffective, since it removes up to 30% of emtricitabine, about 10% of tenofovir, and does not remove rilpivirine due to the high bond of the latter with plasma proteins (for this purpose, activated charcoal can be used). There is no data on the possibility of elimination of tenofovir and emtricitabine using peritoneal dialysis.
special instructions
Patients should be informed that Eviplera does not cure HIV or prevent HIV infection through sexual contact or blood. Therefore, they must comply with the measures necessary to prevent HIV infection.
Antiretroviral drug should be prescribed after a preliminary analysis of genotypic resistance.
Eviplera has not been evaluated in patients with a history of virologic failure from antiretroviral therapy. It is not recommended to use the drug in case of HIV-1 infection with a mutation in the K65R codon. The list of mutations associated with rilpivirine should only be followed when prescribing the drug as first-line therapy.
When using a combination of emtricitabine + tenofovir + rilpivirine in patients with an indicator at the time of initiation of HIV-1 RNA therapy above 100,000 copies per ml, virological response is more often absent and resistance to NNRTI drugs is formed.
Effect on cardiovascular system provides high doses of rilpivirine, and its daily dose of 25 mg clinically significant effect on the length of the interval QT c on the ECG is not observed. Caution is required if it is necessary to combine Eviplera with drugs that can cause ventricular tachycardia of the "pirouette" type.
Before starting treatment, it is recommended to assess the QC and monthly during the first 12 months of therapy to examine renal function (including the concentration of phosphates in plasma and QC). Further, the check is carried out 1 time in 3 months. In patients with an increased risk of renal impairment who are on concomitant therapy with adefovir dipivoxil, monitoring of renal function should be performed more frequently. If, against the background of Eviplera's use, the serum phosphate level is less than 1.5 mg / dL or 0.48 mmol / L, and the CC is less than 50 ml / min, then a re-assessment of the state of renal function is required within ¼ month. At the same time, the concentration of glucose in the blood and urine, the content of potassium in the blood are determined. If it is necessary to change the dosage intervals or to cancel individual components of the drug in patients with a confirmed CC below 50 ml / min or a serum phosphate concentration of less than 1 mg / dL (0.32 mmol / L), the drug is discontinued. The patient is transferred to monotherapy with individual dosage forms of the active components of Eviplera.
If you suspect the development of bone disorders, you should consult a doctor.
Due to the high risk of severe exacerbation of hepatitis after discontinuation of Eviplera in patients with HIV infection and concomitant hepatitis B, close monitoring of their clinical and laboratory parameters is required for several months after stopping treatment. If such an exacerbation occurs, the decision to resume treatment for hepatitis B is considered reasonable. If the patient has severe liver disease or cirrhosis, it is not recommended to discontinue therapy, since exacerbation of hepatitis due to drug withdrawal may lead to decompensation.
With a history of liver dysfunction, an increased incidence of liver dysfunction was noted with the use of combined antiretroviral therapy. In this regard, the treatment of such patients should be accompanied by careful observation, in case of signs of deterioration in liver function, taking Eviplera should be suspended or completely canceled.
The use of nucleoside analogs can cause the development of lactic acidosis with concomitant fatty liver infiltration. Symptomatic hyperlactatemia can include nausea, vomiting and / or abdominal pain, loss of appetite, malaise, loss of body weight, as well as symptoms of respiratory disorders (in the form of rapid and / or deep breathing) and neurological symptoms (including muscle weakness). Lactic acidosis usually occurs after several months of therapy and is associated with a high mortality rate. With the development of symptomatic hyperlactatemia, progressive hepatomegaly or rapidly increasing aminotransferase activity, Eviplera should be discontinued.
Nucleoside analogs should be used with caution in hepatomegaly, hepatitis, concomitant therapy with alpha interferon and ribavirin, and other known risk factors.
Against the background of combined antiretroviral therapy, lipodystrophy or redistribution of subcutaneous fatty tissue (SFA) may occur. The risk of developing lipodystrophy increases with such individual factors as old age and metabolic disorders caused by prolonged use of antiretroviral drugs. In this regard, the clinical examination of the patient should include an assessment of physical signs of redistribution of subcutaneous fat, monitoring of blood glucose concentration and fasting serum lipid levels. Treatment of lipid disorders is carried out taking into account clinical indications.
The ability of nucleosides and their analogues to cause various degrees of mitochondrial disorders has been established. The main adverse reactions include hematological disorders (in the form of anemia, neutropenia) and metabolic disorders (in the form of hyperlactatemia, hyperlipasemia). They are often transitory. Mitochondrial abnormalities have been reported in HIV-negative infants exposed to nucleoside analogs in utero and / or postnatally. Therefore, these children (including HIV-negative newborns) should be closely monitored for mitochondrial changes when symptoms appear.
During the first month after starting antiretroviral therapy, HIV-infected patients with severe immunodeficiency may develop an inflammatory response to the presence of asymptomatic opportunistic infections in the form of the appearance or exacerbation of a previously asymptomatic disease (cytomegalovirus retinitis, focal and / or generalized mycobacterial infections, pneumocystis pneumonia). This condition is called immune reconstitution syndrome and requires timely treatment.
If you experience joint pain or aches, stiffness, or difficulty moving with antiretroviral combination therapy, you should see your doctor.
Influence on the ability to drive vehicles and complex mechanisms
Due to the possibility of such undesirable phenomena as drowsiness, fatigue and / or dizziness, during the period of application of Eviplera, it is recommended to be careful and individually assess the ability to drive vehicles and work with complex mechanisms.
Application during pregnancy and lactation
During gestation, the use of Eviplera is possible only in cases where the expected therapeutic effect for the mother, in the opinion of the doctor, exceeds the possible threat to the fetus.
Breastfeeding is contraindicated for HIV-infected women, including while taking Eviplera.
The effect of the drug on fertility has not been established.
During the period of treatment, men and women are advised to use effective contraception.
Pediatric use
The appointment of Evipler tablets for the treatment of children under the age of 18 is contraindicated.
With impaired renal function
The use of Eviplera is contraindicated for the treatment of patients with moderate and severe renal impairment (CC less than 50 ml / min).
For violations of liver function
The use of Eviplera is contraindicated for the treatment of patients with severe hepatic insufficiency (class C on the Child-Pugh scale).
It is recommended to prescribe a combination drug with caution in case of mild to moderate liver failure (classes A and B on the Child-Pugh scale), the need for dose adjustment is unlikely.
Use in the elderly
Eviplera should be used with caution to treat elderly patients.
Drug interactions
Special studies on the subject of drug interactions Eviplera have not been carried out, therefore, when combining the drug with other drugs, it is recommended to be guided by information on drug interactions of emtricitabine, rilpivirine hydrochloride and tenofovir disoproxil fumarate.
Drugs that inhibit or induce the activity of the CYP3A isoenzyme affect the clearance of rilpivirine. Inducers of CYP3A isoenzymes can cause a clinically significant decrease in plasma levels and reduce the therapeutic effect of Eviplera.
Proton pump inhibitors cause an increase in gastric acidity, which can lead to a significant decrease in plasma rilpivirine concentration.
With the simultaneous use of tenofovir disoproxil fumarate and didanosine, the systemic action of didanosine increases by 40-60%, which can lead to the development of pancreatitis, lactic acidosis and other undesirable reactions, including fatal ones. Therefore, the combined use of Eviplera and didanosine is contraindicated.
Do not use the drug in combination with adefovir dipivoxil, lamivudine, and other cytidine analogues.
Since tenofovir and emtricitabine are predominantly excreted by the kidneys, concomitant therapy with drugs that compete for active tubular secretion or reduce renal function should not be prescribed. This is associated with the existing risk of a significant increase in serum concentration of tenofovir, emtricitabine and / or co-administered agents.
In vitro studies have shown inhibition of P-glycoprotein activity by rilpivirin, which can negatively affect the metabolism of drugs transported by P-glycoproteins in the intestine and cause an increase in their plasma concentration.
In connection with the inhibition of active tubular secretion of creatinine in the kidneys by rilpivirine, an increase in the exposure of metformin in the blood is possible.
With the simultaneous use of protease inhibitors (atazanavir, darunavir, lopinavir), boosted by a low dose of ritonavir, the plasma concentration of rilpivirine increases.
When Eviplera is combined with antagonists of the CCR5 receptor (CC-receptor of chemokine 5), integrase inhibitors, ribavirin, no clinically significant interaction is expected.
Concomitant use with telaprevir can cause an increase in the plasma concentration of rilpivirine, which does not require dose adjustment.
Concomitant therapy with azole antifungal agents (ketoconazole, posaconazole, fluconazole, itraconazole, voriconazole) may increase the plasma concentration of rilpivirine; dose adjustment of Eviplera is not required.
Antimycobacterial agents (rifabutin, rifampicin), when combined with Eviplera, cause a clinically significant decrease in the plasma concentration of rilpivirine, so their combination should not be used.
The simultaneous use of the drug with macrolide antibiotics (erythromycin, clarithromycin, troleandomycin) is not recommended. Azithromycin or other alternatives can be taken as needed.
Anticonvulsants, proton pump inhibitors cause a decrease in the antiviral activity of Eviplera.
Antagonists of H2 -receptors (famotidine, cimetidine, nizatidine, ranitidine) and antacids cause an increase in gastric acidity, which leads to a decrease in absorption and a significant decrease in rilpivirine plasma levels. Therefore, if necessary, their simultaneous appointment should be used only those forms that are applied once a day. In this case, Eviplera should be taken 4 hours before or 12 hours after taking H 2 receptor antagonists or antacids.
When combined with methadone (in a daily dose of 60–100 mg), dose adjustment is not required, the maintenance dose of methadone is set taking into account the patient's clinical condition.
With the simultaneous use of non-narcotic analgesics (paracetamol), the use of oral contraceptives (ethinylestradiol, norethindrone), dose adjustment of Eviplera is not required.
Concomitant therapy with digoxin (an antiarrhythmic agent), dabigatran (an anticoagulant), or metformin (a hypoglycemic agent) may be accompanied by an increase in plasma levels of digoxin, dabigatran, or metformin due to inhibition of P-glycoprotein in the intestine. In this regard, it is required to control their content in the blood. It is recommended to carefully monitor the patient's condition at the beginning of metformin therapy and after its end.
When combined with drugs based on St. John's wort (Hypericum perforatum), there is a high risk of a clinically significant decrease in plasma concentration of rilpivirine.
Inhibitors of hydroxymethylglutaryl coenzyme A-reductase (HMG-CoA reductase) and phosphodiesterase-5 (PDE-5) inhibitors do not require dose adjustment of Eviplera.
Analogs
The analogues of Eviplera are: Atripla, Abakavir, Kivexa, Lamivudin-Teva, Duovir-N, Maktrivir, Trizivir, Combivir, Truvada, Zidolam-N, Tenvir-Em, Tenohop-E and others.
Terms and conditions of storage
Keep out of the reach of children.
Store at temperatures up to 30 ° C.
Shelf life is 2 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Evipler
Reviews about Evipler, which would assess the effectiveness of the drug by patients, are practically absent. Experts note a low virological activity, a high probability of damage to kidney function and the risk of osteoporosis, especially in women.
The disadvantages include the high cost of the drug.
Price for Eviplera in pharmacies
The price of Eviplera for a pack containing 30 tablets can range from 26,777 rubles.
Eviplera: prices in online pharmacies
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Drug name Price Pharmacy |
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Eviplera 200 mg + 25 mg + 300 mg film-coated tablets 30 pcs. RUB 22,700 Buy |
Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
