H

H₂ Antagonists

USES

Short-term treatment of duodenal ulcer (DU), active benign gastric ulcer (GU), maintenance therapy of DU, pathologic hypersecretory conditions (e.g., Zollinger-Ellison syndrome), gastroesophageal reflux disease (GERD), and prevention of upper GI bleeding in critically ill pts.

ACTION

Inhibit gastric acid secretion by interfering with histamine at the histamine H₂ receptors in parietal cells. Also inhibit acid secretion caused by gastrin. Inhibition occurs with basal (fasting), nocturnal, food-stimulated, or fundic distention secretion. H₂ antagonists decrease both the volume and H₂ concentration of gastric juices.

H₂ ANTAGONISTS

Name	Availability	Dosage Range	Side Effects
Cimetidine (Tagamet)	T: 200 mg, 300 mg, 400 mg, 800 mg L: 300 mg/5 ml	Treatment of DU: 800 mg at bedtime, 400 mg 2 times/day or 300 mg 4 times/day Maintenance of DU: 400 mg at bedtime Treatment of GU: 800 mg at bedtime or 300 mg 4 times/day GERD: 400 mg 4 times/day or 800 mg 2 times/day Hypersecretory: 300 mg 4 times/day. Maximum: 2,400 mg/day	Headaches, fatigue, dizziness, confusion, diarrhea, gynecomastia
Famotidine (Pepcid)	T: 10 mg, 20 mg, 40 mg OS: 40 mg/5 ml I: 10 mg/ml	Treatment of DU: 40 mg/day in 1 or 2 divided doses Maintenance of DU: 20 mg/day Treatment of GU: 40 mg/day at bedtime GERD: 20 mg 2 times/day for 6 wks Hypersecretory: Initially, 20 mg q6h. May increase up to 160 mg q6h	Headaches, dizziness, diarrhea, constipation, abdominal pain, tinnitus
Nizatidine (Axid)	OS: 15 mg/ml C: 75 mg, 150 mg, 300 mg	Treatment of GU: 300 mg at hs or 150 mg 2 times/day GERD: 150 mg 2 times/day Treatment of DU: 300 mg at hs or 150 mg 2 times/day Maintenance of DU: 150 mg/day at bedtime	Fatigue, urticaria, abdominal pain, constipation, nausea
Ranitidine (Zantac)	T: 75 mg, 150 mg, 300 mg C: 150 mg, 300 mg Syrup: 15 mg/ml I: 25 mg/ml	Treatment of DU: 300 mg at hs or 150 mg 2 times/day Maintenance of DU: 150 mg/day at bedtime Treatment of GU: 150 mg 2 times/day GERD: 150 mg 2 times/day Hypersecretory: 150 mg 2 times/day. Maximum: 6 g/day Erosive Esophagitis: Treatment: 150 mg 4 times/day. Maintenance: 150 mg 2 times/day	Blurred vision, constipation, nausea, abdominal pain

C, Capsules; DT, disintegrating tablets; DU, duodenal ulcer; GERD, gastroesophageal reflux disease; GU, gastric ulcer; I, injection; L, liquid; OS, oral suspension; T, tablets.

Hepatitis C Virus

Hepatitis C virus (HCV) is the leading blood borne infection in the US. HCV is transmitted by exposure to infected blood products. Risk factors for acquiring HCV include injection drug use, receiving contaminated blood products, needle sticks, and vertical transmission. If untreated, HCV may progress to chronic HCV and long-term sequelae including cirrhosis and hepatocellular carcinoma. There are seven known genotypes of HCV (genotypes 1-7) which impact the selection of initial therapy and treatment response. Genotype 1 is the most common and is further subtyped into genotypes 1a and 1b.

Currently, there are two indirect-acting antivirals and seven direct-acting antivirals approved for the treatment of chronic HCV.

ACTION

Indirect Acting Antivirals (IAA)

Alpha Interferons (peg-interferons): Induces immune response against HCV, inhibiting viral replication

Ribavirin: Exact mechanism unknown but has activity against several RNA and DNA viruses

Direct Acting Antivirals (DAA)

NS3/4A Protease Inhibitors (PIs): Targets the serine protease NS3/NS4 that is responsible for processing HCV polyprotein and producing new viruses.

Nonstructural Protein 5A (NS5A) Inhibitors: Suppress the NS5A protein, that is essential for viral assembly and replication.

Nonstructural Protein 5B (NS5B) Inhibitors: Suppress the NS5B RNA-dependent RNA polymerase that is responsible for HCV replication.

ANTI-HEPATITIS C VIRUS PREPARATIONS

Name	Type	Genotype	Dosage	Side Effects
Elbasvir, grazoprevir (Zepatier)	DAA NS5A/NS3/4A protease inhibitor	1, 4	Genotype 1a: One tablet daily for 12 wks (16 wks with baseline NS5A polymorphins) Genotype 1b: One tablet daily for 12 wks Genotype 4: One tablet daily for 12 wks (16 wks peginterferon/ribavirin experienced)	Fatigue, headache, nausea
Simeprevir (Olysio)	DAA (NS3/4A-PI)	1, 4	150 mg once daily plus peginterferon and ribavirin for 12 wks, then additional 12–36 wks of peginterferon and ribavirin) 150 mg once daily plus sofosbuvir for 12 wks without cirrhosis or 24 wks with cirrhosis	(With peginterferon, ribavirin): rash, itching, nausea, photosensitivity (With sofosbuvir): fatigue, headache, nausea, insomnia, pruritus, rash, dizziness, diarrhea
Sofosbuvir (Sovaldi)	DAA (NS5B)	1, 2, 3, 4	Genotypes 1, 4: 400 mg once daily plus peginterferon and ribavirin for 12 wks 400 mg once daily plus simeprevir for 12 wks without cirrhosis or 24 wks with cirrhosis Genotypes 2, 3: 400 mg once daily plus ribavirin for 12 wks for genotype 2 or 24 wks for genotype 3	(With peginterferon, ribavirin):Fatigue, headache, nausea, insomnia, anemia (With simeprevir): fatigue, headache, nausea, insomnia, pruritus, rash, dizziness, diarrhea
Ledipasvir, Sofosbuvir (Harvoni)	DAA (NS5A/NS5B)	1, 4, 5, 6	Genotype 1: One tablet (90 mg/400 mg) for 12 wks in treatment-naïve pt with or without cirrhosis and treatment-experienced pt without cirrhosis; for 24 wks for treatment experienced pts with cirrhosis Genotypes 4, 5, 6: One tablet daily for 12 wks	Fatigue, headache, nausea, diarrhea, insomnia; elevations in bilirubin, lipase, and creatinine kinase
Ombitasvir, Paritaprevir, Ritonavir, Dasabuvir (Viekira Pak)	DAA (NS5A/protease inhibitor/CYP3A inhibitor/polymerase inhibitor)	1	Two ombitasvir, paritaprevir, ritonavir tablets (12.5 mg, 75 mg, 50 mg) once daily in the morning plus one dasabuvir 250 mg tablet 2 times/day Patients with genotype 1a or 1b with cirrhosis will also receive ribavirin for 12 wks (genotype 1a with cirrhosis: 12–24 wks based on treatment history; liver transplant pts: 24 wks)	(With ribavirin): fatigue, nausea, itching, insomnia (Without ribavirin): nausea, itching, insomnia
Peginterferon alfa 2a (Pegasys)	IAA (Interferon)	1, 2, 3, 4	180 mcg SQ wkly for 12–48 wks based on antiviral regimen, pt history, response	(With ribavirin): fatigue, weakness, fever, myalgia, headache
Peginterferon alfa 2b (PegIntron)	IAA (Interferon)	1, 2, 3, 4	1.5 mcg/kg SQ wkly for 12–48 wks based on antiviral regimen, pt history, response	(With ribavirin): injection site reaction, fatigue, weakness, headache, rigors, fever, nausea, myalgia, insomnia, mood instability, hair loss
Ribavirin (Copegus, Ribasphere)	IAA (Nucleoside analogue)	1, 2, 3, 4	Genotypes 2, 3 400 mg 2 times/day (with peginterferon) Genotypes 1, 4 < 75 kg: 400 mg qam and 600 mg qpm 75kg or greater: 600 mg 2 times/day	(With peginterferon): fatigue, weakness, headache, rigors, fever, nausea, myalgia, insomnia, mood instability, hair loss
Daclatasvir (Daklinza)	DAA (NS5A)	3	60 mg once daily with sofosbuvir for 12 wks	Headache, fatigue
Ombitasvir, paritaprevir, ritonavir (Technivie)	DAA (NS5A/protease Inhibitor/CYP3A inhibitor)	4	Two tablets once daily with ribavirin for 12 wks	Asthenia, fatigue, nausea, insomnia
Sofosbuvir/velpatasvir (Epclusa)	DAA (NS5B/NS5A)	1, 2, 3, 4, 5, 6	One tablet daily for 12 wks	Insomnia, anemia, headache, fatigue, nausea, diarrhea

Hormones

USES

Functions of the body are regulated by two major control systems: the nervous system and the endocrine (hormone) system. Together they maintain homeostasis and control different metabolic functions in the body.

Hormones are concerned with control of different metabolic functions in the body (e.g., rates of chemical reactions in cells, transporting substances through cell membranes, cellular metabolism [growth/secretions]). By definition, a hormone is a chemical substance secreted into body fluids by cells and has control over other cells in the body.

Hormones can be local or general:

• Local hormones have specific local effects (e.g., acetylcholine, which is secreted at parasympathetic and skeletal nerve endings).

• General hormones are mostly secreted by specific endocrine glands (e.g., epinephrine/norepinephrine are secreted by the adrenal medulla in response to sympathetic stimulation), transported in the blood to all parts of the body, causing many different reactions.

Some general hormones affect all or almost all cells of the body (e.g., thyroid hormone from the thyroid gland increases the rate of most chemical reactions in almost all cells of the body); other general hormones affect only specific tissue (e.g., ovarian hormones are specific to female sex organs and secondary sexual characteristics of the female).

ACTION

Endocrine hormones almost never directly act intracellularly affecting chemical reactions. They first combine with hormone receptors either on the cell surface or inside the cell (cell cytoplasm or nucleus). The combination of hormone and receptors alters the function of the receptor, and the receptor is the direct cause of the hormone effects. Altered receptor function may include the following:

Altered cell permeability, which causes a change in protein structure of the receptor, usually opening or closing a channel for one or more ions. The movement of these ions causes the effect of the hormone.

Activation of intracellular enzymes immediately inside the cell membrane (e.g., hormone combines with receptor that then becomes the activated enzyme adenyl cyclase, which causes formation of cAMP).

◀ ALERT ▶ cAMP has effects inside the cell. It is not the hormone but cAMP that causes these effects.

Regulation of hormone secretion is controlled by an internal control system, the negative feedback system:

• Endocrine gland oversecretes.

• Hormone exerts more and more of its effect.

• Target organ performs its function.

• Too much function in turn feeds back to endocrine gland to decrease secretory rate.

The endocrine system contains many glands and hormones. A summary of the important glands and their hormones secreted are as follows:

The pituitary gland (hypophysis) is a small gland found in the sella turcica at the base of the brain. The pituitary is divided into two portions physiologically: the anterior pituitary (adenohypophysis) and the posterior pituitary (neurohypophysis). Six important hormones are secreted from the anterior pituitary and two from the posterior pituitary.

Anterior pituitary hormones:

• Growth hormone (GH)

• Adrenocorticotropin (corticotropin)

• Thyroid-stimulating hormone (thyrotropin) (TSH)

• Follicle-stimulating hormone (FSH)

• Luteinizing hormone (LH)

• Prolactin

Posterior pituitary hormones:

• Antidiuretic hormone (vasopressin)

• Oxytocin

Almost all secretions of the pituitary hormones are controlled by hormonal or nervous signals from the hypothalamus. The hypothalamus is a center of information concerned with the well-being of the body, which in turn is used to control secretions of the important pituitary hormones just listed. Secretions from the posterior pituitary are controlled by nerve signals originating in the hypothalamus; anterior pituitary hormones are controlled by hormones secreted within the hypothalamus. These hormones are as follows:

• Thyrotropin-releasing hormone (TRH) releasing thyroid-stimulating hormone

• Corticotropin-releasing hormone (CRH) releasing adrenocorticotropin

• Growth hormone–releasing hormone (GHRH) releasing growth hormone and growth hormone inhibitory hormone (GHIH) (same as somatostatin)

• Gonadotropin-releasing hormone (GnRH) releasing the two gonadotropic hormones LH and FSH

• Prolactin inhibitory factor (PIF) causing inhibition of prolactin and prolactin-releasing factor

Anterior Pituitary Hormones

All anterior pituitary hormones (except growth hormone) have as their principal effect stimulating target glands.

Growth Hormone (GH)

Growth hormone affects almost all tissues of the body. GH (somatopropin) causes growth in almost all tissues of the body (increases cell size, increases mitosis with increased number of cells, and differentiates certain types of cells). Metabolic effects include increased rate of protein synthesis, mobilization of fatty acids from adipose tissue, decreased rate of glucose utilization.

Thyroid-Stimulating Hormone (TSH)

Thyroid-stimulating hormone controls secretion of the thyroid hormones. The thyroid gland is located immediately below the larynx on either side of and anterior to the trachea and secretes two significant hormones, thyroxine (T₄) and triiodothyroxine (T₃), which have a profound effect on increasing the metabolic rate of the body. The thyroid gland also secretes calcitonin, an important hormone for calcium metabolism. Calcitonin promotes deposition of calcium in the bones, which decreases calcium concentration in the extracellular fluid.

Adrenocorticotropin

Adrenocorticotropin causes the adrenal cortex to secrete adrenocortical hormones. The adrenal glands lie at the superior poles of the two kidneys. Each gland is composed of two distinct parts: the adrenal medulla and the cortex. The adrenal medulla, related to the sympathetic nervous system, secretes the hormones epinephrine and norepinephrine. When stimulated, they cause constriction of blood vessels, increased activity of the heart, inhibitory effects on the GI tract, and dilation of the pupils. The adrenal cortex secretes corticosteroids, of which there are two major types: mineralocorticoids and glucocorticoids. Aldosterone, the principal mineralocorticoid, primarily affects electrolytes of the extracellular fluids. Cortisol, the principal glucocorticoid, affects glucose, protein, and fat metabolism.

Luteinizing Hormone (LH)

Luteinizing hormone plays an important role in ovulation and causes secretion of female sex hormones by the ovaries and testosterone by the testes.

Follicle-Stimulating Hormone (FSH)

Follicle-stimulating hormone causes growth of follicles in the ovaries before ovulation and promotes formation of sperm in the testes.

Ovarian sex hormones are estrogens and progestins. Estradiol is the most important estrogen; progesterone is the most important progestin.

Estrogens mainly promote proliferation and growth of specific cells in the body and are responsible for development of most of the secondary sex characteristics. Primarily cause cellular proliferation and growth of tissues of sex organs/other tissue related to reproduction. Ovaries, fallopian tubes, uterus, vagina increase in size. Estrogen initiates growth of breast and milk-producing apparatus, external appearance.

Progesterone stimulates secretion of the uterine endometrium during the latter half of the female sexual cycle, preparing the uterus for implantation of the fertilized ovum. Decreases the frequency of uterine contractions (helps prevent expulsion of the implanted ovum). Progesterone promotes development of breasts, causing alveolar cells to proliferate, enlarge, and become secretory in nature.

Testosterone is secreted by the testes and formed by the interstitial cells of Leydig. Testosterone production increases under the stimulus of the anterior pituitary gonadotropic hormones. It is responsible for distinguishing characteristics of the masculine body (stimulates the growth of male sex organs and promotes the development of male secondary sex characteristics, e.g., distribution of body hair, effect on voice, protein formation, and muscular development).

Prolactin

Prolactin promotes the development of breasts and secretion of milk.

POSTERIOR PITUITARY HORMONES

Antidiuretic Hormone (ADH) (Vasopressin)

ADH can cause antidiuresis (decreased excretion of water by the kidneys). In the presence of ADH, the permeability of the renal-collecting ducts and tubules to water increases, which allows water to be absorbed, conserving water in the body. ADH in higher concentrations is a very potent vasoconstrictor, constricting arterioles everywhere in the body, increasing B/P.

Oxytocin

Oxytocin contracts the uterus during the birthing process, esp. toward the end of the pregnancy, helping expel the baby. Oxytocin also contracts myoepithelial cells in the breasts, causing milk to be expressed from the alveoli into the ducts so that the baby can obtain it by suckling.

PANCREAS

The pancreas is composed of two tissue types: acini (secrete digestive juices in the duodenum) and islets of Langerhans (secrete insulin/glucagons directly into the blood). The islets of Langerhans contain three cells: alpha, beta, and delta. Alpha cells secrete glucagon, beta cells secrete insulin, and delta cells secrete somatostatin.

Insulin promotes glucose entry into most cells, thus controlling the rate of metabolism of most carbohydrates. Insulin also affects fat metabolism.

Glucagon effects are opposite those of insulin, the most important of which is increasing blood glucose concentration by releasing it from the liver into the circulating body fluids.

Somatostatin (same chemical as secreted by the hypothalamus) has multiple inhibitory effects: depresses secretion of insulin and glucagon, decreases GI motility, decreases secretions/absorption of the GI tract.

Human Immunodeficiency Virus (HIV) Infection

USES

Antiretroviral agents are used in the treatment of HIV infection.

ACTION

Nucleoside reverse transcriptase inhibitors (NRTIs) compete with natural substrates for formation of proviral DNA by reverse transcriptase inhibiting viral replication.

Nucleotide reverse transcriptase inhibitors (NtRTIs) inhibit reverse transcriptase by competing with the natural substrate deoxyadenosine triphosphate and by DNA chain termination.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) directly bind to reverse transcriptase and block RNA-dependent and DNA-dependent DNA polymerase activities by disrupting the enzyme’s catalytic site.

Protease inhibitors (PIs) bind to the active site of HIV-1 protease and prevent the processing of viral gag and gag-pol polyprotein precursors resulting in immature, noninfectious viral particles.

Fusion inhibitors interfere with the entry of HIV-1 into cells by inhibiting fusion of viral and cellular membranes.

CCR5 co-receptor antagonist selectively binds to human chemokine receptor CCR5 present on cell membrane preventing HIV-1 from entering cells.

Integrase inhibitor inhibits catalytic activity of HIV-1 integrase, an HIV-1 encoded enzyme required for viral replication.

ANTIRETROVIRAL AGENTS FOR TREATMENT OF HIV INFECTION

Name	Availability	Dosage Range	Side Effects
Nucleoside Analogues
Abacavir (Ziagen)	T: 300 mg OS: 20 mg/ml	A: 300 mg 2 times/day or 600 mg once daily	Nausea, vomiting, malaise, rash, fever, headaches, asthenia, fatigue, hypersensitivity reactions
Didanosine (Videx EC)	DR: 125 mg, 200 mg, 250 mg, 400 mg OS: 2 g/bottle, 4 g/bottle	DR (weighing 60 kg or more): 400 mg once daily; (weighing 25–59 kg): 250 mg once daily; (weighing 20–24 kg): 200 mg once daily OS (weighing more than 60 kg): 200 mg q12h or 400 mg once daily; (weighing less than 60 kg): 125 mg q12h or 250 mg once daily	Peripheral neuropathy, pancreatitis, diarrhea, nausea, vomiting, headaches, insomnia, rash, hepatitis, seizures
Emtricitabine (Emtriva)	C: 200 mg OS: 10 mg/ml	A: 200 mg/day (C) 240 mg/day (OS)	Headaches, insomnia, depression, diarrhea, nausea, vomiting, rhinitis, asthenia, rash
Lamivudine (Epivir)	T: 100 mg, 150 mg, 300 mg OS: 5 mg/ml, 10 mg/ml	A: 150 mg 2 times/day or 300 mg once daily C: 4 mg/kg 2 times/day	Diarrhea, malaise, fatigue, headaches, nausea, vomiting, abdominal pain, peripheral neuropathy, arthralgia, myalgia, skin rash
Stavudine (Zerit)	C: 15 mg, 20 mg, 30 mg, 40 mg OS: 1 mg/ml	A (weighing more than 60 kg): 40 mg 2 times/day (20 mg 2 times/day if peripheral neuropathy occurs); (weighing 60 kg or less): 30 mg 2 times/day (15 mg 2 times/day if peripheral neuropathy occurs)	Peripheral neuropathy, anemia, leukopenia, neutropenia
Zidovudine (Retrovir)	C: 100 mg T: 300 mg Syrup: 50 mg/5 ml, 10 mg/ml	A: 300 mg 2 times/day	Anemia, granulocytopenia, myopathy, nausea, malaise, fatigue, insomnia
Nucleotide Analogues
Tenofovir TAF (Vemlidy)	T: 25 mg	A: 25 mg once daily	Headache, abdominal pain, fatigue, cough, nausea, back pain
Tenofovir TDF (Viread)	T: 300 mg	A: 300 mg once daily	Nausea, vomiting, diarrhea, headache, fatigue
Non-nucleoside Analogues
Delavirdine (Rescriptor)	T: 100 mg, 200 mg	A: 200 mg 3 times/day for 14 days, then 400 mg 3 times/day	Rash, nausea, headaches, elevated hepatic function tests
Efavirenz (Sustiva)	C: 50 mg, 200 mg T: 600 mg	A: 600 mg/day C: 200–600 mg/day based on weight	Headaches, dizziness, insomnia, fatigue, rash, nightmares
Etravirine (Intelence)	T: 100 mg, 200 mg	A: 200 mg 2 times/day	Skin reactions (e.g., Stevens-Johnson syndrome, erythema multiforme), nausea, abdominal pain, vomiting
Nevirapine (Viramune, Viramune XR)	T: 200 mg T (ER): 400 mg S: 50 mg/ml	A: 200 mg/day for 14 days, then (if no rash) 200 mg 2 times/day	Rash, nausea, fatigue, fever, headaches, abnormal hepatic function tests
Rilpivirine (Edurant)	T: 25 mg	A: 25 mg once daily with a meal	Depression, insomnia, headache, rash
Protease Inhibitors
Atazanavir (Reyataz)	C: 100 mg, 150 mg, 200 mg, 300 mg	A: 400 mg/day or 300 mg (with 100 mg ritonavir) once daily	Headaches, diarrhea, abdominal pain, nausea, rash
Darunavir (Prezista)	T: 400 mg, 600 mg	A: 600 mg 2 times/day (with ritonavir 100 mg) or 800 mg once daily with ritonavir 100 mg	Diarrhea, nausea, vomiting, headaches, skin rash, constipation
Fosamprenavir (Lexiva)	T: 700 mg OS: 50 mg/ml	A: 1,400–2,800 mg/day with 100 mg ritonavir	Headaches, fatigue, rash, nausea, diarrhea, vomiting, abdominal pain
Indinavir (Crixivan)	C: 200 mg, 400 mg	A: 800 mg q8h or 800 mg 2 times/day with ritonavir 100 mg	Nephrolithiasis, hyperbilirubinemia, abdominal pain, asthenia, fatigue, flank pain, nausea, vomiting, diarrhea, headaches, insomnia, dizziness, altered taste
Lopinavir/ritonavir (Kaletra)	C: 133/33 mg OS: 80/20 mg	A: 400 mg/100 mg 2 times/day or 800 mg/200 mg once daily C (4–12 yrs): 10–13 mg/kg 2 times/day	Diarrhea, nausea, vomiting, abdominal pain, headaches, rash
Nelfinavir (Viracept)	T: 250 mg Oral Powder: 50 mg/g	A: 750 mg q8h or 1,250 mg 2 times/day C: 20–25 mg/kg q8h	Diarrhea, fatigue, asthenia, headaches, hypertension, impaired concentration
Ritonavir (Norvir)	C: 100 mg OS: 80 mg/ml	A: Titrate up to 800 mg/day based on protease inhibitor	Nausea, vomiting, diarrhea, altered taste, fatigue, elevated LFT and triglyceride levels
Saquinavir (Invirase)	C: 200 mg T: 500 mg	A: 1,000 mg 2 times/day with ritonavir 100 mg	Diarrhea, elevated LFTs, hypertriglycerides, cholesterol, abnormal fat accumulation, hyperglycemia
Tipranavir (Aptivus)	C: 250 mg OS: 100 mg/ml	A: 500 mg (with 200 mg ritonavir) 2 times/day	Diarrhea, nausea, fatigue, headaches, vomiting
Fusion Inhibitors
Enfuvirtide (Fuzeon)	I: 108 mg (90 mg when reconstituted)	Subcutaneous: 90 mg 2 times/day	Insomnia, depression, peripheral neuropathy, decreased appetite, constipation, asthenia, cough
CCR5 Antagonists
Maraviroc (Selzentry)	T: 150 mg, 300 mg	A: 300 mg 2 times/day CYP3A4 inducers: 600 mg 2 times/day CYP3A4 inhibitors: 150 mg 2 times/day	Cough, pyrexia, upper respiratory tract infections, rash, musculoskeletal symptoms, abdominal pain, dizziness
Integrase Inhibitor
Raltegravir (Isentress)	T: 400 mg	A: 400 mg 2 times/day	Nausea, headache, diarrhea, pyrexia
Dolutegravir (Tivicay)	T: 50 mg	A: 50 mg once daily or 50 mg bid (with CYP3A inducers or resistance)	Insomnia, headache

A, Adults; C, capsules; C (dosage), children; DR, delayed-release; ER, extended-release; I, injection; OS, oral solution; S, suspension; T, tablets; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.

FIXED-COMBINATION THERAPIES

Brand Name	Generic Name	Dosage
Atripla	Efavirenz 600 mg Emtricitabine 200 mg Tenofovir (TDF) 300 mg	1 tablet once daily
Combivir	Lamivudine 150 mg Zidovudine 300 mg	1 tablet twice daily
Complera	Emtricitabine 200 mg Rilpivirine 27.5 mg Tenofovir (TDF) 300 mg	1 tablet once daily
Descovy	Emtricitabine 200 mg Tenofovir (TAF) 25 mg	1 tablet once daily
Epzicom	Abacavir 600 mg Lamivudine 300 mg	1 tablet once daily
Evotaz	Atazanavir 300 mg Cobicistat 150 mg	1 tablet once daily
Genvoya	Cobicistat 150 mg Elvitegravir 150 mg Emtricitabine 200 mg Tenofovir (TAF) 10 mg	1 tablet once daily
Odefsey	Emtricitabine 200 mg Rilpivirine 25 mg Tenofovir (TAF) 25 mg	1 tablet once daily
Prezcobix	Cobicistat 150 mg Darunavir 800 mg	1 tablet once daily
Stribild	Cobicistat 150 mg Elvitegravir 150 mg Emtricitabine 200 mg Tenofovir (TDF) 300 mg	1 tablet once daily
Triumeq	Abacavir 600 mg Dolutegravir 50 mg Lamivudine 300 mg	1 tablet once daily
Trizivir	Abacavir 300 mg Lamivudine 150 mg Zidovudine 300 mg	1 tablet twice daily
Truvada	Emtricitabine 200 mg Tenofovir (TDF) 300 mg	1 tablet once daily

TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.