Comparative Pharmacology
Head-to-head clinical analysis: EMTRICITABINE versus SYMTUZA.
Peer-Reviewed Evidence
Head-to-head clinical analysis: EMTRICITABINE versus SYMTUZA.
EMTRICITABINE vs SYMTUZA
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Nucleoside reverse transcriptase inhibitor; phosphorylated to emtricitabine triphosphate which competes with endogenous deoxycytidine triphosphate and incorporates into viral DNA causing chain termination.
SYMTUZA is a fixed-dose combination of darunavir (a HIV-1 protease inhibitor), cobicistat (a CYP3A inhibitor), emtricitabine (a nucleoside reverse transcriptase inhibitor), and tenofovir alafenamide (a nucleotide reverse transcriptase inhibitor). Darunavir inhibits HIV-1 protease, preventing cleavage of viral polyproteins and resulting in immature, non-infectious virus. Emtricitabine and tenofovir alafenamide inhibit HIV reverse transcriptase by competing with natural substrates and causing DNA chain termination. Cobicistat inhibits CYP3A, boosting darunavir exposure.
200 mg orally once daily, typically in combination with other antiretroviral agents.
One tablet (darunavir 800 mg/cobicistat 150 mg/emtricitabine 200 mg/tenofovir alafenamide 10 mg) orally once daily with food.
None Documented
None Documented
Clinical Note
moderateEmtricitabine + Ribavirin
"Emtricitabine may increase the hepatotoxic activities of Ribavirin."
Clinical Note
moderateLamivudine + Emtricitabine
"The risk or severity of adverse effects can be increased when Lamivudine is combined with Emtricitabine."
Clinical Note
moderateGanciclovir + Emtricitabine
"The risk or severity of adverse effects can be increased when Ganciclovir is combined with Emtricitabine."
Clinical Note
moderateValganciclovir + Emtricitabine
Terminal elimination half-life is approximately 10 hours (range 8–12 hours) in adults with normal renal function; prolonged to >20 hours in severe renal impairment (CrCl <30 mL/min).
Darunavir: 15 hours (when boosted with cobicistat). Cobicistat: 3-4 hours. Emtricitabine: 10 hours. Tenofovir alafenamide: 0.5 hours (active metabolite tenofovir diphosphate intracellular half-life >60 hours).
Renal: approximately 86% of the dose is excreted unchanged in urine via glomerular filtration and active tubular secretion. Biliary/fecal: minimal (<14% as unchanged drug and metabolites in feces).
Darunavir: ~80% feces (mostly metabolites), ~14% urine (unchanged 1.5%). Cobicistat: ~86% feces, ~8% urine. Emtricitabine: ~86% urine (unchanged), ~14% feces. Tenofovir alafenamide: ~31% urine, ~47% feces (as tenofovir).
Category C
Category C
Antiretroviral, NRTI
Antiretroviral
"The risk or severity of adverse effects can be increased when Valganciclovir is combined with Emtricitabine."