Managing Nausea and Vomiting with On-Demand Truvada PrEP

Understanding the Problem

Gastrointestinal side effects, particularly nausea and vomiting, are common with tenofovir disoproxil fumarate (TDF)-containing regimens, occurring in a substantial proportion of users, which can lead to medication discontinuation and undermine HIV prevention efficacy 2

The Centers for Disease Control and Prevention (CDC) recommends taking Truvada with food to reduce gastrointestinal symptoms 1
Eating smaller, more frequent meals rather than large meals when taking the medication can help minimize gastrointestinal distress, as suggested by the Praxis Medical Insights 3
Staying well-hydrated throughout the day can help minimize gastrointestinal distress 1
Preemptive antiemetic prescribing is recommended when gastrointestinal side effects are anticipated with antiretroviral regimens, according to the CDC 1

Metoclopramide (dopamine receptor antagonist) can be used for persistent nausea, though may cause sedation, as recommended by the Journal of the National Comprehensive Cancer Network 4
Prochlorperazine is another dopamine antagonist option for breakthrough nausea, also recommended by the Journal of the National Comprehensive Cancer Network 4

You should reach out to your healthcare professional immediately if you experience treatment-limiting tolerability issues, such as vomiting that prevents you from keeping the medication down, or symptoms that persist beyond 48-72 hours after each dose, as advised by the CDC and the MMWR Recommendations and Reports 1, 2, 3

If you have experienced treatment-limiting tolerability with TDF/FTC, an alternative regimen should be prescribed, such as switching to TAF/FTC (Descovy), which has superior gastrointestinal tolerability, or using prophylactic antiemetics with continued TDF/FTC, as recommended by the CDC 1