Skip to main content

Stribild Side Effects

Generic name: cobicistat / elvitegravir / emtricitabine / tenofovir disoproxil

Medically reviewed by Philip Thornton, DipPharm. Last updated on Aug 7, 2024.

Note: This document provides detailed information about Stribild Side Effects associated with cobicistat / elvitegravir / emtricitabine / tenofovir disoproxil. Some dosage forms listed on this page may not apply specifically to the brand name Stribild.

Applies to cobicistat / elvitegravir / emtricitabine / tenofovir disoproxil: oral tablet.

Important warnings This medicine can cause some serious health issues

Oral route (tablet)

Posttreatment Acute Exacerbation of Hepatitis BSevere acute exacerbations of hepatitis B have been reported in patients who are coinfected with HIV-1 and HBV and have discontinued emtricitabine or tenofovir disoproxil fumarate, two of the components of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate tablets.

Hepatic function should be monitored closely in these patients.

If appropriate, initiation of anti-hepatitis B therapy may be warranted.

Serious side effects of Stribild

Along with its needed effects, cobicistat/elvitegravir/emtricitabine/tenofovir disoproxil may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking cobicistat/elvitegravir/emtricitabine/tenofovir disoproxil:

More common side effects

  • cloudy urine

Incidence not known

  • bloody urine
  • bone fractures
  • bone pain
  • change in urination
  • chest tightness
  • chills
  • constipation
  • cough
  • dark-colored urine
  • decreased appetite
  • difficulty with swallowing
  • dizziness
  • dry mouth
  • fast or irregular heartbeat
  • fast, shallow breathing
  • fever
  • general feeling of discomfort
  • increased thirst
  • indigestion
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • light-colored stools
  • loss of appetite
  • lower back or side pain
  • mood changes
  • muscle pain, cramps, or stiffness
  • nausea, vomiting or diarrhea
  • numbness or tingling in the hands, feet, or lips
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • seizures
  • skin rash, hives, itching
  • sleepiness
  • stomach pain
  • swelling of the face, fingers, or lower legs
  • trouble breathing
  • unusual tiredness or weakness
  • weight gain
  • yellow eyes and skin

Other side effects of Stribild

Some side effects of cobicistat / elvitegravir / emtricitabine / tenofovir disoproxil may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common side effects

  • abnormal dreams
  • headache

Less common side effects

  • bloated
  • full feeling
  • passing gas
  • trouble sleeping
  • unusual drowsiness

For healthcare professionals

Applies to cobicistat / elvitegravir / emtricitabine / tenofovir disoproxil: oral tablet.

General adverse events

In clinical trials, the most common side effects reported with cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide were nausea, diarrhea, and headache. The safety profiles in patients with mild to moderate renal dysfunction and patients coinfected with HIV and hepatitis B virus were similar to safety profiles in patients with normal renal function and patients with HIV-1 monoinfection, respectively.

The most common side effects reported in clinical trials with cobicistat / elvitegravir / emtricitabine / tenofovir disoproxil fumarate (DF) were nausea, diarrhea, upper respiratory tract infection, and depression in therapy-naive patients and nausea and fatigue in virologically-suppressed patients.

The manufacturer product information for cobicistat, elvitegravir, emtricitabine, and tenofovir DF should be consulted.[Ref]

Genitourinary

Cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide:

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Emtricitabine or tenofovir DF:

Tenofovir DF:

Hematuria (greater than 75 RBC/high power field) has been reported in up to 3% and up to 3% of patients using cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide and cobicistat/elvitegravir/emtricitabine/tenofovir DF, respectively. Proteinuria (all grades) has been reported in up to 52% of patients using cobicistat/elvitegravir/emtricitabine/tenofovir DF.

Glycosuria (3+ or greater) was reported with emtricitabine or tenofovir DF.[Ref]

Gastrointestinal

Cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide:

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Emtricitabine or tenofovir DF:

Tenofovir DF:

Elevated amylase (greater than 2 times the upper limit of normal [2 x ULN]) was reported in up to 3% and up to 5% of patients using cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide and cobicistat/elvitegravir/emtricitabine/tenofovir DF, respectively. If serum amylase was greater than 1.5 x ULN, lipase was also measured; elevated lipase was reported in up to 5% and up to 17% of patients using cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide and cobicistat/elvitegravir/emtricitabine/tenofovir DF, respectively.

Dyspepsia and vomiting have been reported in at least 5% of patients receiving emtricitabine or tenofovir DF with other antiretroviral drugs in other clinical trials.

Elevated amylase (including elevated pancreatic amylase), elevated serum lipase, abdominal distension, and pancreatitis were reported in clinical trials or during postmarketing experience for emtricitabine or tenofovir DF with other antiretrovirals.[Ref]

Musculoskeletal

Cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide:

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Emtricitabine or tenofovir DF:

Tenofovir DF:

Combination antiretroviral therapy:

During comparison studies in therapy-naive HIV-1-infected patients, BMD decreases were greater with cobicistat/elvitegravir/emtricitabine/tenofovir DF than with cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide. In virologically-suppressed tenofovir DF-treated patients who switched to cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide or who remained on initial regimen, mean BMD increased between baseline and 96 weeks in those who switched and decreased slightly in those on initial regimen; decreased BMD was also reported in patients who switched to cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide.

Elevated creatine kinase (at least 10 x ULN) has been reported in up to 11% and up to 10% of patients using cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide and cobicistat/elvitegravir/emtricitabine/tenofovir DF, respectively.

Arthralgia, myalgia, and back pain have been reported in at least 5% of patients receiving emtricitabine or tenofovir DF with other antiretroviral drugs in other clinical trials.

Elevated creatine kinase, rhabdomyolysis, muscular weakness, osteomalacia (manifested as bone pain and infrequently contributing to fractures), and myopathy were reported in clinical trials or during postmarketing experience for emtricitabine or tenofovir DF with other antiretrovirals.

Rhabdomyolysis, osteomalacia, muscular weakness, and myopathy have occurred as a result of proximal renal tubulopathy.[Ref]

Nervous system

Cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide:

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Emtricitabine or tenofovir DF:

Paresthesia and peripheral neuropathy (including peripheral neuritis and neuropathy) have been reported in at least 5% of patients receiving emtricitabine or tenofovir DF with other antiretroviral drugs in other clinical trials.[Ref]

Metabolic

Cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide:

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Emtricitabine or tenofovir DF:

Tenofovir DF:

Antiretroviral therapy:

Altered serum glucose (less than 40 mg/dL or greater than 250 mg/dL) has been reported in patients receiving emtricitabine or tenofovir DF with other antiretroviral drugs in other clinical trials.

Hypophosphatemia, hyperglycemia, hypertriglyceridemia, hypokalemia, and lactic acidosis were reported in clinical trials or during postmarketing experience for emtricitabine or tenofovir DF with other antiretrovirals.

Lactic acidosis and severe hepatomegaly with steatosis (including fatal cases) have been reported with the use of nucleoside analogs.

Hypokalemia and hypophosphatemia have occurred as a result of proximal renal tubulopathy.[Ref]

Other

Cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide:

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Emtricitabine or tenofovir DF:

Tenofovir DF:

Antiretroviral therapy:

During trials in therapy-naive patients, increases from baseline for the fasting lipid parameters (total cholesterol, direct LDL cholesterol, and HDL cholesterol) were observed with cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide and cobicistat/elvitegravir/emtricitabine/tenofovir DF at 144 weeks of therapy; such increases were greater with cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide.

Elevated fasting LDL cholesterol (greater than 190 mg/dL) and elevated fasting total cholesterol (greater than 300 mg/dL) have been reported in up to 11% and up to 4%, respectively, of patients using cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide and up to 5% and up to 3%, respectively, of patients using cobicistat/elvitegravir/emtricitabine/tenofovir DF.

In clinical trials, the following mean increases in fasting lipid values were reported after 144 weeks of therapy: total cholesterol increased by 31 mg/dL, LDL cholesterol by 20 mg/dL, HDL cholesterol by 7 mg/dL, and triglycerides by 29 mg/dL with cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide and total cholesterol increased by 14 mg/dL, LDL cholesterol by 8 mg/dL, HDL cholesterol by 3 mg/dL, and triglycerides by 17 mg/dL with cobicistat/elvitegravir/emtricitabine/tenofovir DF.

Elevated alkaline phosphatase (greater than 550 units/L), elevated fasting cholesterol (greater than 240 mg/dL), and elevated fasting triglycerides (greater than 750 mg/dL) have been reported in patients receiving emtricitabine or tenofovir DF with other antiretroviral drugs in other clinical trials. Abdominal pain, fever, and pain have been reported in at least 5% of patients receiving emtricitabine or tenofovir DF with other antiretroviral drugs in other clinical trials.

Asthenia and pain were reported in clinical trials or during postmarketing experience for emtricitabine or tenofovir DF with other antiretrovirals.[Ref]

Psychiatric

Cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide:

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Elvitegravir:

Emtricitabine or tenofovir DF:

Suicidal ideation, suicidal behavior, and suicide attempt were reported with cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide; all were serious and occurred in patients with history of depression or psychiatric illness.

Suicidal ideation and suicide attempt were reported with cobicistat/elvitegravir/emtricitabine/tenofovir DF in patients with history of depression or psychiatric illness.

Depression was reported in clinical trials for elvitegravir with other antiretrovirals.

Depression and anxiety have been reported in at least 5% of patients receiving emtricitabine or tenofovir DF with other antiretroviral drugs in other clinical trials.[Ref]

Renal

Cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide:

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Emtricitabine or tenofovir DF:

Cobicistat:

Tenofovir DF:

In clinical trials of cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide, increases in serum creatinine occurred by the second week of therapy and was stable through 144 weeks. In therapy-naive patients, the change from baseline averaged 0.04 mg/dL (3.5 mcmol/L) after 144 weeks of therapy. Increases from baseline were smaller with cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide than increases with cobicistat/elvitegravir/emtricitabine/tenofovir DF at 144 weeks.

In 1 trial, 248 HIV-1-infected patients with estimated CrCl between 30 and 69 mL/min (by Cockcroft-Gault method) were treated with cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide for a median duration of 144 weeks; of these patients, 65% had previously been on a stable tenofovir DF-containing regimen. This drug was permanently discontinued in 5 patients who developed renal side effects through 96 weeks; 3 of the 5 patients were among the 80 patients with baseline estimated CrCl less than 50 mL/min and 2 patients were among the 162 subjects with baseline estimated CrCl at least 50 mL/min. No further renal discontinuations occurred between 96 and 144 weeks. Overall, patients with renal dysfunction using cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide in this study had a mean serum creatinine of 1.5 mg/dL at baseline and 1.4 mg/dL at 144 weeks.

In 2 trials in therapy-naive HIV-1-infected patients (median baseline estimated CrCl 115 mL/min), mean serum creatinine increased by less than 0.1 mg/dL and 0.1 mg/dL from baseline to week 144 with cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide and cobicistat/elvitegravir/emtricitabine/tenofovir DF, respectively. In a trial in virologically-suppressed tenofovir DF-treated patients (mean baseline estimated CrCl 112 mL/min) who switched to cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide or who remained on initial regimen, mean serum creatinine was similar to baseline for both at 96 weeks.

Elevated serum creatinine (all grades) has been reported in 10% of patients using cobicistat/elvitegravir/emtricitabine/tenofovir DF.

In clinical trials, decreases in estimated CrCl occurred early during cobicistat/elvitegravir/emtricitabine/tenofovir DF therapy. The change in eGFR averaged -14 mL/min after 144 weeks of therapy.

In a clinical trial in HIV-1-infected therapy-naive patients with mild to moderate renal dysfunction (eGFR between 50 and 89 mL/min), the change in serum creatinine and eGFR averaged 0.17 mg/dL and -6.9 mL/min, respectively, for cobicistat/elvitegravir/emtricitabine/tenofovir DF.

Acute tubular necrosis, nephritis (including acute interstitial nephritis), and nephrogenic diabetes insipidus were reported in clinical trials or during postmarketing experience for emtricitabine or tenofovir DF with other antiretrovirals.

Proximal renal tubulopathy generally resolved or improved after tenofovir DF was stopped; however, decreased CrCl did not completely resolve in some patients after stopping the drug. Rhabdomyolysis, osteomalacia, bone abnormalities (infrequently contributing to fractures), hypokalemia, muscular weakness, myopathy, and hypophosphatemia have occurred as a result of proximal renal tubulopathy.[Ref]

Dermatologic

Cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide:

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Emtricitabine and/or tenofovir alafenamide:

Emtricitabine or tenofovir DF:

Emtricitabine:

Emtricitabine-containing products:

Tenofovir alafenamide-containing products:

Tenofovir DF:

Vesiculobullous rash, pustular rash, maculopapular rash, pruritus, urticaria, skin discoloration (increased pigmentation), and angioedema were reported in clinical trials or during postmarketing experience for emtricitabine or tenofovir DF with other antiretrovirals.

Skin discoloration (hyperpigmentation) was very common in pediatric patients using emtricitabine.[Ref]

Hepatic

Cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide:

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Emtricitabine:

Emtricitabine or tenofovir DF:

Tenofovir DF:

Elevated AST (greater than 5 x ULN) and elevated ALT (greater than 5 x ULN) have both been reported in up to 3% of patients using cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide and up to 4% and up to 3%, respectively, of patients using cobicistat/elvitegravir/emtricitabine/tenofovir DF. Elevated ALT (greater than 3 x ULN) has been reported in up to 2% of patients using cobicistat/elvitegravir/emtricitabine/tenofovir DF.

Severe acute exacerbations of hepatitis B have been reported in patients coinfected with HBV and HIV-1 after discontinuation of emtricitabine or tenofovir DF and were associated with liver failure and liver decompensation in some emtricitabine-treated patients.

Elevated ALT (greater than 215 units/L in males and 170 units/L in females) and elevated bilirubin (greater than 2.5 x ULN) have been reported in patients receiving emtricitabine or tenofovir DF with other antiretroviral drugs in other clinical trials.

Increased transaminases, hyperbilirubinemia, hepatic steatosis, and hepatitis were reported in clinical trials or during postmarketing experience for emtricitabine or tenofovir DF with other antiretrovirals.

Lactic acidosis and severe hepatomegaly with steatosis (including fatal cases) have been reported with the use of nucleoside analogs.[Ref]

Respiratory

Cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide:

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Emtricitabine or tenofovir DF:

Tenofovir DF:

Nasopharyngitis, pneumonia, sinusitis, upper respiratory tract infection, increased cough, and rhinitis have been reported in at least 5% of patients receiving emtricitabine or tenofovir DF with other antiretroviral drugs in other clinical trials.[Ref]

Ocular

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Immunologic

Cobicistat/elvitegravir/emtricitabine/tenofovir DF:

Emtricitabine and/or tenofovir alafenamide:

Emtricitabine:

Tenofovir DF:

Hematologic

Emtricitabine or tenofovir DF:

Decreased neutrophils (less than 750/mm3) have been reported in patients receiving emtricitabine or tenofovir DF with other antiretroviral drugs in other clinical trials.

Neutropenia and anemia were reported in clinical trials or during postmarketing experience for emtricitabine or tenofovir DF with other antiretrovirals.

Anemia was common in pediatric patients using emtricitabine.[Ref]

Hypersensitivity

Emtricitabine or tenofovir DF:

Tenofovir DF:

Allergic reaction was reported in clinical trials or during postmarketing experience for emtricitabine or tenofovir DF with other antiretrovirals.[Ref]

Endocrine

Tenofovir DF:

References

1. Cerner Multum, Inc. "UK Summary of Product Characteristics."

2. Cerner Multum, Inc. "Australian Product Information."

3. (2015) "Product Information. Genvoya (cobicistat/elvitegravir/emtricitabine/tenofov)." Gilead Sciences

4. (2012) "Product Information. Stribild (cobicistat/elvitegravir/emtricitabine/tenofov)." Gilead Sciences

5. Olin JL, Spooner LM, Klibanov OM (2012) "Elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate single tablet for HIV-1 infection treatment." Ann Pharmacother, 46, p. 1671-7

6. (2012) "A 4-drug combination (stribild) for HIV." Med Lett Drugs Ther, 54, p. 95-6

Frequently asked questions

Further information

Stribild side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.