Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead 150mg/150mg/200mg/10mg film-coated tablets (previously known as Genvoya)

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead is and what it is used for
2. What you need to know before you take Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead
3. How to take Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead
4. Possible side effects
5. How to store Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead
6. Contents of the pack and other information

If Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead has been prescribed for your child, please note that all the information in this leaflet is addressed to your child (in this case please read “your child” instead of “you”).

• If you are allergic to elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide or any of the other ingredients of this medicine (listed in section 6 of this leaflet).
• If you are taking one of these medicines:
  • alfuzosin (used to treat an enlarged prostate gland)
  • dabigatran (used to prevent and treat blood clots)
  • amiodarone, quinidine (used to correct irregular heartbeats)
  • carbamazepine, phenobarbital, phenytoin (used to prevent seizures)
  • rifampicin (used to prevent and treat tuberculosis and other infections)
  • dihydroergotamine, ergometrine, ergotamine (used to treat migraine headache)
  • cisapride (used to relieve certain stomach problems)
  • St. John’s wort (Hypericum perforatum, a herbal remedy used for depression and anxiety) or products that contain it
  • lomitapide, lovastatin, simvastatin (used to lower blood cholesterol)
  • lurasidone, pimozide (used to treat abnormal thoughts or feelings)
  • sildenafil (when used to treat pulmonary arterial hypertension – a lung disease that makes breathing difficult)
  • orally administered midazolam, triazolam (used to help you sleep and/or relieve anxiety)
    • If any of these applies to you, do not take Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead and tell your doctor immediately.

You must remain under the care of your doctor while taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead.

This medicine is not a cure for HIV infection. While taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead you may still develop infections or other illnesses associated with HIV infection.

Talk to your doctor before taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead:

• If you have liver problems or a history of liver disease, including hepatitis. Patients with liver disease including chronic hepatitis B or C, who are treated with antiretrovirals, have a higher risk of severe and potentially fatal liver complications. If you have hepatitis B infection, your doctor will carefully consider the best treatment regimen for you.
  If you have hepatitis B infection, liver problems may become worse after you stop taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead. It is important not to stop taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead without talking to your doctor: see section 3, Do not stop taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead.
• If you have had kidney disease or if tests have shown problems with your kidneys. Your doctor may order blood tests to monitor how your kidneys work when starting and during treatment with Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead.

Once you start taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead, look out for:

• Signs of inflammation or infection
• Joint pain, stiffness or bone problems
  • If you notice any of these symptoms, tell your doctor immediately. For more information see section 4, Possible side effects.

There is a possibility that you may experience kidney problems when taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead over a long period of time (see Warnings and precautions).

Do not give this medicine to children under 2 years of age, or weighing less than 14 kg regardless of age. The use of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead in children under 2 years of age, or weighing less than 14 kg has not yet been studied.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead may interact with other medicines. As a result, the amounts of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead or other medicines in your blood may be affected. This may stop your medicines from working properly, or may make any side effects worse. In some cases, your doctor may need to adjust your dose or check your blood levels.

Medicines that must never be taken with Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead:

• alfuzosin (used to treat an enlarged prostate gland)
• amiodarone, quinidine (used to correct irregular heartbeats)
• carbamazepine, phenobarbital, phenytoin (used to prevent seizures)
• dabigatran (used to prevent and treat blood clots)
• rifampicin (used to prevent and treat tuberculosis and other infections)
• dihydroergotamine, ergometrine, ergotamine (used to treat migraine headache)
• cisapride (used to relieve certain stomach problems)
• St. John’s wort (Hypericum perforatum, a herbal remedy used for depression and anxiety) or products that contain it
• lomitapide, lovastatin, simvastatin (used to lower blood cholesterol)
• lurasidone, pimozide (used to treat abnormal thoughts or feelings)
• sildenafil (when used to treat pulmonary arterial hypertension – a lung disease that makes breathing difficult)
• orally administered midazolam, triazolam (used to help you sleep and/or relieve anxiety)
  • If you are taking any of these medicines, do not take Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead and tell your doctor immediately.

Medicines used in treating hepatitis B infection:

You should not take Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead with medicines containing:

• tenofovir alafenamide
• tenofovir disoproxil
• lamivudine
• adefovir dipivoxil
  • Tell your doctor if you are taking any of these medicines.

Talk to your doctor if you are taking:

• antifungals, used to treat fungal infections, such as:
  • ketoconazole, itraconazole, voriconazole, posaconazole and fluconazole
• antibiotics, used to treat bacterial infections including tuberculosis, containing:
  • rifabutin, clarithromycin and telithromycin
• antidepressants, used to treat depression:
  • medicines containing trazodone or escitalopram
• sedatives and hypnotics, used to treat anxiety:
  • buspirone, clorazepate, diazepam, estazolam, flurazepam, zolpidem and lorazepam
• immunosuppressants, used to control your body’s immune response after a transplant, such as:
  • ciclosporin, sirolimus and tacrolimus
• corticosteroids including:
  • betamethasone, budesonide, fluticasone, mometasone, prednisone, triamcinolone.
  These medicines are used to treat allergies, asthma, inflammatory bowel diseases, inflammatory conditions of the skin, eyes, joints and muscles and other inflammatory conditions. These medicines are generally taken orally, inhaled, injected or applied to the skin or eye. If alternatives cannot be used, its use should only take place after medical evaluation and under close monitoring by your doctor for corticosteroid side effects.
• medicines used to treat diabetes:
  • metformin
• contraceptive pill, used to prevent pregnancy
• erectile dysfunction medicines, used to treat impotence, such as:
  • sildenafil, tadalafil and vardenafil
• heart medicines, such as:
  • digoxin, disopyramide, flecainide, lidocaine (injectable), mexiletine, propafenone, metoprolol, timolol, amlodipine, diltiazem, felodipine, nicardipine, nifedipine and verapamil
• medicines used to treat pulmonary arterial hypertension:
  • bosentan and tadalafil
• anticoagulants, used to prevent and treat blood clots, such as:
  • apixaban, edoxaban, rivaroxaban and warfarin
• bronchodilators, used to treat asthma and other lung-related problems:
  • salmeterol
• cholesterol lowering medicines, such as:
  • atorvastatin and pitavastatin
• medicines used to treat gout:
  • colchicine
• antiplatelets, used to reduce the risk of blood clots such as:
  • clopidogrel
• medicines or oral supplements containing minerals (such as magnesium, aluminium, calcium, iron, zinc), such as:
  • mineral supplements, vitamins (including multivitamins), antacids and laxatives
    • If you are taking medicines, oral supplements, antacids or laxatives containing minerals (such as magnesium, aluminium, calcium, iron, zinc), take them at least 4 hours before or at least 4 hours after Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead.
    • Tell your doctor if you are taking these or any other medicines. Do not stop your treatment without contacting your doctor.

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

• Tell your doctor immediately if you are pregnant, think you may be pregnant or are planning to have a baby. Pregnant women should not take Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead. The amount of this medicine in your blood may decrease during pregnancy which may stop it from working properly.
• Use effective contraception while taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead.
• Do not breast-feed during treatment with Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead. This is because some of the active substances in this medicine pass into human breast milk. Breast-feeding is not recommended in women living with HIV because HIV infection can be passed on to the baby in breast milk. If you are breast-feeding, or thinking about breast-feeding, you should discuss it with your doctor as soon as possible.

Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead can cause dizziness. If you feel dizzy when taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead, do not drive or ride a bicycle and do not use any tools or machines.

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

• If any of these applies to you, talk to your doctor before taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead.

Adults, adolescents and children who weigh at least 25 kg: one tablet each day with food (one 150 mg/150 mg/200 mg/10 mg tablet)

Children 2 years of age and older, who weigh at least 14 kg but less than 25 kg: one tablet each day with food (one 90 mg/90 mg/120 mg/6 mg tablet)

Due to the bitter taste, it is recommended not to chew or crush the tablet.

If you have difficulty swallowing the tablet whole, you can split it in half. Take both halves of the tablet one after the other to get the full dose. Do not store the split tablet.

The score line on the 90 mg/90 mg/120 mg/6 mg tablet is only there to help you break the tablet if your child has difficulty swallowing it whole.

Always take the dose recommended by your doctor. This is to make sure that your medicine is fully effective, and to reduce the risk of developing resistance to the treatment. Do not change the dose unless your doctor tells you to.

Do not take antacids or multivitamins at the same time as Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead. If you are taking medicines, oral supplements, antacids or laxatives containing minerals (such as magnesium, aluminium, calcium, iron, zinc), take them at least 4 hours before or at least 4 hours after Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead.

If you are on dialysis, take your daily dose of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead following completion of dialysis.

If you accidentally take more than the recommended dose of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead you may be at increased risk of experiencing possible side effects with this medicine (see section 4, Possible side effects).

Contact your doctor or nearest emergency department immediately for advice. Keep the tablet bottle with you so that you can easily describe what you have taken.

It is important not to miss a dose of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead.

If you do miss a dose:

• If you notice within 18 hours of the time you usually take Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead, you must take the tablet as soon as possible. Always take the tablet with food. Then take the next dose as usual.
• If you notice 18 hours or more after the time you usually take Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead, then do not take the missed dose. Wait and take the next dose, with food, at your usual time.

If you vomit less than 1 hour after taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead, take another tablet with food.

Do not stop taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead without talking to your doctor. Stopping Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead can seriously affect your response to future treatment. If Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead is stopped for any reason, speak to your doctor before you restart taking Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead tablets.

When your supply of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead starts to run low, get more from your doctor or pharmacist. This is very important because the amount of virus may start to increase if the medicine is stopped for even a short time. The disease may then become harder to treat.

If you have both HIV infection and hepatitis B, it is especially important not to stop your Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead treatment without talking to your doctor first. You may require blood tests for several months after stopping treatment. In some patients with advanced liver disease or cirrhosis, stopping treatment is not recommended as this may lead to worsening of your hepatitis, which may be life-threatening.

• Tell your doctor immediately about new or unusual symptoms after you stop treatment, particularly symptoms you associate with hepatitis B infection.

• Any signs of inflammation or infection. In some patients with advanced HIV infection (AIDS) and a history of opportunistic infections (infections that occur in people with a weak immune system), signs and symptoms of inflammation from previous infections may occur soon after anti-HIV treatment is started. It is thought that these symptoms are due to an improvement in the body’s immune response, enabling the body to fight infections that may have been present with no obvious symptoms.
• Autoimmune disorders, when the immune system attacks healthy body tissue, may also occur after you start taking medicines for HIV infection. Autoimmune disorders may occur many months after the start of treatment. Look out for any symptoms of infection or other symptoms such as:
  • muscle weakness
  • weakness beginning in the hands and feet and moving up towards the trunk of the body
  • palpitations, tremor or hyperactivity.
    • If you notice the side effects described above, tell your doctor immediately.

Very common side effects

(may affect more than 1 in 10 people)

• feeling sick (nausea)

Common side effects

(may affect up to 1 in 10 people)

• abnormal dreams
• headache
• dizziness
• diarrhoea
• vomiting
• stomach pain
• wind (flatulence)
• rash
• tiredness (fatigue)

Uncommon side effects

(may affect up to 1 in 100 people)

• low red blood cell count (anaemia)
• suicidal thoughts and suicide attempt (in patients who have had depression or mental health problems before), depression
• problems with digestion resulting in discomfort after meals (dyspepsia)
• swelling of the face, lips, tongue or throat (angioedema)
• itching (pruritus)
• hives (urticaria)
  • If any of the side effects get serious tell your doctor.

The frequency of the following side effects is not known (frequency cannot be estimated from the available data).

• Bone problems. Some patients taking combination antiretroviral medicines such as Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead may develop a bone disease called osteonecrosis (death of bone tissue caused by loss of blood supply to the bone). Taking this type of medicine for a long time, taking corticosteroids, drinking alcohol, having a very weak immune system, and being overweight, may be some of the many risk factors for developing this disease. Signs of osteonecrosis are:
  • joint stiffness
  • joint aches and pains (especially of the hip, knee and shoulder)
  • difficulty with movement
    • If you notice any of these symptoms tell your doctor.

During HIV therapy there may be an increase in weight and in levels of blood lipids and glucose. This is partly linked to restored health and life style, and in the case of blood lipids sometimes to the HIV medicines themselves. Your doctor will test for these changes.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme.

Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store

By reporting side effects you can help provide more information on the safety of this medicine.

The active substances are elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide.

• Each Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead 150 mg/150 mg/200 mg/10 mg film-coated tablet contains 150 mg of elvitegravir, 150 mg of cobicistat, 200 mg of emtricitabine and tenofovir alafenamide fumarate equivalent to 10 mg of tenofovir alafenamide.
• Each Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead 90 mg/90 mg/120 mg/6 mg film-coated tablet contains 90 mg of elvitegravir, 90 mg of cobicistat, 120 mg of emtricitabine and tenofovir alafenamide fumarate equivalent to 6 mg of tenofovir alafenamide.

The other ingredients are

Tablet core:

Lactose (as monohydrate), microcrystalline cellulose (E460), croscarmellose sodium, hydroxypropyl cellulose (E463), silicon dioxide (E551), sodium lauryl sulfate, magnesium stearate.

Film-coating:

Polyvinyl alcohol (E1203), titanium dioxide (E171), polyethylene glycol (E1521), talc (E553b), iron oxide yellow (E172), indigo carmine aluminium lake (E132 - 150 mg/150 mg/200 mg/10 mg tablet only), iron oxide black (E172 - 90 mg/90 mg/120 mg/6 mg tablet only).

Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead 150 mg/150 mg/200 mg/10 mg film-coated tablets are green, capsule-shaped tablets, debossed on one side with “GSI” and the number “510” on the other side of the tablet.

Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead 90 mg/90 mg/120 mg/6 mg film-coated tablets are green, capsule-shaped tablets, debossed on one side with “GSI” and scored on the other side of the tablet.

Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead comes in bottles of 30 tablets (with a silica gel desiccant that must be kept in the bottle to help protect your tablets). The silica gel desiccant is contained in a separate sachet or canister and should not be swallowed.

The following pack sizes are available: outer cartons containing 1 bottle of 30 film-coated tablets and outer cartons containing 90 (3 bottles of 30) film-coated tablets. Not all pack sizes may be marketed.

For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder: