Bixlenvo (bictegravir/lenacapavir) is a combination medicine used to treat HIV. Like other HIV medicines, Bixlenvo can cause side effects and may interact with other medicines or supplements.
Keep reading to learn about the possible side effects of Bixlenvo, how to manage them, and which medicines may interact with Bixlenvo.
This article does not include all possible side effects or interactions. Tell your health care provider about any symptoms that concern you or do not improve.
Bixlenvo Side Effects
Common side effects
The most common side effects reported with Bixlenvo include:
- Headache
- Nausea
- Diarrhea
Serious side effects
While less common, potentially serious side effects of Bixlenvo include:
- Loss of HIV control caused by a drug interaction, which can let the virus become resistant to treatment
- Severe allergic reactions
If you have symptoms that feel serious or life-threatening, seek medical care right away.
How to Manage Bixlenvo Side Effects
While not a complete guide, the following tips can help you prevent or manage the common side effects of Bixlenvo.
Headache
Headache is one of the most common side effects of Bixlenvo. Symptoms may include mild-to-moderate head pain or pressure.
To help manage headaches:
- Rest in a quiet, dark room if needed.
- Drink enough fluids throughout the day, and eat regular meals or snacks.
- Maintain a regular sleep schedule.
- Try relaxation techniques, such as deep breathing, and minimize stress.
An over-the-counter (OTC) pain reliever may help ease your headache, but check with your health care provider or pharmacist first to make sure it is safe to take with Bixlenvo.
Nausea
Some people feel nauseated while taking Bixlenvo. You can take Bixlenvo with or without food, so if it upsets your stomach, taking it with a meal or snack may help.
Here are a few other tips to ease nausea:
- Eat smaller meals more often instead of large meals.
- Choose bland foods, such as crackers, rice, or toast. Avoid greasy or spicy foods.
- Sip cold, clear fluids throughout the day.
- Try ginger, such as ginger tea, if it agrees with you.
Contact your health care provider if your nausea is severe, does not go away, or keeps you from eating, drinking, or taking your medicine.
Diarrhea
Diarrhea is another common side effect of Bixlenvo. Possible symptoms include loose or watery stools and stomach cramps.
Mild diarrhea often improves on its own. These tips may help manage it:
- Eat bland foods, such as rice, bananas, or toast.
- Avoid greasy, spicy, or high-fiber foods that may make symptoms worse.
- Limit caffeine and alcohol.
- Drink fluids often to prevent dehydration. Good choices may include water, broth, or electrolyte drinks such as Gatorade or Pedialyte.
- Ask your health care provider or pharmacist if an OTC antidiarrheal medicine may help.
Call your health care provider if your diarrhea is severe, does not go away, or comes with blood in your stool, a fever, or signs of dehydration (such as feeling very thirsty, dizzy, or urinating less than usual).
Loss of HIV control
Bixlenvo works by keeping the amount of HIV in your body low. If the level of medicine in your blood drops too low, the virus can start multiplying again. Over time, this can lead to resistance, meaning Bixlenvo (and sometimes similar medicines) may no longer work well against your HIV.
This is not something you manage after it happens; the goal is to prevent it. To help keep your HIV under control:
- Take Bixlenvo exactly as prescribed, every day, and try not to miss doses.
- Do not let your supply run out. Refill your prescription before you run low.
- Follow the timing instructions for antacids and supplements, as these can lower how much Bixlenvo your body absorbs.
- Tell your provider and pharmacist about every medicine and supplement you take so they can check for interactions that could lower your Bixlenvo levels.
- Do not stop taking Bixlenvo or change your dose without talking to your health care provider first.
Your health care provider will check your viral load with regular blood tests to make sure your treatment is still working.
Bixlenvo Interactions
Bixlenvo can interact with a number of medicines, supplements, and antacids. An interaction happens when a substance changes how a medicine works or affects the body.
This is not a full list of interactions, but the following are important to know while taking Bixlenvo.
Other medicines for HIV
Bixlenvo is a complete HIV regimen. It is not meant to be combined with other HIV medicines.
Examples include:
- Nucleoside or nucleotide reverse transcriptase inhibitors (known as NRTIs), such as abacavir, emtricitabine, lamivudine, and tenofovir
- Integrase strand inhibitors (known as INSTIs), such as bictegravir, dolutegravir, elvitegravir, or raltegravir
You may have been on one or more of these medicines before switching to Bixlenvo. But, you should not continue taking them while you are taking Bixlenvo, as it is a complete regimen. Talk to your health care provider about all of your medicines so you know which ones you should keep taking and which ones you should stop when you start taking Bixlenvo.
Antacids and iron or calcium supplements
Antacids and supplements that contain aluminum, magnesium, calcium, or iron can attach to Bixlenvo in your stomach and keep your body from absorbing it fully. This can make Bixlenvo not work as well as it should. Separating them helps reduce the risk of this happening.
Some antacids, supplements, and other medicines can affect how well Bixlenvo is absorbed. This includes products that contain aluminum, magnesium, calcium, or iron, such as some antacids, laxatives, buffered medicines, and sucralfate. Follow your health care provider’s instructions about how to take these products with Bixlenvo. Typical instructions are as follows.
Antacids containing aluminum or magnesium. Bixlenvo is usually taken at least two hours before or six hours after these products.
Products containing calcium or iron. These may be taken at the same time as Bixlenvo if taken with food.
During pregnancy. Your health care provider may give you specific instructions about timing. In general, follow the above spacing instructions for antacids containing aluminum or magnesium. For products containing calcium or iron, take them with Bixlenvo with food. If you take them on an empty stomach, take Bixlenvo at least two hours before or six hours after the calcium or iron product.
Follow this or instructions from your health care provider about how to separate these from your doses of Bixlenvo. Do not stop or change any medicines without talking with your health care provider first. Ask your pharmacist if you are unsure about a product.
Medicines whose levels Bixlenvo can raise
The medicines in Bixlenvo can slow down how your body processes certain other medicines. This can raise their levels and increase your risk for side effects.
Examples include:
- Certain cholesterol medicines called statins, such as lovastatin and simvastatin
- Certain sedatives, including midazolam and triazolam
- Certain opioid pain medicines, such as fentanyl, oxycodone, and tramadol (watch for extra drowsiness or slowed breathing)
- Medicines for erectile dysfunction or pulmonary arterial hypertension, such as sildenafil, tadalafil, and vardenafil
- Metformin, which is a medicine for diabetes
- Certain blood thinners called direct oral anticoagulants (DOACs), such as dabigatran, edoxaban, and rivaroxaban
This is only a partial list. Give your care team a full list of your medicines so they can check for interactions with Bixlenvo. Depending on the medicine, your health care provider may adjust the dose, watch you more closely, or suggest a different option.
Medicines that should not be taken with Bixlenvo
Some medicines and products should not be combined with Bixlenvo.
Examples include:
- Dofetilide, a medicine for heart rhythm problems, is one of them. Taking it with Bixlenvo can raise dofetilide to dangerous (possibly life-threatening) levels.
- Medicines that are known as strong CYP3A inducers can speed up how your body breaks down Bixlenvo and can keep it from working as well as it should. Some examples include rifampin (a medicine for tuberculosis) or certain seizure medicines, such as carbamazepine and phenytoin.
These medicines should not be taken with Bixlenvo. Always tell your health care provider and pharmacist about every medicine and supplement you take so they can check for these unsafe combinations.
FAQs: Bixlenvo Interactions
Does Bixlenvo interact with alcohol?
It is not known whether alcohol affects Bixlenvo. If you drink alcohol, talk with your health care provider about what is safe for you and your overall health.
Does Bixlenvo interact with herbs?
Yes. The herbal supplement St. John’s wort should not be taken with Bixlenvo because it can make Bixlenvo stop working. Always tell your pharmacist and health care providers about any vitamins, herbal products, or dietary supplements you use, and check before starting anything new.
Reducing Your Risk of Side Effects and Interactions
You can help reduce your risk of side effects and interactions by taking Bixlenvo exactly as prescribed and following all instructions from your health care provider.
Helpful tips include:
- Always tell your health care provider and pharmacist about all prescription drugs, OTC medicines, and any vitamins, herbs, or other supplements you use.
- Ask your health care provider before you start or stop any medicine, vitamin, or supplement.
- Take Bixlenvo exactly as prescribed, and follow the timing instructions for antacids and calcium or iron supplements.
- Do not miss doses or let your supply run out because this can allow HIV to become resistant. Do not stop taking Bixlenvo without talking to your health care provider.
- Keep all follow-up appointments and lab tests.
- Report any new or worsening symptoms to your health care provider.
Your health care provider can review your treatment plan and make adjustments if needed to help make sure that this medicine is safe for you.
