References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Odefsey is a once-daily single-tablet HIV treatment containing three drugs: rilpivirine, emtricitabine and tenofovir alafenamide (TAF). It’s essentially an updated version of Eviplera, swapping the older tenofovir DF for the newer TAF, which is gentler on the kidneys and bones.
Here’s what Odefsey offers and what to consider.
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What’s in Odefsey?
| Ingredient | Class | Role |
|---|---|---|
| Rilpivirine 25mg | NNRTI | Blocks reverse transcriptase directly |
| Emtricitabine 200mg | NRTI | Stops viral DNA chain formation |
| Tenofovir alafenamide 25mg | NRTI | Stops viral DNA chain formation |
Who Can Take Odefsey?
- Adults starting treatment with a viral load below 100,000 copies/ml
- People switching from another regimen with an undetectable viral load
- Those without rilpivirine resistance
Odefsey is not recommended if your viral load is very high at the start of treatment, because rilpivirine is less effective at high viral loads.
How to Take Odefsey
One tablet once a day with a meal. Food is essential — rilpivirine absorption drops significantly on an empty stomach.
Side Effects
- Headache
- Insomnia or vivid dreams
- Nausea (usually mild)
- Mood changes (uncommon)
- TAF is gentler on kidneys and bones than TDF
Key Drug Interactions
- Proton pump inhibitors (omeprazole, lansoprazole) — contraindicated
- H2 blockers — take 12 hours before or 4 hours after Odefsey
- Antacids — take 2 hours before or 4 hours after
- Rifampicin, carbamazepine, phenytoin — contraindicated
- St John’s Wort — avoid
The acid-reducing restrictions are the main practical limitation. If you need regular acid-reducing medication, Odefsey may not be suitable.
Odefsey vs Eviplera
Both contain rilpivirine and emtricitabine. The difference is the tenofovir version:
- Eviplera uses TDF — slightly more kidney and bone impact
- Odefsey uses TAF — gentler on kidneys and bones, but associated with slightly more weight gain and lipid changes
Read more: Eviplera | Biktarvy | What is HIV?
Frequently Asked Questions
Do I really need to eat with Odefsey?
Yes. Taking it on an empty stomach can reduce rilpivirine absorption by around 40%, risking treatment failure and resistance.
Can I take antacids with Odefsey?
Only with careful timing — at least 2 hours before or 4 hours after. Proton pump inhibitors are completely contraindicated.
Is Odefsey better than Biktarvy?
They suit different situations. Biktarvy has fewer food requirements and drug interactions. Odefsey may be preferred for specific clinical scenarios. Your HIV team will recommend the best fit.
Related reading
- Choosing the Right PrEP Drug: Truvada vs Descovy
- Dovato for HIV: A Two-Drug Regimen
- Triumeq for HIV: A Straightforward Guide
- Efavirenz for HIV: An Older NNRTI Still in Use
- Eviplera: How This Anti-HIV Drug Works
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
