What are common side effects of a 28-day PEP course?

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A 28‑day course of Post‑Exposure Prophylaxis (PEP) is generally safe and well tolerated, but mild temporary side effects are common as the body adjusts to antiretroviral medications. Most symptoms appear in the first few days and resolve within one to two weeks without discontinuing therapy.Common Short‑Term Side EffectsSymptomApproximate frequencyTypical onset and durationFatigue or tiredness30–40%Appears within first week; subsides gradually Nausea or upset stomach20–30%Often mild; relieved with food or anti‑nausea medication Diarrhea20–25%Temporary gastrointestinal reaction to tenofovir or integrase inhibitors Headache10–15%May accompany fatigue or dehydration; treatable with OTC analgesics Bloating, gas, or abdominal cramps15–20%Linked to digestive adaptation, usually self‑limiting Insomnia or vivid dreams10–15%Mostly associated with efavirenz or integrase inhibitors Less Common or Rare EffectsMild skin rash or itching (usually transient)Mild liver enzyme elevation or increased creatinine, especially with tenofovir-based regimens — monitored through follow‑up labsMood swings or mild depression, rarely reported in efavirenz‑based therapySevere reactions (e.g., persistent vomiting, severe rash, jaundice) are extremely rare and should prompt medical review.Management and TolerabilityTake doses with food to minimize nausea and GI discomfort.Hydration and small, frequent meals help normalize digestion.OTC remedies (antiemetics, paracetamol, antacids) can be used safely with clinician approval.Switching to an alternative integrase inhibitor (e.g., dolutegravir instead of raltegravir) may help if persistent side effects occur.

What are common side effects of a 28-day PEP course?

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Symptom	Approximate frequency	Typical onset and duration
Fatigue or tiredness	30–40%	Appears within first week; subsides gradually
Nausea or upset stomach	20–30%	Often mild; relieved with food or anti‑nausea medication
Diarrhea	20–25%	Temporary gastrointestinal reaction to tenofovir or integrase inhibitors
Headache	10–15%	May accompany fatigue or dehydration; treatable with OTC analgesics
Bloating, gas, or abdominal cramps	15–20%	Linked to digestive adaptation, usually self‑limiting
Insomnia or vivid dreams	10–15%	Mostly associated with efavirenz or integrase inhibitors