Juluca, made simple.
Juluca is a once a day pill that treats HIV with just two medicines. It is a complete regimen, and it is made for people who are already doing well on HIV treatment and want to simplify. It has two firm rules: take it with a real meal, and avoid certain heartburn medicines. This guide explains all of it, written by a Mississippi pharmacist, with care.
This guide is here to teach you. It is not medical advice, and it does not replace your doctor or pharmacist. Always do what your doctor tells you, and ask a pharmacist before you change how you take any medicine.
Print this guide for your fridgeWhat Juluca is and why your doctor gave it to you
Juluca is a once a day pill for HIV. It holds two medicines in one tablet.
It is a complete regimen, which means Juluca by itself is the whole HIV treatment. You do not add other HIV pills to it.
Juluca is a switch medicine. It is meant for people who are already on HIV treatment, already doing well with the virus fully controlled, and who want to simplify to a smaller regimen. It is not used to start treatment for someone newly diagnosed. If your doctor put you on Juluca, it is usually a sign your HIV has been well controlled, which is good news.
Here is the part worth holding onto. When HIV is kept undetectable by taking your medicine every day, it is not passed to others through sex. Doctors call this U equals U, undetectable equals untransmittable. Treatment protects your health, and the people you care about.
How Juluca works
To make more of itself, HIV has to get inside your cells and copy itself.
The two medicines in Juluca block two different steps. One blocks the virus from inserting itself into your cells. The other blocks the virus from copying its genetic material.
Two well chosen medicines are enough to keep HIV controlled in someone who is already doing well. This works only while you keep taking the pill every day, with a meal.
Your dose, and the meal rule
Juluca is one tablet, once a day. Here is the rule that matters most: always take Juluca with a real meal.
Not a snack. Not a cup of coffee. Not a protein shake. One of the two medicines in Juluca, called rilpivirine, is only absorbed properly when you take it with a substantial meal. If you take Juluca on an empty stomach or with just a light snack, your body does not get enough of the medicine, and the virus can slip back and even become harder to treat.
So plan your Juluca dose around your largest, most reliable meal of the day. Your doctor picks your dose and your pharmacist checks it. This page will not tell you what dose to take. The two things that keep Juluca working: take it every day, and take it with a full meal.
Timing, and what to do if you miss a dose
Take Juluca once a day, with a real meal, at about the same time each day. Tie it to your most dependable meal.
HIV medicine works best taken every day without gaps. Missed doses, or doses taken without food, give the virus a chance to rebound.
If you miss a dose:
- If less than 12 hours have passed since your usual dose time, take the missed dose right away, with a meal.
- If more than 12 hours have passed, skip the missed dose and take your next dose on schedule, with a meal.
- Never take two doses at once to catch up.
- If you realize you took a dose without food, tell your pharmacist, and going forward make the meal part of the routine.
Side effects, what is normal and what is not
Common, and usually mild.
- A headache.
- Nausea or loose stools.
- Trouble sleeping, or unusual dreams.
- These are most common early on and often settle as your body adjusts.
Call your doctor if you see:
- New or worsening low mood, sadness, or feeling down. Both medicines in Juluca can affect mood in some people, so this is worth a call.
- Yellowing of your skin or the white of your eyes, dark urine, or pain on the upper right of your belly.
- A new rash, especially with a fever or feeling unwell.
- A fluttering or irregular heartbeat.
Go to the emergency room right away if:
- You have a rash with a fever, blistering, facial swelling, or feeling very unwell. This can be a serious allergic reaction. Stop the medicine and get care.
- You have signs of liver trouble: severe belly pain, yellow skin or eyes, and confusion.
- You have thoughts of harming yourself. Call or text 988, or go to the emergency room.
What to be careful with
Juluca has one interaction that is more important than all the others, and it is a common one: heartburn medicines.
The strong heartburn medicines called proton pump inhibitors must not be taken with Juluca at all. These include omeprazole, pantoprazole, lansoprazole, esomeprazole, and rabeprazole, and many are sold over the counter under brand names like Prilosec, Protonix, Prevacid, and Nexium. They lower stomach acid, and that stops the rilpivirine in Juluca from being absorbed. The result can be HIV rebounding. This is not a caution to take loosely. This combination must be avoided.
If you have heartburn, there are other options. A different kind of heartburn medicine, famotidine, can usually be used with careful timing, and simple antacids can be used if you space them at least 2 hours before or 4 hours after Juluca. Your doctor and pharmacist will help you find a safe choice.
A few other things do not mix with Juluca: certain seizure medicines, the tuberculosis medicines rifampin and rifapentine, more than a single dose of the steroid dexamethasone, and the herbal supplement St. John's Wort. The simple rule: before you start or stop anything, including over the counter heartburn medicine, tell your pharmacist you take Juluca. Every single time.
What it costs
The cost is different for every person, because every insurance plan is different.
Here is the honest way to find your price. If you pay cash, call Fairview and we will give you a price for your situation. If you have private insurance, there may be a coupon or a savings program from the maker of the drug that helps lower your cost, and we will check if one is available for you. The best step is to let a pharmacist look at your plan. We do this for every patient.
Do not let cost make you skip doses. Call us first. There is almost always something we can do.
There is also a generic version of many medicines. The generic is the same medicine. Ask your pharmacist if a generic is a good fit for you.
What should be checked
Before you switch to Juluca, and while you take it, your care team checks a few things to keep you safe and confirm the medicine is working.
Your doctor should check:
- That your HIV is fully controlled before the switch, since Juluca is a switch medicine.
- Whether you have hepatitis B, which matters before any change in treatment.
- Your HIV viral load after the switch, to confirm it stays undetectable.
- Your mood and how well you are sleeping.
Your pharmacist should:
- Ask specifically about heartburn medicines, every time, including over the counter ones.
- Make sure you understand the meal rule.
- Check every new medicine and supplement against Juluca.
- Keep your information private, always.
At Fairview, we ask every Juluca patient about heartburn medicines at every fill, because that is the interaction most likely to cause harm and the one patients most often forget to mention. If a refill is running late, we call you.
Special situations
Heartburn medicines.
This is the one to remember. If you ever need something for heartburn or reflux, do not just grab an over the counter product, and do not let another doctor add one without checking. The proton pump inhibitor heartburn medicines must not be used with Juluca. Call Fairview first. There is almost always a safe alternative, it just has to be the right one.
Meals while traveling or on shift work.
Juluca needs a real meal every time. If you travel, work nights, or have an irregular eating schedule, plan ahead so you always have a proper meal at your dose time. This is worth thinking through in advance, not improvising.
If you also have hepatitis B.
Juluca does not treat hepatitis B. If you have both HIV and hepatitis B, switching to Juluca needs careful planning, because the regimen you are leaving may have been covering your hepatitis B. Your doctor will check this before any switch.
Mood and mental health.
Both medicines in Juluca can affect mood for some people. If you have a history of depression, tell your doctor before the switch, and tell them if your mood changes after. This is a real part of your care.
Cost should never be the reason you stop.
HIV medicine is expensive, but there is real help, including manufacturer programs and assistance programs for people with limited income. If cost is a worry, call Fairview before you ever skip a dose.
How Fairview helps Juluca patients
When you fill Juluca at Fairview, here is what you get. This is normal care for us, and it is always private.
At your first fill:
- We explain the meal rule and the heartburn medicine warning clearly.
- We check all your medicines and supplements, with special attention to heartburn products.
- We help you tie your dose to a dependable daily meal.
- We talk through cost and help you find any program you qualify for.
At every refill:
- We ask again about any heartburn medicine, prescription or over the counter.
- We check your file for any new medicines.
- We make sure there is no gap before your next refill.
On our own, without being asked:
- If a refill is running late, we call you.
- If we see a medicine that does not mix with Juluca, we call your doctor.
- We check your cost at every fill to keep it as low as possible.
- We keep your care discreet and respectful, always.
Questions people ask about Juluca
Yes. Juluca is a complete regimen in one pill a day, with two medicines that work together. You do not need to add other HIV medicines while taking it.
Related guides
Have a question about your Juluca? Ask a pharmacist you can trust.
Being switched to Juluca usually means your HIV has been well controlled, and that is something to feel good about. Keeping it that way comes down to two habits: a real meal with every dose, and no proton pump inhibitor heartburn medicines. Fairview is here to help you hold both, privately and without judgment. Moving your prescription to us takes one phone call.