Which medication is not recommended to be given with creatinine clearance lower than 60 for its use in PrEP?

The recommendation against the use of Truvada in patients with creatinine clearance lower than 60 mL/min is based on concerns regarding its safety and efficacy in individuals with compromised renal function. Truvada contains tenofovir disoproxil fumarate, which can lead to nephrotoxicity. Renal impairment increases the risk of accumulation of the drug, potentially leading to adverse effects such as renal failure or tubular toxicity.

In contrast, the other medications mentioned are either not subject to the same limitations regarding renal function or have alternative dosing regimens that may mitigate the renal risks. Vocabria, Apretude, and Cabenuva are formulations that are typically better tolerated in renal impairment or have different pharmacokinetic profiles, making their use safer in patients with lower creatinine clearance. Therefore, Truvada is specifically contraindicated based on these renal safety concerns.