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Tenofovir disoproxil fumarate (Viread) is an antiviral tablet used, in combination with other antiretroviral agents, to treat HIV-1 infection, and alone to treat chronic hepatitis B infection in adults and certain pediatric patients.
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Dr. Steve Malen, PharmD
Dr. Steven Blikstein, PharmD
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Tenofovir disoproxil fumarate is a nucleotide reverse transcriptase inhibitor (NRTI) available as a 300 mg tablet, taken once daily with food, that works by blocking the reverse transcriptase enzyme HIV needs to replicate. For HIV-1 infection, it is always used in combination with other antiretroviral medications as part of a complete regimen. For chronic hepatitis B, it can be used alone. Tenofovir disoproxil fumarate carries a boxed warning for lactic acidosis and severe hepatomegaly with steatosis (including fatal cases), which have been reported with the use of nucleoside analogs, and for severe acute exacerbations of hepatitis B in patients coinfected with HIV-1 and HBV who discontinue this medication; hepatic function should be monitored closely for several months after stopping treatment. Other warnings include new-onset or worsening renal impairment (including Fanconi syndrome), decreased bone mineral density, and immune reconstitution syndrome. Common side effects include nausea, diarrhea, vomiting, flatulence, and headache. Tell your provider about all other medications you take, as tenofovir has interactions with certain drugs (including some HIV medications, tenofovir alafenamide-containing products, and drugs affecting renal clearance), and report any unusual muscle pain, breathing difficulty, or signs of liver problems promptly.
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Boxed Warning: Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogs such as tenofovir disoproxil fumarate, alone or in combination with other antiretrovirals. Severe acute exacerbations of hepatitis B have also occurred in patients coinfected with HIV-1 and hepatitis B who discontinued this medication; liver function should be monitored closely for several months after stopping treatment.
Other warnings include new-onset or worsening kidney impairment (including Fanconi syndrome), decreases in bone mineral density, and immune reconstitution syndrome (an inflammatory response to residual infections shortly after starting therapy).
Common side effects include nausea, diarrhea, vomiting, flatulence, and headache.
Dosing: The standard dose is 300 mg by mouth once daily with food. For HIV-1, tenofovir is always combined with other antiretroviral medications; for chronic hepatitis B, it may be used alone. Dose adjustments are required for reduced kidney function.
Tell your provider about all medications you take, including other HIV or hepatitis medications, as tenofovir has clinically significant drug interactions. Report unusual muscle weakness, trouble breathing, or signs of liver problems (yellowing skin/eyes, dark urine, severe fatigue) right away.