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# Tab%252525252525252525252525252525252525252525252525252525252525252525252525252525252520voihep
## Overview
Tab%252525252525252525252525252525252525252525252525252525252525252525252525252525252520voihep (tenofovir disoproxil fumarate) is a nucleotide analogue reverse transcriptase inhibitor (NtRTI) used in the treatment of chronic hepatitis B virus (HBV) infection.
## Primary Indications
Chronic Hepatitis B Virus (HBV) infection in adults and pediatric patients.
## Adult Dosing
300 mg orally once daily.
## Pediatric Dosing
* **12 to < 18 years:** 300 mg orally once daily.
* **Age < 12 years:** Dosing is weight-based. Consult specific pediatric guidelines. Generally, 10 mg/kg orally once daily, not to exceed 300 mg daily.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is required based on creatinine clearance (CrCl).
* CrCl 50-80 mL/min: 300 mg every 2 days.
* CrCl 30-49 mL/min: 300 mg every 3 days.
* CrCl 10-29 mL/min: 300 mg every 4 days.
* CrCl < 10 mL/min or on hemodialysis: 300 mg every 7 days (once weekly) after a full supplemental dose on dialysis days.
* Dosing for significant hepatic impairment is not typically adjusted but requires careful monitoring.
## Contraindications
* Hypersensitivity to tenofovir disoproxil fumarate or any component of the formulation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache, dizziness, rash, asthenia.
* **Serious:** Lactic acidosis, severe hepatomegaly with steatosis, renal impairment (including acute renal failure and Fanconi syndrome), bone mineral density reduction.
## Key Drug Interactions
* **Nephrotoxic agents:** Increased risk of renal toxicity. Avoid coadministration or monitor renal function closely (e.g., aminoglycosides, NSAIDs, certain antivirals).
* **Didanosine:** Increased risk of pancreatitis and peripheral neuropathy. Avoid coadministration.
* **Stavudine:** Increased risk of lactic acidosis and hyperlactatemia. Avoid coadministration.
* **Drugs eliminated by active tubular secretion:** May increase plasma concentrations of tenofovir disoproxil fumarate, increasing the risk of adverse effects (e.g., acyclovir, cidofovir, valacyclovir).
## Monitoring
* Renal function (serum creatinine, BUN, electrolytes, urinalysis) at baseline and periodically during treatment.
* Liver function tests (ALT, AST, bilirubin) at baseline and periodically.
* Hepatitis B viral load (HBV DNA) and serological markers (HBeAg, anti-HBe) as indicated.
* Bone mineral density may be considered in patients with a history of fractures or other risk factors.
## Clinical Pearls
* Consider switching to tenofovir alafenamide (TAF) in patients with pre-existing renal or bone disease due to a lower incidence of these toxicities.
* Adherence is crucial for optimal viral suppression and to prevent the development of resistance.
* Educate patients on potential renal and bone side effects.
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This information is intended for healthcare professionals. Please consult the most current prescribing information and relevant clinical guidelines for complete details before making any treatment decisions.
