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# Tabu Voihep (generic name: Tenofovir Alafenamide/Emtricitabine)
## Overview
Tabu Voihep is a fixed-dose combination of tenofovir alafenamide (TAF) and emtricitabine (FTC). Both are nucleoside reverse transcriptase inhibitors (NRTIs) used in the treatment of HIV-1 infection. TAF is a prodrug of tenofovir with improved intracellular concentrations and reduced plasma tenofovir levels compared to tenofovir disoproxil fumarate (TDF), potentially leading to improved renal and bone safety.
## Primary Indications
* Treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults and pediatric patients aged 12 years and older and weighing at least 35 kg.
## Adult Dosing
* **One tablet (TAF 25 mg/FTC 200 mg) orally once daily.**
## Pediatric Dosing
* **Pediatric patients aged 12 years and older and weighing at least 35 kg:** One tablet (TAF 25 mg/FTC 200 mg) orally once daily.
* **Note:** Dosing for pediatric patients weighing less than 35 kg is not established with this specific formulation. Alternative formulations or regimens may be required.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is required in adults or pediatric patients (≥12 years and ≥35 kg) with any degree of renal impairment (CrCl ≥ 30 mL/min). Data is limited for CrCl < 30 mL/min.
* **Hepatic Impairment:** No dose adjustment is required. However, TAF/FTC is not recommended for the treatment of chronic hepatitis B virus (HBV) infection.
## Contraindications
* Concurrent use with dofetilide.
* Known history of hypersensitivity to emtricitabine or tenofovir alafenamide or any component of the product.
## Adverse Effects
* **Common:** Diarrhea, nausea, headache, dizziness, fatigue, rash.
* **Serious:** Lactic acidosis, severe hepatomegaly with steatosis, immune reconstitution inflammatory syndrome (IRIS), new-onset or worsening renal impairment, bone mineral density loss (less common with TAF compared to TDF), fat redistribution.
## Key Drug Interactions
* **Dofetilide:** Contraindicated due to increased dofetilide plasma concentrations and risk of serious ventricular arrhythmias.
* **Certain Anticonvulsants (e.g., carbamazepine, phenytoin):** May decrease plasma concentrations of TAF/FTC.
* **Certain Antiretrovirals (e.g., ritonavir-boosted protease inhibitors):** May increase TAF plasma concentrations.
* **Inducers of P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP) (e.g., rifampin, St. John's Wort):** May decrease plasma concentrations of TAF/FTC.
## Monitoring
* **Baseline and periodic assessment of renal function** (serum creatinine, eGFR, urinalysis for proteinuria).
* **Baseline and periodic assessment of liver function** (ALT, AST, bilirubin), especially in patients with pre-existing liver disease or risk factors for liver disease.
* **Baseline and periodic assessment of bone mineral density** may be considered, particularly in patients with a history of fractures or other risk factors for osteoporosis.
* **HIV-1 RNA viral load** to assess treatment efficacy.
* **CD4+ T-cell count** to assess immune system recovery.
## Clinical Pearls
* TAF/FTC should be taken orally once daily with or without food.
* If taken with other antiretroviral agents, consult specific combination therapy guidelines.
* Emphasize adherence to medication to prevent viral resistance.
* Advise patients to report any new or worsening symptoms, especially those related to kidney or liver function, or bone pain.
* Consider testing for Hepatitis B virus (HBV) co-infection before initiating therapy, as TAF/FTC may be associated with HBV flare upon discontinuation.
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*Disclaimer: This information is intended for clinical use and does not replace comprehensive drug reference materials. Always consult the most current prescribing information and local guidelines before making treatment decisions.*
