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# Tabvoihep
## Overview
Tabvoihep is a brand name for tenofovir disoproxil fumarate (TDF). It is a nucleotide analog reverse transcriptase inhibitor (NtRTI) used in the treatment of HIV-1 infection.
## Primary Indications
Treatment of human immunodeficiency virus type 1 (HIV-1) infection in combination with other antiretroviral agents.
## Adult Dosing
The recommended dose for adults is **300 mg orally once daily**.
## Pediatric Dosing
* **Children 2 to < 12 years of age and weighing at least 10 kg:**
* **Weight-based dosing:** 6 mg/kg orally once daily, not to exceed the adult dose of 300 mg once daily.
* **Children < 2 years of age:** Dosing is not established.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is required based on creatinine clearance (CrCl).
* CrCl ≥ 50 mL/min: 300 mg once daily.
* CrCl 30 to < 50 mL/min: 300 mg every 48 hours.
* CrCl 10 to < 30 mL/min: 300 mg every 72 hours.
* CrCl < 10 mL/min or on hemodialysis: 300 mg every 7 days after a 300 mg dose on a hemodialysis day.
* **Hepatic Impairment:** No dose adjustment is recommended.
## Contraindications
* Hypersensitivity to tenofovir disoproxil fumarate or any component of the formulation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache, dizziness, rash, weakness.
* **Serious:**
* Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases.
* Renal impairment, including acute renal failure and Fanconi syndrome.
* Bone mineral density reduction (osteomalacia).
* New onset or exacerbation of hyperglycemia.
* Immune reconstitution inflammatory syndrome (IRIS).
## Key Drug Interactions
* **Didanosine:** Increased risk of pancreatitis and peripheral neuropathy. Concurrent use is generally not recommended.
* **Hepatotoxic drugs:** Increased risk of hepatotoxicity.
* **Drugs affecting renal function:** Concomitant use with nephrotoxic agents (e.g., aminoglycosides, NSAIDs, certain antivirals like tenofovir alafenamide) may increase the risk of renal adverse events.
## Monitoring
* **Renal function:** Serum creatinine and urinalysis with urine protein and glucose at baseline and periodically during treatment.
* **Bone mineral density:** Particularly in patients with a history of pathological fractures or other risk factors for osteoporosis.
* **Liver function tests:** Especially in patients with pre-existing liver disease or elevated transaminases.
* **Blood glucose:** In patients with diabetes or at risk for diabetes.
* **Viral load and CD4 count:** To assess treatment efficacy.
## Clinical Pearls
* Tabvoihep should be used in combination with other antiretroviral agents.
* Renal function monitoring is crucial, and dose adjustments are necessary for impaired renal clearance.
* Consider alternative NtRTI (e.g., tenofovir alafenamide) if bone mineral density loss or renal toxicity is a concern.
* Patient education on potential side effects, adherence, and the importance of regular monitoring is vital.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.
