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# Tab ## Overview Tab represents an oral formulation of tenofovir disoproxil fumarate (TDF), a nucleotide analogue reverse transcriptase inhibitor (NtRTI). It is primarily used in combination with other antiretroviral agents for the treatment of HIV-1 infection. ## Primary Indications * Treatment of Human Immunodeficiency Virus type 1 (HIV-1) infection in adults and pediatric patients. ## Adult Dosing * **Standard Dose:** 300 mg orally once daily. ## Pediatric Dosing * **Age 2 years and older, weighing at least 10 kg:** 300 mg orally once daily. * **Weight-based dosing:** 8 mg/kg orally once daily, not to exceed 300 mg per day. * Dosing for younger children or those weighing less than 10 kg is not established. ## Dose Adjustments * **Renal Impairment:** Dose adjustment is required based on creatinine clearance (CrCl). * CrCl 30-49 mL/min: 300 mg every 48 hours. * CrCl < 30 mL/min: 300 mg every 72 hours. * Hemodialysis: 300 mg every 7 days after completion of 6 doses spaced every 7 days. * **Hepatic Impairment:** No dose adjustment necessary. ## Contraindications * Hypersensitivity to tenofovir disoproxil fumarate or any of its components. ## Adverse Effects * **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache, rash, asthenia. * **Serious:** * **Nephrotoxicity:** Acute renal failure, proximal tubulopathy (Fanconi syndrome). Monitor renal function. * **Lactic Acidosis:** Potentially fatal. Symptoms include dyspnea, abdominal pain, malaise, myalgia, and hypothermia. * **Hepatotoxicity:** Including hepatomegaly with steatosis. * **Bone Mineral Density:** Decreases in bone mineral density (BMD) have been observed. * **Immune Reconstitution Inflammatory Syndrome (IRIS):** Can occur with combination antiretroviral therapy. ## Key Drug Interactions * **Nephrotoxic Drugs:** Coadministration with other nephrotoxic drugs (e.g., aminoglycosides, NSAIDs, lithium, foscarnet, cyclosporine) may increase the risk of renal impairment. Avoid concomitant use where possible. * **Didanosine:** Increased risk of pancreatitis and elevated systemic exposure of didanosine. Avoid coadministration or consider dose reduction of didanosine if used concurrently. * **Atazanavir:** Higher doses of atazanavir may be required when coadministered with TDF. * **Lopinavir/Ritonavir:** No dose adjustment for TDF is typically needed. ## Monitoring * **Renal Function:** Serum creatinine, blood urea nitrogen (BUN), and urine tests (proteinuria, glucosuria) at baseline and periodically during treatment. * **Electrolytes:** Serum electrolytes, particularly phosphate. * **Liver Function Tests:** AST, ALT, bilirubin. * **Bone Mineral Density:** Consider monitoring in patients with a history of skeletal fracture or other risk factors for osteopenia. * **Lipid Profile:** Consider monitoring. ## Clinical Pearls * TDF is renally excreted and requires dose adjustment in patients with impaired renal function. * Regular monitoring of renal function is crucial due to the risk of proximal tubulopathy. * Consider baseline and ongoing monitoring of bone mineral density, especially in patients with risk factors for osteoporosis. * TDF is often used in combination antiretroviral therapy (cART) regimens. *** **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current prescribing information and relevant guidelines for complete and up-to-date information before making any treatment decisions.