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# Tabovoihep
## Overview
Tabovoihep is a combination medication containing tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC), nucleoside reverse transcriptase inhibitors (NRTIs) used for the treatment of HIV-1 infection.
## Primary Indications
Treatment of HIV-1 infection in adults and pediatric patients.
## Adult Dosing
One tablet (TDF 300 mg / FTC 200 mg) orally once daily.
## Pediatric Dosing
For treatment-naive patients weighing at least 17 kg to less than 22 kg: 150 mg TDF / 100 mg FTC orally once daily.
For treatment-naive patients weighing at least 22 kg to less than 28 kg: 200 mg TDF / 133 mg FTC orally once daily.
For treatment-naive patients weighing at least 28 kg to less than 35 kg: 250 mg TDF / 167 mg FTC orally once daily.
For treatment-naive patients weighing 35 kg or more: One tablet (TDF 300 mg / FTC 200 mg) orally once daily.
Dosing for treatment-experienced pediatric patients or those with specific comorbidities may differ and should be determined by a specialist.
## Dose Adjustments
No dose adjustment is required for patients with mild to moderate renal impairment.
**CrCl < 30 mL/min:** Avoid use or consult prescribing information for dose reduction recommendations.
**CrCl < 10 mL/min:** Use is not recommended.
## Contraindications
* Known hypersensitivity to emtricitabine, tenofovir disoproxil fumarate, or any component of the formulation.
* Use in patients with severe renal impairment (CrCl < 30 mL/min).
## Adverse Effects
* **Common:** Nausea, diarrhea, headache, dizziness, rash, asthenia.
* **Serious:** Lactic acidosis, severe hepatomegaly with steatosis, renal impairment (including acute renal failure and Fanconi syndrome), bone mineral density decrease, immune reconstitution inflammatory syndrome (IRIS).
## Key Drug Interactions
* **Didanosine:** Increased risk of pancreatitis and peripheral neuropathy. Avoid co-administration.
* **Adefovir dipivoxil:** Increased risk of renal toxicity. Avoid co-administration.
* **Nephrotoxic agents:** Concomitant use with drugs that can impair renal function (e.g., NSAIDs, certain antibiotics like aminoglycosides) may increase the risk of renal-related adverse events. Monitor renal function closely.
* **Raltegravir, dolutegravir, bictegravir:** Co-administration may affect serum concentrations. Consult prescribing information for specific recommendations.
## Monitoring
* Renal function (serum creatinine, CrCl, urinalysis) at baseline and periodically during treatment.
* Hepatitis B virus (HBV) status at baseline and monitor for flare upon discontinuation in patients with pre-existing HBV infection.
* Bone mineral density may be considered in patients with a history of fractures or other risk factors for osteoporosis.
* Liver function tests.
* Signs and symptoms of lactic acidosis.
## Clinical Pearls
* This combination is also available as a single tablet regimen with efavirenz (e.g., Atripla) or with rilpivirine (e.g., Complera/Eviplera), or with elvitegravir/cobicistat (e.g., Stribild).
* For patients with moderate renal impairment (CrCl 30-49 mL/min), a dose adjustment is necessary, typically by extending the dosing interval. Consult specific prescribing information.
* Discontinuation of emtricitabine or tenofovir can lead to severe exacerbations of hepatitis B. Patients with co-infection of HIV and HBV should be carefully monitored.
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*Disclaimer: This information is intended for clinical decision-making and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before initiating or modifying drug therapy. Dosing and recommendations may vary based on individual patient factors, local protocols, and evolving clinical evidence.*
