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# Tabovoihep
## Overview
Tabovoihep is a brand name for a combination product containing tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC). It is a nucleoside reverse transcriptase inhibitor (NRTI) combination used for the treatment of HIV-1 infection.
## Primary Indications
Treatment of established HIV-1 infection in adult and pediatric patients (as part of combination antiretroviral therapy).
## Adult Dosing
**Recommended Dose:** One tablet (TDF 300 mg / FTC 200 mg) orally once daily.
## Pediatric Dosing
**Recommended Dose:** One tablet (TDF 300 mg / FTC 200 mg) orally once daily for pediatric patients weighing at least 35 kg.
* Dosing for pediatric patients weighing less than 35 kg requires alternative formulations of TDF and FTC, and specific dosing should be determined by a specialist.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is required in patients with moderate to severe renal impairment.
* CrCl 30-49 mL/min: 1 tablet every 48 hours.
* CrCl < 30 mL/min or End Stage Renal Disease (ESRD): Not recommended. Consult prescribing information for specific recommendations on TDF/FTC dose adjustments when used in combination with other antiretrovirals.
## Contraindications
* None listed for the combination product itself, beyond hypersensitivity to the individual components.
## Adverse Effects
* **Common:** Diarrhea, nausea, headache, rash, fatigue, dizziness.
* **Serious:** Lactic acidosis, severe hepatomegaly with steatosis (including cases of hepatic failure), immune reconstitution inflammatory syndrome (IRIS), renal impairment (including cases of acute renal failure and Fanconi syndrome, particularly with TDF), bone mineral density reduction (osteopenia, osteoporosis).
## Key Drug Interactions
* **Didanosine:** Increased risk of pancreatitis and hyperlactatemia. Concomitant use is not recommended.
* **Hepatitis B Virus (HBV) Agents:** Emtricitabine and tenofovir are active against HBV. Discontinuation may lead to severe acute exacerbations of hepatitis B.
* **Nephrotoxic Drugs:** Increased risk of renal toxicity when co-administered with other drugs that may affect renal function (e.g., NSAIDs, certain antivirals like adefovir dipivoxil, certain antibiotics like aminoglycosides).
## Monitoring
* **Renal Function:** Baseline and periodic monitoring of serum creatinine and creatinine clearance.
* **Liver Function:** Baseline and periodic monitoring of hepatic transaminases and bilirubin.
* **Bone Mineral Density:** Consider monitoring in patients with a history of pathological fractures or other risk factors for osteoporosis.
* **Lactate Levels:** Monitor for signs and symptoms of lactic acidosis.
* **HIV Viral Load and CD4 Count:** Regular monitoring as per HIV treatment guidelines.
* **Hepatitis B Status:** Screen for HBV infection before initiating therapy.
## Clinical Pearls
* Tabovoihep should be taken with food to improve absorption.
* Patients should be advised not to take other medications containing TDF or FTC.
* Due to the risk of Fanconi syndrome and renal impairment, careful monitoring of renal function is crucial, especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic medications.
* Bone density monitoring may be warranted in select patient populations receiving TDF-containing regimens.
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete and up-to-date details before making any treatment decisions.
