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# Tabovoihep
## Overview
Tabovoihep is a brand name for a combination medication containing Tenofovir Alafenamide (TAF) and Emtricitabine (FTC), nucleoside reverse transcriptase inhibitors (NRTIs). It is a prodrug of tenofovir which is more efficiently delivered to lymphoid cells and hepatocytes compared to older formulations.
## Primary Indications
* Treatment of chronic hepatitis B virus (HBV) infection in adults and pediatric patients.
## Adult Dosing
* **Recommended Dose:** One tablet (TAF 25 mg / FTC 200 mg) taken orally once daily.
## Pediatric Dosing
* **Recommended Dose:** One tablet (TAF 25 mg / FTC 200 mg) taken orally once daily for patients weighing at least 35 kg.
* Dosing for pediatric patients weighing less than 35 kg should be based on local protocol and expert consultation, as weight-based dosing for this formulation is not fully established.
## Dose Adjustments
* No dose adjustment is generally required for mild to moderate renal impairment (CrCl ≥ 30 mL/min).
* **Severe Renal Impairment (CrCl < 30 mL/min) or End-Stage Renal Disease (ESRD):** Dosing information is not established. Use with caution or consider alternative agents.
## Contraindications
* Hypersensitivity to emtricitabine, tenofovir alafenamide, or any other component of the formulation.
## Adverse Effects
* **Common:** Nausea, diarrhea, headache, abdominal pain, rash, fatigue.
* **Serious:** Lactic acidosis, severe hepatomegaly with steatosis, redistribution/accumulation of body fat, immune reconstitution inflammatory syndrome (IRIS) in patients with HBV and HIV co-infection, renal impairment (less common with TAF compared to TDF), bone density changes (less common with TAF compared to TDF).
## Key Drug Interactions
* **Drugs affecting renal function:** Concomitant use with nephrotoxic drugs may increase the risk of renal adverse events.
* **Inducers of P-glycoprotein (P-gp) or Breast Cancer Resistance Protein (BCRP):** May decrease plasma concentrations of tenofovir alafenamide.
* **Anticonvulsants (e.g., carbamazepine, phenytoin):** May decrease plasma concentrations of tenofovir alafenamide.
## Monitoring
* Baseline and periodic liver function tests (ALT, AST, bilirubin).
* Renal function tests (serum creatinine, BUN, urinalysis) at baseline and periodically.
* Hepatitis B viral load at baseline and periodically to assess treatment response.
* For patients with HIV co-infection, monitor HIV viral load and CD4 count.
* Monitor for signs and symptoms of lactic acidosis and hepatotoxicity.
* Monitor bone mineral density if a history of pathological fracture exists or other risk factors for osteoporosis are present.
## Clinical Pearls
* Tabovoihep is effective for the treatment of chronic HBV infection and has a favorable renal and bone safety profile compared to older tenofovir formulations.
* It is crucial to counsel patients about adherence and the potential for serious adverse effects.
* Discontinuation of therapy can lead to HBV exacerbations; consider monitoring liver function closely after discontinuation.
* If used in patients co-infected with HIV, ensure the regimen provides adequate viral suppression for both viruses.
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This information is intended for healthcare professionals. Always verify the most current prescribing information with the official product labeling or consult with a specialist.
