tenofovir alafenamide (TAF)
Standard DoseOne 25 mg tablet once per day, with food. Take your missed dose as soon as possible, unless it is closer to the time of your next dose. Never double your dose.
AWP$1,407 / month
Potential Side Effects and Toxicity
Vemlidy is a very well-tolerated medication with minimal side effects. The most commonly reported side effects were headache, abdominal pain, fatigue, cough, nausea, and back pain. Not everyone experiences side effects, and among those who do, approximately 1% have to stop taking Vemlidy. Vemlidy is processed by the kidneys, so there is some risk of kidney toxicity. Before starting treatment, patients should have their creatinine clearance (CrCl) assessed. Routine monitoring of glucose and protein in the urine, and of serum phosphorus should be standard of care, too. If you experience any pain in the extremities, persistent or worsening bone achiness/pain, or fractures with or without muscular pain, consult your medical provider immediately. Vemlidy may lead to lactic acidosis, a buildup of lactic acid in the blood that could be fatal. Signs and symptoms of lactic acidosis include feeling very weak or excessively fatigued, difficulty breathing, stomach pain with nausea and vomiting, feeling cold and chills (especially in arms and legs), dizziness and light-headedness, fast or irregular heartbeat, or unusual muscle pain. If you experience any of these symptoms contact your medical provider immediately. Two liver conditions, hepatomegaly (enlarged liver) or steatosis (fatty liver), may occur. Signs and symptoms of these liver conditions include yellowing of the eyes and/or skin (jaundice), dark colored urine, light colored stools, nausea, loss of appetite, and pain, achiness or tenderness of the liver (lower right side of the belly, below the ribcage and next to the belly button).
Potential Drug Interactions
Be sure to tell your medical provider or pharmacist about all the medications, supplements, and herbs you take, whether they are prescribed, over-the-counter, or illicit, before starting this regimen; report any changes as they happen. Because Vemlidy is related to Viread (tenofovir DF), the two medications cannot be taken together. Similarly, it cannot be taken with any of the following HIV combination medications, as they contain tenofovir DF: Atripla, Biktarvy, Cimduo, Complera, Delstrigo, Descovy, Odefsey, Stribild, Symfi, Symfi Lo, Symtuza, Genvoya, or Truvada. If taken with the anticonvulsant carbamazepine, Vemlidy dosage should be increased to two tablets once per day. Vemlidy should not be taken with oxcarbazepine, phenobarbital, or phenytoin. Vemlidy should not be taken with the antimycobacterial medications rifabutin, rifampin, and rifapentine. Vemlidy should not be taken with St. John’s wort.
Vemlidy will not cure HBV—no HBV medication will cure you—but it can decrease your risk of long-term complications such as cirrhosis or liver cancer. Vemlidy is related to Viread, using a smaller dose that is more efficiently delivered so the risks of kidney disease and loss of bone density appear to be less. Before starting Vemlidy, you should be tested for HIV. If you are co-infected with HBV/HIV, you should not treat HBV without also treating your HIV. If you have HBV/HIV, and need to switch from any tenofovir-containing regimen, there is a risk of an HBV flare-up with signs and symptoms of acute HBV infection. For individuals with HBV/HCV co-infection, or those at risk of HBV reactivation while undergoing HCV DAA treatment, Vemlidy is one of the medications you could be prescribed to prevent this from happening. There is no dosage requirement for people with kidney disease who have a creatinine clearance greater or equal to 15mL per minute. For those with end stage kidney disease (those who have a creatinine clearance below 15mL per minute), they can take Vemlidy as long as they undergo dialysis. On days of dialysis, Vemlidy should be taken upon completion of dialysis. Vemlidy is safe for people with mild liver damage (Child-Pugh A), but it should not be used in patients with decompensated cirrhosis (Child-Pugh B or C).