tenofovir disoproxil fumarate (TDF)
Standard DoseOne 300 mg tablet once daily, without regard to food in adults and children at least 2 years old weighing at least 21 pounds (10 kg). Viread tablets are also available in the following dosages: 150 mg, 200 mg, 250 mg tablets, and oral powder (40 mg/g in 60 g packets). Viread tablets can be disintegrated in water, grape juice, or orange juice with minor stirring and pressure from a spoon. In children, Viread is dosed based on body weight. See package insert for specific weight-based dosing. Must be taken in combination with another antiretroviral(s) which does not contain the medication in this drug.
Take missed dose as soon as possible, unless it is closer to the time of your next dose. Do not double up on your next dose. Dosing frequency needs to be adjusted for adults and children with decreased kidney function (for creatinine clearance, or CrCl, less than 50 mL/min). See package insert for guidance on dosing in the setting of kidney impairment. FDA approved for chronic HBV in patients 12 years and older weighing at least 77 pounds (35 kg).
See package insert for more complete information on potential side effects and interactions.
ManufacturerGilead Sciences, Inc.
(800) GILEAD-5 (445-3235)
AWP300 mg tablets: $1,368.26/month
generic 300 mg tablets: $1215.94/month
Potential Side Effects and Toxicity
Generally well tolerated, but some may experience nausea, diarrhea, vomiting, and gas. Decreases in bone mineral density (BMD) have been observed. BMD monitoring should be considered in people who have a history of bone fracture due to bone disease or are at risk for osteopenia or osteoporosis. Viread may cause kidney toxicities. Creatinine clearance (CrCl) should be assessed before initiating treatment. In addition to CrCl, glucose and protein in the urine and serum phosphorus should be monitored more often in patients at risk for kidney problems. Tell your provider about any pain in extremities, persistent or worsening bone pain and fractures, with or without muscular pain or weakness, as well as any concerning changes in urinary habits, as these could be signs of kidney problems. If you have HIV and HBV, guidelines recommend treatment for both viruses. Viread can treat both HIV and HBV, but must be used in combination with another hep B drug (such as Emtriva) to treat the hep B. If you are co-infected with HBV and HIV, you should not stop Viread without medical supervision because it can cause your HBV to flare and cause you to experience signs and symptoms of acute hepatitis. HBV should be closely monitored by your provider. The Viread formulation contains lactose, which can cause some abdominal discomfort, especially in patients sensitive to lactose.
Potential Drug Interactions
Viread decreases the levels of Reyataz; therefore, Reyataz 300 mg must be boosted with Norvir 100 mg or Tybost 150 mg (taken together with food) when used in combination with TDF. Kaletra, Prezista/Norvir, and Reyataz/Norvir increase Viread levels, but there is no dose adjustment needed. Patients taking Kaletra, Prezista/Norvir, or Reyataz/Norvir with TDF should be monitored for Viread side effects (including kidney disorders) due to the higher TDF levels. Do not take Viread with adefovir. Avoid taking Viread with drugs that negatively affect the kidneys, including chronic use or high doses of NSAIDS (non-steroidal anti-inflammatory drugs for pain, such as Advil or Motrin (ibuprofen) and Aleve (naproxen). Viread may be used with hepatitis C drugs such as Daklinza, Harvoni, Olysio, Sovaldi, Viekira Pak, or Zepatier, depending on the other components in the HIV regimen. Monitor for tenofovir toxicities if used with Epclusa. Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not.
TDF with emtricitabine, as Truvada, is a recommended NRTI combination by DHHS HIV treatment guidelines for first-time therapy. A new version of tenofovir, called tenofovir alafenamide (TAF), replaced TDF in certain fixed-dose combinations. Biktarvy, Genvoya, and Odefsey are three single-tablet regimens containing TAF instead of TDF. Descovy is another version of Truvada, combining emtricitabine with TAF instead of TDF. In clinical trials, TAF had fewer kidney and bone issues than TDF. The NIH reported last year that infants exposed in the womb to TDF may have lower bone mineral content than those exposed to other antivirals. Tenofovir DF was approved in 2012 as part of Truvada for HIV prevention as PrEP (pre-exposure prophylaxis; see Truvada for PrEP page). TDF is part of the single-tablet regimens Atripla, Symfi, Symfi Lo, Complera, Delstrigo, and Stribild as well as the fixed-dose combination tablets Cimduo and Temixys. Viread as part of the combination tablet Truvada is recommended by DHHS as one of the preferred NRTI combination components of an ART regimen in pregnancy.
Dr. David Hardy says:
Viread was approved in 2001 as the sixth nuke. Because of its different HIV resistance mutation pattern, it continued to be potent when other nukes had failed and thus became a common part of most ART regimens from 2001 to 2015. Its most common short-term side effects are mild nausea, queasiness, and mild diarrhea; on a long-term basis it can cause kidney damage and weakening of bones (osteoporosis or bone demineralization) in a small percentage of PLWH. It is increasingly being replaced by TAF-containing regimens. A generic form of Viread became available in the U.S. in December 2017.
Activist Moisés Agosto-Rosario says:
Viread, or tenofovir disoproxil fumarate (TDF), is potent, well tolerated, and has a long half-life. Monitoring kidney function is important while taking TDF. It has been shown to cause kidney toxicity as well as loss of bone density. These side effects tend to disappear when discontinued. It is a component of the single-tablet regimens Complera and Stribild, as well as Truvada, a widely used fixed-dose combination as a nuke backbone, and as a prophylaxis for HIV infection. Its manufacturer has developed an improved version of TDF known as TAF (tenofovir alafenamide fumarate). TAF is a component of the single-tablet regimen Genvoya and is replacing TDF in many fixed-dose combination and single-tablet regimens.