Viread
TDF tenofovir disoproxil fumarate
Standard Dose
One 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).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).
Generic available.
See package insert for more complete information on potential side effects and interactions.
Manufacturer
Gilead Sciences, Inc.gilead.com
(800) GILEAD-5 (445-3235)
AWP
300 mg tablets: $1,504.20/monthgeneric 300 mg tablets: $1,151.82/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 Harvoni 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.
More Information
TDF with emtricitabine (as Truvada) and TDF with lamivudine (as Cimduo or Temixys) are recommended NRTI combinations 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, Odefsey, and Symtuza are four 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 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 is part of the combination tablets Truvada, Cimduo, and Temixys, which are recommended by DHHS as part of the preferred NRTI combination components of an ART regimen in pregnancy.
Doctor Comments
Dr. Ross Slotten says:
No comment provided because of redundancy. Viread is almost exclusively used as part of combination tablets.
Activist Comments
Activist Bridgette Picou says:
Viread, more commonly known as tenofovir disoproxil fumarate (TDF), is a component of Truvada. It is also found in several STRs. TDF has been known to cause kidney toxicity and bone density loss, so monitoring will need to be done while taking the medication. Often the symptoms of the kidney problems will disappear once the medication is discontinued. The newer formulation of the drug is called TAF, and has a better safety profile and is becoming more widely used. Even with this, TDF is mostly well tolerated. Side effects should be minimal.