Viread

Viread is a very well-tolerated medication with minimal side effects. The most commonly reported side effects are diarrhea, nausea, asthenia (muscle weakness), headache, depression, and abdominal pain. Other, more rarely reported side effects include rash, excessive gas, and generalized pain and achiness, including back pain. Nervous system side effects include depression, insomnia, peripheral neuropathy, and dizziness. All Viread products contain lactose and may exacerbate symptoms in someone who is lactose intolerant. Viread may lead to decreases in bone mineral density (BMD), and patients should be monitored for osteopenia or osteoporosis. This decrease in BMD is likely reversed when the medication is stopped. As Viread is processed by the kidneys, there is risk of kidney toxicity, including acute renal failure and Fanconi Syndrome (injury to kidney tubules and high levels of phosphorus). Before starting it, 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.

There are two potential serious side effects when taking Viread: lactic acidosis and the serious liver conditions. They are, however, more common with older medications in the same class as Viread (NRTI) and are unlikely to occur. (1) Lactic acidosis: The 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. (2) 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).

Be sure to tell your medical provider or pharmacist about all the medications, supplements, and herbal products you take, whether prescribed, over-the-counter, or illicit, before starting this regimen, and inform them of any changes as they happen. Do not take Viread with the HBV treatment Hepsera (adefovir) due for possible worsening of renal function in combination. Viread cannot be taken with any of the following HIV combination medications, as they also contain tenofovir (duplicate therapy): Atripla, Symfi, Symfi Lo, Complera, Odefsey, Descovy, Truvada, Biktarvy, Stribild, Genvoya, Cimduo, or Delstrigo.  Another HIV medication, Reyataz, must always be “boosted” (meaning given with ritonavir 100 mg or cobicistat 150 mg daily to increase levels in the body) when taken with Viread. Use caution when taking Viread with other medications that could negatively affect the kidneys, including chronic use or high doses of NSAIDS (non-steroidal anti-inflammatory drugs, such as Advil, Aleve, ibuprofen, naproxen, or Motrin). Viread is safe to take with most HCV DAAs, but renal function should be monitored when taken with Epclusa, Harvoni, or Vosevi, especially if a “booster” is also being used.

Viread (and its related drug Vemlidy) are also HIV medications. Before starting Viread, you should be tested for HIV. If you are co-infected with HBV/HIV, you should not treat HBV without also treating HIV to prevent resistance mutations in the HIV. Two other HIV medications —Epivir and Emtriva —also work against HBV, although Epivir is no longer preferred for the treatment of HBV. In people with HBV/HIV co-infection, the combination of Emtriva and Viread (or Vemlidy) is the preferred regimen for treatment of HBV.

Abrupt discontinuation of Viread may cause a severe, acute exacerbation of hepatitis B, which can result in hepatic decompensation and liver failure. If Viread is discontinued, your doctor should closely monitor you for symptoms of exacerbation. Do not stop this medication without talking to your doctor first.

For individuals with HBV/HCV co-infection or those at risk of HBV reactivation while undergoing HCV DAA treatment, Viread is one of the medications you could be prescribed to prevent this from happening. See HBV Reactivation for more information and consult your medical provider.

Viread is safe to use in children age 2 and older, weighing at least 22 pounds (10 kg) or more. Dose adjustments may be needed and should be done in consultation with an experienced medical provider. For people with kidney disease, there may also be a need for dose adjustments. See the chart below for recommendations, and make sure you are routinely monitored by your medical provider while taking this treatment.

Dosage interval adjustment for adults with altered creatinine clearance

*Assuming 3 hemodialysis sessions/week, each lasting approximately 4 hours.