tenofovir
Tenofovir disoproxil fumarate (Viread), also known as TDF, is a first-choice medication that's used as part of an antiretroviral (ARV) regimen for treating human immunodeficiency virus (HIV) infections. It's also a preferred medication used for treating hepatitis B virus (HBV). Tenofovir disoproxil fumarate, the active ingredient in Viread, is also found in Truvada, a combination medication commonly used for HIV PrEP. Tenofovir disoproxil fumarate (Viread) is available as both an oral tablet and a powder that's mixed with soft food. Common side effects include rash, diarrhea, and headache.
What is Tenofovir disoproxil fumarate (Viread)?
What is Tenofovir disoproxil fumarate (Viread) used for?
How Tenofovir disoproxil fumarate (Viread) works
Tenofovir disoproxil fumarate (Viread) is a nucleoside reverse transcriptase inhibitor (NRTI). It works in HIV by inserting itself into the genetic material of the virus. In doing so, it prevents HIV from making copies of itself and spreading.
Tenofovir disoproxil fumarate (Viread) also works in HBV by blocking an enzyme (protein) called HBV polymerase that usually helps the virus make copies of itself. By blocking HBV polymerase, tenofovir disoproxil fumarate (Viread) also stops HBV virus from spreading.
Drug Facts
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What are the side effects of Tenofovir disoproxil fumarate (Viread)?
Common Side Effects
- Higher cholesterol levels (19-22%)
- Rash (5-18%)
- Diarrhea (9-16%)
- Headache (5-14%)
- Pain (3-13%)
- Higher creatine kinase (CK) levels, suggesting muscle damage (9-12%)
- Feeling depressed (4-11%)
- Nausea (8-11%)
- Lack of energy (6-11%)
Other Side Effects
- Back pain
- Dizziness
- Fever
- Upper respiratory tract or sinus infections
- Stomach pain
- Feeling anxious
- Vomiting
- Trouble sleeping
- Joint pain
Serious Side Effects
- Build up of lactic acid in the blood: feeling more tired and weak, belly pain, muscle pain, breathing problems
- Serious kidney problems: tiredness, confusion, nausea, urinating less than usual, swelling in your legs, ankles, or feet, joint pain, bone pain
- Serious liver problems: nausea, vomiting, not feeling hungry, pain in the right side of the stomach, yellowing of the whites of the eyes or skin, dark-colored urine, light-colored stool
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bone pain
- High lactic acid level—muscle pain or cramps, stomach pain, trouble breathing, general discomfort and fatigue
- Infection—fever, chills, cough, or sore throat
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of Tenofovir disoproxil fumarate (Viread)
Pros
Can treat both HIV and HBV infections
Only taken once a day
Available in a powder form that can be mixed with soft foods for people who have difficulty swallowing pills
Tablet form is available as a lower-cost generic medication
Cons
Requires regular blood work and lab tests to make sure your liver and kidneys are healthy
Can worsen hepatitis B if stopped all of a sudden
More likely to cause bone problems compared to similar medications
Interacts with certain medications for hepatitis C and HIV, such as atazanavir (Reyataz) and Harvoni (ledipasvir / sofosbuvir)
Pharmacist tips for Tenofovir disoproxil fumarate (Viread)
Make sure to get your routine blood tests done on time before and while you’re taking tenofovir disoproxil fumarate (Viread). This helps your provider make sure the medication is working for you and not causing side effects.
Taking tenofovir disoproxil fumarate (Viread) can sometimes put you at risk for kidney problems. During treatment with tenofovir disoproxil fumarate (Viread), it's best to avoid other medications that can raise your risk of kidney damage, such as ibuprofen (Advil) and naproxen (Aleve). Let your provider or pharmacist know what medications you're taking or planning to take, including over-the-counter products and supplements.
Tenofovir disoproxil fumarate (Viread) might weaken your bones. Ask your provider whether you need to take supplements such as calcium and vitamin D to strengthen your bones.
Talk to your provider before stopping tenofovir disoproxil fumarate (Viread) or any of your HIV medications. Doing so can cause the virus to spread and become harder to treat. And if you also have hepatitis B, stopping tenofovir disoproxil fumarate (Viread) suddenly can cause your hepatitis B infection to come back or worsen.
Since tenofovir disoproxil fumarate (Viread) can be used to treat both HIV and HBV infections, your provider might order lab tests before starting treatment to see if you have both viruses. Depending on your test results, your provider might add other medications to make sure your treatment is complete.
Tell your provider if your child experiences any changes in weight while taking tenofovir disoproxil fumarate (Viread) because the dose might need to be changed for those under 77 pounds.
Tips for taking Viread oral powder
If you're having trouble swallowing the tablet, ask your provider about using the Viread oral powder. The powder form is preferred for children who weigh at least 22 pounds and have trouble swallowing pills.
How to take tenofovir disoproxil fumarate (Viread) oral powder: Mix the tenofovir disoproxil fumarate (Viread) oral powder with 2 to 4 ounces of soft foods, such as applesauce, baby food, or yogurt. Swallow the entire dose of medication right away without chewing, since it can cause a bitter taste in your mouth if left out too long. Make sure to use the scoop provided with the oral powder to measure out the amount of medication for each dose.
Don't mix tenofovir disoproxil fumarate (Viread) oral powder with liquid since the powder will float to the top after stirring.
Frequently asked questions about Tenofovir disoproxil fumarate (Viread)
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What are the risks and warnings for Tenofovir disoproxil fumarate (Viread)?
Tenofovir disoproxil fumarate (Viread) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Worsening of hepatitis B infection
Risk factors: Have hepatitis B and HIV | Stopping tenofovir disoproxil fumarate (Viread) | Severe liver problems
If you have hepatitis B virus (HBV), suddenly stopping tenofovir disoproxil fumarate (Viread) can also make your liver condition worse (also called an HBV flare-up). Don't stop taking tenofovir disoproxil fumarate (Viread) without talking with your provider first. Make sure to get your refills on time so that your treatment isn't interrupted. If you need to stop taking tenofovir disoproxil fumarate (Viread), your provider will follow up with you for several months after you stop treatment. They'll order blood work to check your liver for an HBV flare-up.
Kidney problems
Risk factors: History of kidney problems | Taking other medications known to harm kidneys
Some people taking tenofovir disoproxil fumarate (Viread) have developed kidney problems. Sometimes it happens right after starting the medication. For others, the damage happens over time. To be safe, you're recommended to avoid taking other medications that can also harm the kidneys, like high doses of anti-inflammatory drugs called non-steroidal anti-inflammatory drugs (NSAIDs). Before starting and during treatment with tenofovir disoproxil fumarate (Viread), Your provider will order blood work or urine tests regularly to check on your kidneys. Let your provider know right away if you experience bone or muscle pain, pain in your arms or legs, and general weakness that don't go away. These might be signs of kidney problems.
Overactive immune system
Taking tenofovir disoproxil fumarate (Viread) can cause changes to your immune system called immune reconstitution syndrome. This medical condition happens when your immune system becomes more active after you start tenofovir disoproxil fumarate (Viread) treatment. Your immune system begins to fight off different infections that it was too weak to fight off before you started treatment. In rare cases, your immune system might improve so much with treatment that it starts to attack normal cells in your body (autoimmune). You can develop immune reconstitution syndrome as early as during the first few weeks of tenofovir disoproxil fumarate (Viread) treatment or many months later. Tell your healthcare provider right away if you start having any new symptoms, such as fever, pain, hair loss, bulging eyes, or sweating, after starting tenofovir disoproxil fumarate (Viread).
Bone problems
Risk factors: History of bone fractures | HIV infection | Osteoporosis | History of kidney problems
People who take tenofovir disoproxil fumarate (Viread) to treat HIV infection have experienced lower bone mineral density (BMD) and bone loss. This might lead to higher risk of osteoporosis and bone fractures. In addition, some people with kidney problems have also experienced joint or muscle pain while taking tenofovir disoproxil fumarate (Viread). As a result, your provider might order additional tests to check your bone density to avoid bone problems. Talk to your provider about taking calcium and vitamin D supplements to strengthen your bone during treatment of tenofovir disoproxil fumarate (Viread).
Liver problems and lactic acidosis
Risk factor: History of liver problems
Rarely, people who take NRTIs, such as tenofovir disoproxil fumarate (Viread), can experience liver problems. While liver injury can happen to anyone taking these medications, the risk of worsening liver problems might be higher if you also have hepatitis B or hepatitis C. Talk with your provider about your medical history before starting this medication so they can decide how you can safely take tenofovir disoproxil fumarate (Viread).
Additionally, tenofovir disoproxil fumarate (Viread) can cause a buildup of lactic acid in the blood (lactic acidosis) and fatty liver. Both conditions can be life-threatening.
Make sure to get blood tests done while you take tenofovir disoproxil fumarate (Viread) so your provider can check your liver health. If you experience signs and symptoms of liver damage, such as upper right stomach pain, yellowing of the skin or whites of the eyes, or dark urine, talk with your provider right away. Also, let your provider know if you experience symptoms of lactic acidosis, such as feeling weak, muscle pain, and trouble breathing.
Interaction with other medications
Taking certain medications to treat hepatitis C (e.g., Epclusa (sofosbuvir / velpatasvir)) can raise the amount of tenofovir disoproxil fumarate (Viread) in your body. This can worsen your side effects, such as rash, diarrhea, and nausea. Your provider will monitor you to make sure these medications are safe for you.
Because of the potential for interactions with tenofovir disoproxil fumarate (Viread) and various medications, tell your provider and pharmacist about all the medications you take or plan to take. They can make sure your medications are safe to take together.
Tenofovir disoproxil fumarate (Viread) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 300mg | 90 tablets | $52.13 | $0.58 |
Typical dosing for Tenofovir disoproxil fumarate (Viread)
Adults and children who weigh at least 35 kg (77 lb): The typical dose is 300 mg by mouth once daily.
Children 2 years and older who weigh at least 17 kg (37 lbs): The dose will depend on your child’s weight. The typical dose is 8 mg/kg of body weight by mouth daily, up to a maximum of 300 mg.
Your dose might differ if you have kidney problems. Viread is also available as a powder to be mixed with soft foods for people who weigh at least 22 lbs and have trouble swallowing tablets.
How much does Tenofovir disoproxil fumarate (Viread) cost?
What are alternatives to Tenofovir disoproxil fumarate (Viread)?
Hepatitis B virus (HBV) in people ages 6 years and older weighing at least 55 lbs
Treatment of HIV infection for people ages 3 months and older - brand and generic Epivir only
Treatment of chronic (long-term) hepatitis B for people ages 2 years and older - brand and generic Epivir HBV only
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References
Best studies we foundCamber Pharmaceuticals, Inc. (2023). TENOFOVIR DISOPROXIL FUMARATE- tenofovir disoproxil fumarate tablet, film coated [package insert]. DailyMed.
Centers for Disease Control and Prevention. (2021). Preexposure prophylaxis for the prevention of HIV infection in the United States – 2021 update: A clinical practice guideline.
Clinicalinfo.HIV.gov. (2022). Guidelines for the use of antiretroviral agents in adults and adolescents with HIV.
Clinicalinfo.HIV.gov. (n.d.). Immune reconstitution inflammatory syndrome (IRIS).
Clinicalinfo.HIV.gov. (2023). Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States.
Ganesan, M., et al. (2020). Role of alcohol in pathogenesis of hepatitis B virus infection. World Journal of Gastroenterology.
Gilead Sciences, Inc. (2016). U.S. Food and Drug Administration approves Gilead’s Vemlidy (tenofovir alafenamide) for the treatment of chronic hepatitis B virus infection.
Gilead Sciences, Inc. (2019). Patient information: VIREAD tablets. VIREAD oral powder [package insert].
Gilead Sciences, Inc. (2021). VIREAD- tenofovir disoproxil fumarate tablet, coated. VIREAD- tenofovir disoproxil fumarate powder [package insert]. DailyMed.
HIV.gov. (2022). Alcohol and HIV risk.
HIVinfo.NIH.gov. (2021). Drug resistance.
MedlinePlus. (2017). Fatty liver disease.
Terrault, N. A., et al. (2016). AASLD guidelines for treatment of chronic hepatitis B. Hepatology.
Terrault, N. A., et al. (2018). Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology.
Thapa, S., et al. (2023). Immune reconstitution inflammatory syndrome. StatPearls.
U.S. Department of Health and Human Services. (2023). Hepatitis B basic information.
VEMLIDY. (n.d.). VEMLIDY: An improved bone safety profile.
Wassner, C., et al. (2020). A review and clinical understanding of tenofovir: Tenofovir disoproxil fumarate versus tenofovir alafenamide. Journal of the International Association of Providers of AIDS Care.
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