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
Side effects of Tenofovir disoproxil fumarate (Viread)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
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%)
Please note: The side effects above were reported by people taking this medication for HIV infection.
Less Common Side Effects
- Back pain
- Dizziness
- Fever
- Upper respiratory tract or sinus infections
- Stomach pain
- Feeling anxious
- Vomiting
- Trouble sleeping
- Joint pain
Tenofovir disoproxil fumarate (Viread) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- 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
The following Tenofovir disoproxil fumarate (Viread) 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):
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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.
Common questions about Tenofovir disoproxil fumarate (Viread)
Yes, tenofovir disoproxil fumarate (Viread) can be used as PrEP, but it needs to be taken with other HIV ARVs. PrEP, also known as pre-exposure prophylaxis (prevention), is a combination of HIV medications that people who don't have HIV can take to prevent infection before getting potentially exposed to the virus (e.g., through sex, through sharing needles). According to the CDC guidelines, one of the preferred PrEP medications is Truvada, which is a complete HIV PrEP medication that contains tenofovir disoproxil fumarate, the ingredient in Viread. If you're interested in taking medications for PrEP, talk to your provider about the best option for you.
It's best to avoid alcohol if you're taking tenofovir disoproxil fumarate (Viread) for HBV or HIV infection. In general, drinking too much alcohol while you're taking tenofovir disoproxil fumarate (Viread) can worsen your side effects, such as dizziness, diarrhea, nausea, and vomiting. In addition, alcohol can damage your liver, which can cause your hepatitis B to get worse. Speak with your provider about your alcohol habits while taking tenofovir disoproxil fumarate (Viread).
Though not common, some people did report weight loss as a side effect after taking tenofovir disoproxil fumarate (Viread) in clinical studies. Tenofovir disoproxil fumarate (Viread) can cause side effects such as diarrhea, nausea, and vomiting. As a result, you might experience losing some weight during treatment with this medication. Make sure to let your provider know if you experience these side effects and they won’t go away. Too much vomiting and diarrhea can lead to dehydration (low body fluids), which can be dangerous.
Tenofovir disoproxil fumarate (Viread) and Vemlidy (tenofovir alafenamide) are both approved to treat HBV infection. But tenofovir disoproxil fumarate (Viread) is also approved to treat HIV. The medications get absorbed differently by your body. As a result, there are some differences in side effects. Research also suggest that Vemlidy is less likely to cause side effects to your kidneys and bones in comparison to tenofovir disoproxil fumarate (Viread). Talk to your provider to discuss which one is the right treatment option for you.
No, tenofovir disoproxil fumarate (Viread) isn't a cure for hepatitis B. Currently, all available medications for hepatitis B can only slow down the development of serious liver problems, including liver cancer. Medications, such as tenofovir disoproxil fumarate (Viread), can lower the amount of HBV in your body, which prevents the virus from spreading. In clinical studies that looked at how well tenofovir disoproxil fumarate (Viread) worked in people with active HBV, results showed that 67% of people had a very low viral load (amount of virus in the blood) and improvement in liver health after about a year of treatment.
In general, studies showed that tenofovir disoproxil fumarate (Viread) didn't raise the risk of birth defects if taken during pregnancy. If you're pregnant, talk with your provider to see if tenofovir disoproxil fumarate (Viread) is a good option for you. HIV clinical guidelines recommend that pregnant people with HIV start treatment as soon as possible to lower the risk of transferring the virus to the unborn baby. On the other hand, HBV clinical guidelines recommend treatment for only certain pregnant people with hepatitis B. If you choose to take tenofovir disoproxil fumarate (Viread) during pregnancy, you’re encouraged to enroll in the Antiretroviral Pregnancy Registry (APR). This registry collects information about your and your baby’s health during treatment with tenofovir disoproxil fumarate (Viread).
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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
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 300mg | 90 tablets | $42.16 | $0.47 |
Typical dosage 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.
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