II. Indications
- Chronic Hepatitis B Infection (compensated liver disease)
- HIV Infection (combination therapy)
III. Contraindications
- eGFR <15 ml/min without Hemodialysis
- Decompensated Cirrhosis (Child-Pugh B or C)
IV. Mechanism
V. Precautions
- Risk of severe HBV exacerbation on discontinuation
- Monitor for at least 2 months after discontinuation
- Risk of induced HIV resistance in undiagnosed HIV coinfection
- HIV Test before use
- Do NOT use in monotherapy in HIV infected patients (must be used in combined regimens)
VI. Medications
-
Tenofovir disoproxil Fumarate (TDF, Viread)
- See Tenofovir Disoproxil
- Original Tenofovir formulation and used in Stribild, Truvada and Complera
- Associated with nephrotoxicity and decreased Bone Mineral Density
- Tenofovir Alafenamide Fumarate (TAF, Vemlidy)
- Covered on this page
- Tenofovir formulation released in 2016 and used in Genvoya, Descovy, Odefsey
- TAF appears to have less adverse Renal Function and Bone Mineral Density effects than the original TDF
- TAF is associated with greater weight gain and dyslipidemia than TDF
VII. Dosing
- Adults with Chronic Hepatitis B Infection
- Tenofovir Alafenamide (TAF) 25 mg orally daily with food
- Adults with HIV Infection
- Tenofovir Alafenamide (TAF) 25 mg orally daily with food AND
- Take with Emtricitibine 200 mg orally daily
- Renal
- Contraindicated in eGFR <15 ml/min without Hemodialysis
- No renal dose adjustments needed if on Hemodialysis OR eGFR >15 ml/min
VIII. Adverse Effects
- See nRTI for adverse effects attributed to the class
- See Tenofovir Disoproxil
- Serious (potentially fatal)
- Lactic Acidosis
- Hepatic Steatosis
- Renal dysfunction
- Increased Serum Creatinine
- Proteinuria
- Electrolyte abnormalities
- Acute Renal Failure (1% risk)
- Associated with longer duration of therapy, advanced HIV or pre-existing renal disease
- Gastrointestinal
- Miscellaneous
- Headache
- Hepatitis B flares on withdrawal of medication
IX. Safety
- Avoid in Lactation
- Unknown safety in pregnancy (pregnancy registry exists)
X. Drug Interactions
-
Carbamazepine
- Increase dose to 50 mg orally daily (from 25 mg orally daily)
- Avoid Tenofovir Alafenamide Fumarate (TAF, Vemlidy) with the following agents
XI. Monitoring
- Obtain baseline Renal Function, Phosphorus, Urine Protein and then at 2-8 weeks, and then every 3-6 months
XII. Resources
- Tenofovir Alafenamide (DailyMed)
XIII. References
Images: Related links to external sites (from Bing)
Related Studies
| taf (on 2/22/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| TAFLUPROST 0.0015% EYE DROP | Generic | $4.29 each |
| vemlidy (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| VEMLIDY 25 MG TABLET | $41.78 each | |