Tenofovir (PMPA)

What is Tenofovir (PMPA)

Tenofovir (also known as PMPA) is an acyclic nucleotide analog and is available as an ester prodrug, tenofovir disoproxil fumarate (tenofovir DF).

Tenofovir exhibits activity against HIV-1 viruses with reduced sensitivity to nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs).

Tenofovir’s activity is additive or synergistic when combined with other antiretroviral agents.

The FDA-approval of tenofovir DF was based on 2 clinical trials in previously treated patients who showed signs of continued HIV replication despite ongoing drug therapy.

Patients who received regimens containing tenofovir DF showed significant decreases in HIV RNA compared to patients receiving standard antiretroviral regimens.

Tenofovir also inhibits hepatitis B virus (HBV) and is indicated for chronic HBV infection.

The FDA-approved package labeling for tenofovir has a Black Box warning that acute exacerbations of hepatitis B have been reported in patients after discontinuation of the drug.

If treatment for HIV infection with tenofovir is discontinued in a patient co-infected with HBV, the patient should be closely monitored for several months for signs and symptoms of worsening hepatitis infection.

Decreases in bone mineral density (BMD) have been reported in patients treated with tenofovir.

Tenofovir is FDA-approved in adults and pediatric patients as young as 2 years.

Brand Name

Viread

Indications

  1. hepatitis B infection
  2. hepatitis B virus
  3. human immunodeficiency virus (HIV)
  4. human immunodeficiency virus (HIV) infection
  5. human immunodeficiency virus (HIV) prophylaxis

Side Effects

  1. abdominal pain
  2. angioedema
  3. anorexia
  4. anxiety
  5. arthralgia
  6. asthenia
  7. back pain
  8. bone fractures
  9. bone pain
  10. bullous rash
  11. chest pain (unspecified)
  12. depression
  13. diabetes insipidus
  14. diaphoresis
  15. diarrhea
  16. dizziness
  17. dyspepsia
  18. dyspnea
  19. elevated hepatic enzymes
  20. Fanconi syndrome
  21. fatigue
  22. fever
  23. flatulence
  24. glycosuria
  25. headache
  26. hematuria
  27. hepatitis B exacerbation
  28. hepatomegaly
  29. hyperamylasemia
  30. hypercholesterolemia
  31. hyperglycemia
  32. hypertriglyceridemia
  33. hypokalemia
  34. hypophosphatemia
  35. infection
  36. insomnia
  37. interstitial nephritis
  38. lactic acidosis
  39. lipodystrophy
  40. maculopapular rash
  41. myalgia
  42. myopathy
  43. nausea
  44. neuritis
  45. neutropenia
  46. osteomalacia
  47. osteopenia
  48. osteoporosis
  49. pancreatitis
  50. peripheral neuropathy
  51. pharyngitis
  52. polyuria
  53. proteinuria
  54. pruritus
  55. rash
  56. renal failure (unspecified)
  57. renal tubular acidosis (RTA)
  58. renal tubular necrosis
  59. rhabdomyolysis
  60. sinusitis
  61. steatosis
  62. urticaria
  63. vesicular rash
  64. vomiting
  65. weakness
  66. weight loss

Monitoring Parameters

  • blood glucose
  • CBC with differential
  • CD4+ T cell count
  • hepatitis B serology
  • LFTs
  • plasma hepatitis C RNA
  • plasma HIV RNA
  • pregnancy testing
  • serum bilirubin (total and direct)
  • serum cholesterol
  • serum creatinine/BUN
  • serum lipid profile
  • serum phosphate
  • urinalysis

Contraindications

  • alcoholism
  • autoimmune disease
  • bone fractures
  • breast-feeding
  • children
  • females
  • geriatric
  • Graves’ disease
  • Guillain-Barre syndrome
  • hepatic disease
  • hepatitis B and HIV coinfection
  • hepatitis B exacerbation
  • hepatitis C and HIV coinfection
  • hepatotoxicity or lactic acidosis
  • HIV serum status
  • human immunodeficiency virus (HIV) infection resistance
  • hypophosphatemia
  • immune reconstitution syndrome
  • obesity
  • osteomalacia
  • osteoporosis
  • pregnancy
  • renal failure
  • renal impairment
  • sexually transmitted disease

Interactions

  • Acalabrutinib
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acyclovir
  • Adefovir
  • Alogliptin; Metformin
  • Amikacin
  • Aminoglycosides
  • Aminosalicylate sodium, Aminosalicylic acid
  • Amiodarone
  • Amlodipine; Celecoxib
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Bacitracin
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Bepridil
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Boceprevir
  • Brigatinib
  • Cabozantinib
  • Canagliflozin; Metformin
  • Capmatinib
  • Carboplatin
  • Carvedilol
  • Celecoxib
  • Choline Salicylate; Magnesium Salicylate
  • Cidofovir
  • Cisplatin
  • Clarithromycin
  • Colchicine
  • Colchicine; Probenecid
  • Colistimethate, Colistin, Polymyxin E
  • Conivaptan
  • Cyclosporine
  • Dapagliflozin; Metformin
  • Darolutamide
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Dextromethorphan; Quinidine
  • Dichlorphenamide
  • Diclofenac
  • Diclofenac; Misoprostol
  • Didanosine, ddI
  • Diflunisal
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Dofetilide
  • Dronedarone
  • Elexacaftor; tezacaftor; ivacaftor
  • Eliglustat
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Ertugliflozin; Metformin
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Esomeprazole; Naproxen
  • Etodolac
  • Etravirine
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Flurbiprofen
  • food
  • Fosamprenavir
  • Foscarnet
  • Fostamatinib
  • Ganciclovir
  • Gentamicin
  • Glipizide; Metformin
  • Glyburide; Metformin
  • grapefruit juice
  • Hydrocodone; Ibuprofen
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Indomethacin
  • Iohexol
  • Iopamidol
  • Iopromide
  • Ioversol
  • Isosulfan Blue
  • Istradefylline
  • Itraconazole
  • Ivacaftor
  • Kanamycin
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Lansoprazole; Naproxen
  • Lapatinib
  • Ledipasvir; Sofosbuvir
  • Linagliptin; Metformin
  • Lopinavir; Ritonavir
  • Lumacaftor; Ivacaftor
  • Lumacaftor; Ivacaftor
  • Magnesium Salicylate
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Mefloquine
  • Meloxicam
  • Metformin
  • Metformin; Pioglitazone
  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Metformin; Saxagliptin
  • Metformin; Sitagliptin
  • Mifepristone
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nelfinavir
  • Neratinib
  • Non-Ionic Contrast Media
  • Nonsteroidal antiinflammatory drugs
  • Ombitasvir; Paritaprevir; Ritonavir
  • Orlistat
  • Osimertinib
  • Oxaliplatin
  • Oxaprozin
  • Pamidronate
  • Paromomycin
  • Piroxicam
  • Plazomicin
  • Polymyxin B
  • Polymyxins
  • Posaconazole
  • Probenecid
  • Propafenone
  • Quinidine
  • Ranolazine
  • Regorafenib
  • Rifaximin
  • Ritonavir
  • Rofecoxib
  • Rolapitant
  • Salicylates
  • Salsalate
  • Sapropterin
  • Saquinavir
  • Simeprevir
  • Sofosbuvir; Velpatasvir
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Sorafenib
  • Streptomycin
  • Sulindac
  • Tacrolimus
  • Tafamidis
  • Tedizolid
  • Telaprevir
  • Telithromycin
  • Temsirolimus
  • Testosterone
  • Tezacaftor; Ivacaftor
  • Ticagrelor
  • Tipranavir
  • Tobramycin
  • Tolmetin
  • Tolvaptan
  • Trandolapril; Verapamil
  • Trospium
  • Tucatinib
  • Valacyclovir
  • Valdecoxib
  • Valganciclovir
  • Vancomycin
  • Vemurafenib
  • Verapamil
  • Zoledronic Acid
  • Zonisamide