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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
- hepatitis B infection
- hepatitis B virus
- human immunodeficiency virus (HIV)
- human immunodeficiency virus (HIV) infection
- human immunodeficiency virus (HIV) prophylaxis
Side Effects
- abdominal pain
- angioedema
- anorexia
- anxiety
- arthralgia
- asthenia
- back pain
- bone fractures
- bone pain
- bullous rash
- chest pain (unspecified)
- depression
- diabetes insipidus
- diaphoresis
- diarrhea
- dizziness
- dyspepsia
- dyspnea
- elevated hepatic enzymes
- Fanconi syndrome
- fatigue
- fever
- flatulence
- glycosuria
- headache
- hematuria
- hepatitis B exacerbation
- hepatomegaly
- hyperamylasemia
- hypercholesterolemia
- hyperglycemia
- hypertriglyceridemia
- hypokalemia
- hypophosphatemia
- infection
- insomnia
- interstitial nephritis
- lactic acidosis
- lipodystrophy
- maculopapular rash
- myalgia
- myopathy
- nausea
- neuritis
- neutropenia
- osteomalacia
- osteopenia
- osteoporosis
- pancreatitis
- peripheral neuropathy
- pharyngitis
- polyuria
- proteinuria
- pruritus
- rash
- renal failure (unspecified)
- renal tubular acidosis (RTA)
- renal tubular necrosis
- rhabdomyolysis
- sinusitis
- steatosis
- urticaria
- vesicular rash
- vomiting
- weakness
- 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