Antiretroviral Agents
Severe
Textbook
Increased risk of lactic acidosis and steatosis.
Monitor closely for signs and symptoms of lactic acidosis and steatosis.
Source: G&G 14e · p1233
Drug reference
adefovir
Nucleotide analogue · Antiviral, Hepatitis B agent
Nucleotide analogueAntiviral, Hepatitis B agent
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
2 major
SEVERE in our sources
PREGNANCY
C
FDA category + note
Top interactionssee all 5 →
- Antiretroviral AgentsSevereTextbookG&G 14e · p1233
- Other Nucleoside AnaloguesSevereTextbookG&G 14e · p1233
Mechanism
Adefovir dipivoxil is a prodrug deesterified to adefovir, then converted to its diphosphate by cellular enzymes. Adefovir diphosphate acts as a competitive inhibitor of viral DNA polymerases and reverse transcriptases, and as a chain terminator of viral DNA synthesis.
Indications
Chronic HBV infections in individuals 12 years and older (alternative agent)Indefinite treatment for patients with cirrhosis
Dosing
- Adult
- 10 mg once daily (adefovir dipivoxil)
- Pediatric
- Same as adults for children 12 years or older
- Renal adjustment
- Reduced for renal impairment (ClCr below 50 mL/min)
Pharmacokinetics
Half-life
5–7.5 h (serum elimination)
Bioavailability
Low for parent compound (<12%); 30%–60% for dipivoxil prodrug
Protein binding
Scantily protein bound (<5%)
Excretion
Eliminated unchanged by the kidney (glomerular filtration and tubular secretion); removed by hemodialysis
Contraindications
- Monotherapy for hepatitis B (due to high resistance rate)
- Elderly patients (due to risk of nephrotoxicity)
Side effects
Common
HeadacheAbdominal discomfortDiarrheaAstheniaImpaired renal function
Serious
- Dose-related nephrotoxicity and tubular dysfunction (azotemia, hypophosphatemia, acidosis, glycosuria, proteinuria)
- Acute exacerbations of hepatitis upon discontinuation
- Lactic acidosis (increased risk with other nucleoside analogues/antiretrovirals)
- Steatosis (increased risk with other nucleoside analogues/antiretrovirals)
- Hepatotoxicity (at high doses in animals)
- Lymphoid toxicity (at high doses in animals)
- Renal tubular nephropathy (at high doses in animals)
Pregnancy & lactation
Pregnancy
C
Drug interactions
Other Nucleoside Analogues
Severe
Textbook
Increased risk of lactic acidosis and steatosis.
Monitor closely for signs and symptoms of lactic acidosis and steatosis.
Source: G&G 14e · p1233
Drugs That Compete For Active Tubular Secretion
Moderate
Textbook
Increased adefovir exposure and potential for toxicity (e.g., nephrotoxicity).
Monitor renal function and adefovir levels closely.
Source: G&G 14e · p1233
Drugs That Reduce Renal Function
Moderate
Textbook
Increased adefovir exposure and potential for toxicity (e.g., nephrotoxicity).
Monitor renal function and adefovir levels closely.
Source: G&G 14e · p1233
Ibuprofen
Mild
Textbook
Modest increase in adefovir exposure.
Monitor for adefovir-related adverse effects.
Source: G&G 14e · p1233
Related guidelines
Other Nucleotide analogue drugs
Ask House about adefovir
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Harrison 22e·Verified: 2026-05-10 · House clinical team