Tenofovir disoproxil

Tenofovir disoproxil fumarate is a bis-isopropoxycarbonyloxymethyl ester prodrug of tenofovir that dramatically improves oral bioavailability (25% vs <5% for tenofovir alone). After absorption, ester hydrolysis rapidly releases tenofovir, which is then phosphorylated intracellularly to tenofovir diphosphate — the active inhibitor of HIV and HBV polymerases. It has a long intracellular half-life (>60 hours) enabling once-daily dosing, but carries a risk of proximal renal tubular dysfunction and decreased bone mineral density with long-term use.

Adult

in decompensated liver disease, but low doses can be used with great caution in these patients. Although interferon alfa is contra-indicated in patients receiving immunosuppressant treatment (or who have received it recently), cautious use of peginterferon alfa-2a may be justified in some cases. Entecavir p. 658 or tenofovir disoproxil p.…