Diclofenac
Severe
Textbook
Acute renal insufficiency.
Use with caution.
Source: G&G 14e · p1245-1266
Drug reference
tenofovir disoproxil fumarate
Acyclic nucleoside phosphonate · Antiviral, Hepatitis B agent
Acyclic nucleoside phosphonateAntiviral, Hepatitis B agent
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
1 major
SEVERE in our sources
PREGNANCY
B
FDA category + note
Top interactionssee all 4 →
- DiclofenacSevereTextbookG&G 14e · p1245-1266
Mechanism
Tenofovir disoproxil fumarate is a prodrug that is cleaved to tenofovir in plasma, which is then phosphorylated intracellularly to tenofovir diphosphate. Tenofovir diphosphate inhibits both HIV-1 and HBV reverse transcriptase activities.
Indications
HBV infection in individuals 2 years or older (preferred agent)Indefinite treatment for patients with cirrhosis
Dosing
- Adult
- 300 mg once daily
- Pediatric
- 8 mg/kg, maximum 300 mg daily, for children 2 years or older
- Renal adjustment
- Reduced in patients with renal impairment (ClCr below 50 mL/min)
Pharmacokinetics
Half-life
17 h (plasma); 6 days (tenofovir diphosphate in peripheral blood); 17 days (tenofovir diphosphate in red blood cells)
Bioavailability
Approximately 25%
Protein binding
Negligible (<8%)
Metabolism
Not metabolized by CYP enzymes
Excretion
Roughly 10% of the dose removed by a 4-h hemodialysis session
Side effects
Common
Abdominal pain (in decompensated cirrhosis)Nausea (in decompensated cirrhosis)Insomnia (in decompensated cirrhosis)Pruritus (in decompensated cirrhosis)Vomiting (in decompensated cirrhosis)Dizziness (in decompensated cirrhosis)Pyrexia (in decompensated cirrhosis)
Serious
- Nephrotoxicity
- Bone toxicities
- Decrease in bone mineral density
Pregnancy & lactation
Pregnancy
B
Drug interactions
Ledipasvir
Moderate
Textbook
Increased tenofovir exposure, potentially increasing the risk of renal toxicity, especially in HIV-infected individuals taking TDF with a boosting agent.
Patients receiving such combinations require more frequent renal monitoring. Use of TAF instead of TDF is an option for patients taking an antiretroviral regimen, which includes ritonavir and cobicistat.
Source: G&G 14e · p1232, p1238
Sofosbuvir
Moderate
Textbook
Increased tenofovir exposure, potentially increasing the risk of renal toxicity.
Patients receiving such combinations require more frequent renal monitoring. Consider using tenofovir alafenamide fumarate (TAF) instead of TDF in patients on antiretroviral regimens with boosting agents (ritonavir/cobicistat).
Source: G&G 14e · p1232, p1237, p1238
Velpatasvir
Moderate
Textbook
Increased tenofovir exposure, potentially increasing the risk of renal toxicity, especially in HIV-infected individuals taking TDF with a boosting agent.
Patients receiving such combinations require more frequent renal monitoring. Use of TAF instead of TDF is an option for patients taking an antiretroviral regimen, which includes ritonavir and cobicistat.
Source: G&G 14e · p1232, p1238
Related guidelines
Ask House about tenofovir disoproxil fumarate
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Sources: Goodman & Gilman 14e·Verified: 2026-05-10 · House clinical team