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Tenofovir disoproxil fumarate (TDF) is an antiviral medicine used for HIV-1 and chronic hepatitis B. It is available alone and in combination products, including emtricitabine/tenofovir disoproxil fumarate for HIV treatment or PrEP.
Tenofovir disoproxil fumarate (TDF), also known as tenofovir DF, is a prescription antiviral medicine and prodrug that is converted in the body to the active drug tenofovir diphosphate. It belongs to the nucleotide reverse transcriptase inhibitor (NRTI) class and works by interfering with viral DNA synthesis and replication.
Viread is a well-known single-ingredient brand of tenofovir disoproxil fumarate. TDF is also available as a generic medicine and is included in several fixed-dose combination products used to treat HIV-1 infection and, in appropriate formulations, chronic hepatitis B.
The specific use of TDF depends on the product, the condition being treated, and the other medicines included in the treatment regimen.
Principal tenofovir disoproxil fumarate uses include:
Treating HIV-1 as one part of a complete antiretroviral regimen
Treating chronic hepatitis B in suitable adults and children
Forming part of fixed-dose HIV treatment and prevention medicines
TDF alone is neither a complete HIV treatment nor an approved complete PrEP regimen. Emtricitabine and tenofovir disoproxil fumarate, sold as Truvada and generics, is used for oral PrEP in eligible people.
Tenofovir disoproxil fumarate (TDF) is converted in the body into tenofovir and then into the active metabolite tenofovir diphosphate inside cells. Tenofovir diphosphate inhibits viral reverse transcriptase, an enzyme required for viral DNA synthesis and replication.
By interfering with this process, TDF helps suppress the replication of HIV and hepatitis B virus (HBV) when used in appropriate treatment regimens. TDF controls viral replication but does not eliminate HIV or cure chronic hepatitis B.
A commonly labelled adult TDF dosage is one tenofovir disoproxil fumarate 300 mg tablet once daily, with or without food, when kidney function permits. The appropriate dose and dosing interval can vary depending on the person's age, body weight, medical condition, kidney function, and the specific formulation or combination product.
People with reduced kidney function may require a longer dosing interval or an alternative treatment, depending on the indication and product. Follow the prescribed regimen carefully and do not change, repeat, or stop a dose independently.
Tenofovir disoproxil fumarate (TDF) is used to treat chronic hepatitis B, but liver function and treatment response should be monitored as recommended by a healthcare professional.
Stopping TDF in a person with chronic hepatitis B can cause a serious acute exacerbation of hepatitis B. Appropriate follow-up and liver monitoring may therefore be required for several months after discontinuation.
Rare but serious warnings associated with tenofovir-containing medicines include lactic acidosis and severe hepatomegaly with steatosis (fatty enlargement of the liver). Seek medical attention for symptoms such as yellowing of the skin or eyes, dark urine, persistent vomiting, unusual weakness, severe abdominal symptoms, or rapid or difficult breathing.
When TDF is being used for hepatitis B, HIV testing should be performed before treatment because TDF alone is not an adequate complete treatment regimen for HIV infection.
TDF can cause new or worsening kidney impairment, including acute kidney injury and proximal renal tubulopathy such as Fanconi syndrome. Kidney function should be assessed before and during treatment. Depending on the patient's risk factors, healthcare professionals may also monitor urine protein, urine glucose, serum phosphorus, and other markers of renal function.
Tell your healthcare professional if you have kidney disease or take medicines that may affect kidney function, including frequent or high-dose NSAIDs.
TDF can also cause a reduction in bone mineral density. Kidney-related phosphate loss can rarely contribute to osteomalacia and associated bone or muscle symptoms. Persistent or unexplained bone pain, muscle weakness, or a fracture should be medically evaluated. Bone-density assessment may be appropriate for people with additional risk factors for fractures.
Tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) are different prodrugs of tenofovir and are not dose-equivalent.
TAF delivers tenofovir more efficiently into cells and generally results in less impact on kidney function and bone mineral density than TDF in many treatment settings. TDF, however, has extensive clinical experience, is widely available in generic formulations, and remains an important option for several HIV and hepatitis B treatment regimens.
TDF combined with emtricitabine is also an established PrEP regimen for eligible individuals, whereas TAF-containing PrEP has more limited approved indications depending on the product and population.
TDF may have advantages in certain patients because it can have a more favourable effect on lipid levels, while TAF-containing regimens may be associated with greater increases in lipids or body weight in some settings. The choice between TDF and TAF depends on the indication, kidney and bone health, other medicines, pregnancy considerations, potential interactions, and the specific approved regimen.
Do not take TDF and TAF together unless specifically directed by a qualified healthcare professional.
Possible TDF side effects include nausea, diarrhoea, headache, rash, abdominal discomfort, weakness and dizziness. Combination ingredients can add other effects.
Seek urgent medical help for:
Reduced urination, swelling or unexplained rapid weight gain
Severe bone or muscle pain, weakness or a fracture
Yellow skin or eyes, dark urine or severe upper-abdominal pain
Deep or rapid breathing, persistent vomiting or extreme tiredness
Facial swelling, breathing difficulty or another severe allergic reaction
Do not combine Viread or generic tenofovir disoproxil fumarate (TDF) with another medicine containing TDF, tenofovir alafenamide (TAF), or tenofovir, unless specifically directed by a healthcare professional. TDF should also not be used with adefovir dipivoxil because of overlapping antiviral therapy.
Tell your healthcare professional about all prescription medicines, over-the-counter products, and supplements you take. This is particularly important if you use medicines that may affect kidney function, including nephrotoxic medicines, or other antiviral treatments.
When TDF is prescribed for HIV, it should be used only as part of the complete antiretroviral regimen. Taking it alone is not an adequate treatment for HIV and may increase the risk of antiviral resistance. Take doses consistently and follow the prescribed regimen.
Store tenofovir disoproxil fumarate tablets in the original, tightly closed container at the temperature stated on the product label. Protect the tablets from excess moisture and keep the medicine out of the reach of children. Do not use tablets that are expired, damaged, or have been stored outside the recommended conditions without checking with a pharmacist.
TDF is a specific prodrug that becomes tenofovir in the body. It differs from tenofovir alafenamide (TAF).