Names and pronunciation
(ten-oh-foh′veer) Viread
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Drug reference
(ten-oh-foh′veer) Viread
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Func. class.: Antiretroviral
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Chem. class.: Nucleoside reverse transcriptase inhibitor (NRTI)
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ACTION: Inhibits replication of HIV virus by competing with the natural substrate and then incorporating into cellular DNA by viral reverse transcriptase, thereby terminating cellular DNA chain
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USES: HIV-1 infection with at least 2 other antiretrovirals, hepatitis B
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CONTRAINDICATIONS: Hyper- sensitivity, lactic acidosis Precautions: Pregnancy, breastfeeding, children, geriatric patients, renal dis- ease, CCr <60 mL/min, osteoporosis, immune reconstitution syndrome
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Black Box Warning: Hepatitis B exacer- bation Black Box Warning: Hepatitis exacer- bations: monitor hepatic studies: AST, ALT, bilirubin; amylase, lipase, triglyc- erides baseline and periodically during treatment, after treatment, assess for exacerbations for 6 mo after last dose • Bone, renal toxicity: if bone abnor- malities are suspected, obtain tests; se- rum phosphorus, creatinine • Lactic acidosis, severe hepatomegaly with steatosis, Fanconi’s syndrome: obtain baseline liver function tests; if elevated, discontinue treatment; discon- tinue even if liver function tests normal but lactic acidosis, hepatomegaly pres- ent; may be fatal • Pregnancy/breastfeeding: use only if clearly needed; register patients in the Antiretroviral Pregnancy Registry, 1-800- 258-4263; do not breastfeed
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SIDE EFFECTS CNS: Headache, asthenia GI: Nausea, vomiting, diarrhea, anorexia, flatulence, abdominal pain, pancreatitis GU: Renal failure, renal tubular acidosis/ necrosis, Fanconi’s syndrome HEMA: Neutropenia, osteopenia INTEG: Rash, angioedema META: Lactic acidosis, hypokalemia, hypophosphatemia MS: Arthralgia, myalgia, decreased bone T mineral density, rhabdomyolysis SYST: Lipodystrophy
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INTERACTIONS Increase: tenofovir level—cidofovir, acy- clovir, valACYclovir, ganciclovir, valGANciclovir Increase: level of didanosine when given with tenofovir Increase: tenofovir level—any product that decreases renal function
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DOSAGE AND ROUTES Human immunodeficiency virus (HIV) infection • Adult/adolescent/child weighing ≥35 kg: PO Tablet: 300 mg once daily; Oral powder 300 mg/day (7.5 scoops) with 2-4 oz soft food • Adolescent/child weighing 28-34 kg: PO Tablet: 250 mg/day • Child ≥2 yr and weighing 22-27 kg: PO Tablet: 200 mg/day • Child ≥2 yr and weighing 17-21 kg: PO Tablet: 150 mg/day • Child/adolescent ≥2 yr and weighing <35 kg: PO Oral powder: 8 mg/kg/dose daily with 2-4 oz soft food. Round dose to nearest 20-mg increment Hepatitis B infection Adult/child/adolescent >35 kg: 300 mg/ day × ≥12 mo Renal dose • Adult: PO CCr 30-49 mL/min, 300 mg q48hr; CCr 10-29 mL/min, 300 mg q72-96hr; CCr <10 mL/min, not recom mended
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Available forms: Tabs 150, 200, 250, 300 mg; oral powder 40 mg/scoop
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Administer: • Without regard to food • Store at 25°C (77°F) • Missed dose: take when remembered on same day, do not double doses • Oral powder: use scoop provided, mix powder into 2-4 oz (1⁄4-1⁄2 cup) of apple- sauce, yogurt, do not mix with liquid, product will not mix, product is bitter, use immediately after mixing, clean scoop
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Assess: • HIV: Viral load, CD4+ T-cell count, plasma HIV RNA, serum creatinine/BUN/ phosphate • Resistance testing at start of therapy and at treatment failure
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Evaluate: • Therapeutic response: decrease in signs, symptoms of HIV; hepatitis B
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take without regard to food • That GI complaints resolve after 3-4 wk of treatment • Not to breastfeed while taking this product • That product must be taken daily even if patient feels better • That follow-up visits must be contin- ued because serious toxicity may oc- cur; that blood counts must be done q2wk • That product will control symptoms but is not a cure for HIV; that patient is still infectious, may pass HIV virus on to others • To discuss with provider all OTC, Rx, herbals, supplements taken • Hepatotoxicity: To notify provider of yellow skin, eyes; dark urine, clay-colored stools, nausea, abdominal pain • That other products may be necessary to prevent other infections • If used for prophylaxis (PREP): does not prevent sexually transmitted infec- tions; use appropriate barrier protection and safe sex practices • That changes in body fat distribution; usually in the breasts, neck, and back, may occur • To notify prescriber of symptoms of lactic acidosis (nausea, vomiting, weak ness, abdominal pain)
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PHARMACOKINETICS Rapidly absorbed, distributed to extra- vascular space, excreted unchanged in urine 70%-80%, terminal half-life 17 hr, peak 1-2 hr
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• Adult/adolescent/child weighing ≥35 kg: PO Tablet: 300 mg once daily; Oral powder 300 mg/day (7.5 scoops) with 2-4 oz soft food
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• Adolescent/child weighing 28-34 kg: PO Tablet: 250 mg/day
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• Child ≥2 yr and weighing 22-27 kg: PO Tablet: 200 mg/day
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• Child ≥2 yr and weighing 17-21 kg: PO Tablet: 150 mg/day
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• Child/adolescent ≥2 yr and weighing <35 kg: PO Oral powder: 8 mg/kg/dose daily with 2-4 oz soft food. Round dose to nearest 20-mg increment Hepatitis B infection Adult/child/adolescent >35 kg: 300 mg/ day × ≥12 mo Renal dose
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