Of note, when tenofovir alafenamide is administered as part of a cobicistat-containing product, its availability is increased by cobicistat and a further increase of tenofovir alafenamide concentrations is not expected upon coadministration of an additional P-gp inhibitor. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Tacrolimus: (Major) Tacrolimus therapeutic drug monitoring is recommended when administered concurrently with tenofovir alafenamide. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Drugs that are eliminated by renal tubular secretion, such as emtricitabine, may decrease metformin elimination by competing for common renal tubular transport systems. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Foscarnet: (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as foscarnet. Drugs that decrease renal function may also increase concentrations of tenofovir. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. © document.write(new Date().getFullYear()) PDR, LLC. Drugs that are eliminated by renal tubular secretion, such as tenofovir alafenamide, may decrease metformin elimination by competing for common renal tubular transport systems. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. If these drugs must be coadministered, carefully monitor the estimated creatinine clearance, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. Drugs that decrease renal function may also increase concentrations of tenofovir. Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Aspirin, ASA; Butalbital; Caffeine: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as salicylates. Telithromycin is an inhibitor of the drug transporters P-glycoprotein (P-gp) and organic anion transporting polypeptides (OATP). Consider alternatives to NSAIDs in patients at risk for renal dysfunction. Consider the potential for drug interaction prior to and during concurrent use of these medications. Belladonna Alkaloids; Ergotamine; Phenobarbital: (Major) Administering tenofovir alafenamide with phenobarbital is not recommended. Switch from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in People Living with HIV: Lipid Changes and Statin Underutilization. Aspirin, ASA; Dipyridamole: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as salicylates. Gadoversetamide: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Subsequently, tenofovir undergoes phosphorylation to its active metabolite, tenofovir diphosphate. Policy Updates: 03/22/2017 - policy reviewed and published Pre-exposure prophylaxis is contraindicated in individuals with unknown or positive HIV status, as use in these populations may result in the development of drug-resistance. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. Drugs that decrease renal function may also increase concentrations of tenofovir. Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. In treatment-naive women, begin HAART as soon as pregnancy is recognized or HIV is diagnosed, without waiting for the results of resistance testing; subsequent modifications to the treatment regimen should be made once the test results are available. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. Concurrent use may result in significant decreases in the plasma concentrations of tenofovir alafenamide, leading to a reduction of antiretroviral efficacy and the potential development of viral resistance. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. ODEFSEY (emtricitabine, rilpivirine, and tenofovir alafenamide) is a fixed-dose combination tablet containing emtricitabine (FTC), rilpivirine (RPV), and tenofovir alafenamide (TAF) for oral administration. Aspirin, ASA: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as salicylates. Of note, when tenofovir alafenamide is administered as part of a cobicistat-containing product, its availability is increased by cobicistat and a further increase of tenofovir alafenamide concentrations is not expected upon coadministration of an additional P-gp inhibitor. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein. rilpivirine, and tenofovir alafenamide), 200/25/25 mg fixed-dose combination tablet for your Gilead Access Program that was reviewed as palt of this application. Taking these drugs together is expected to decrease tenofovir plasma concentrations, which may increase the potential for resistance and HIV treatment failure. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein. Tenofovir alafenamide is a P-gp substrate. Drugs that decrease renal function may also increase concentrations of tenofovir. If these drugs must be coadministered, carefully monitor the estimated creatinine clearance, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. If these drugs must be coadministered, carefully monitor the estimated creatinine clearance, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein. In addition, tenofovir prodrugs (i.e., tenofovir disoproxil fumarate, tenofovir alafenamide) have been associated with the development of renal toxicity. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein. Aspirin, ASA; Omeprazole: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as salicylates. Naproxen; Pseudoephedrine: (Moderate) Avoid administering tenofovir-containing medications concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Zoledronic Acid: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as zoledronic acid. Simeprevir: (Moderate) Closely monitor for tenofovir-associated adverse reactions if simeprevir is administered with tenofovir alafenamide. Emtricitabine 5'-triphosphate is a weak inhibitor of mammalian DNA polymerase alpha, beta, epsilon, and mitochondrial DNA polymerase-gamma.The antiviral activity of emtricitabine against laboratory and clinical isolates of HIV-1 was assessed in lymphoblastoid cell lines, the MAGI-CCR5 cell line, and peripheral blood mononuclear cells (PBMC). Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as cyclosporine. (Moderate) Certain medications used concomitantly with metformin may increase the risk of lactic acidosis. From the recovered dose in urine, about 75% is represented as unchanged tenofovir followed by uric acid and a small dose of tenofovir alafenamide. If these drugs must be coadministered, carefully monitor the estimated creatinine clearance, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. If appropriate, resumption of anti-hepatitis B treatment may be required. Coadministration may result in increased tenofovir plasma concentrations. Drugs that are eliminated by renal tubular secretion, such as tenofovir alafenamide, may decrease metformin elimination by competing for common renal tubular transport systems. Pharmacokinetics: Absorption: Rapidly absorbed from the gastrointestinal tract.Time to peak plasma concentration: 0.48 hours. Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Orlistat: (Major) According to the manufacturer of orlistat, HIV RNA levels should be frequently monitored in patients receiving orlistat while being treated for HIV infection with tenofovir, PMPA. Coadministration may result in increased tenofovir alafenamide plasma concentrations. Drugs that are eliminated by renal tubular secretion, such as tenofovir alafenamide, may decrease metformin elimination by competing for common renal tubular transport systems. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Coadministration may result in increased tenofovir plasma concentrations. Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as salicylates. Amphotericin B lipid complex (ABLC): (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as amphotericin B. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. HIV-1 isolates containing the K65R substitution, selected in vivo by abacavir, didanosine, and tenofovir, demonstrated reduced susceptibility to inhibition by emtricitabine. Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Safety and efficacy of tenofovir alafenamide have not been established in neonates, infants, and children younger than 18 years of age. (Moderate) Certain medications used concomitantly with metformin may increase the risk of lactic acidosis. (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Consider the potential for drug interaction prior to and during concurrent use of these medications. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Aspirin, ASA; Carisoprodol: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as salicylates. Drugs that are eliminated by renal tubular secretion, such as tenofovir alafenamide, may decrease metformin elimination by competing for common renal tubular transport systems. TAF has been approved in November 2015 (in the US a … Both emtricitabine and aminoglycosides are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Drugs that decrease renal function may also increase concentrations of tenofovir. Each tablet contains 50 mg bictegravir + 25 mg tenofovir alafenamide + 200 mg emtricitabine. Vemurafenib: (Moderate) Coadministration of vemurafenib and tenofovir alafenamide may result in elevated tenofovir concentrations. Ivacaftor is an inhibitor of the drug transporter P-glycoprotein (P-gp). Although such interactions remain theoretical, careful patient monitoring and dose adjustment of metformin and/or the interfering cationic drug are recommended. St. John's Wort, Hypericum perforatum: (Major) Administering tenofovir alafenamide with St. John's Wort, Hypericum perforatum is not recommended. For coadministration with P-gp substrates, eliglustat's product labeling recommends monitoring therapeutic drug concentrations of the P-gp substrate, if possible, or consideration of a dosage reduction and titrating to clinical effect. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein. Methotrexate: (Major) Avoid concomitant use of methotrexate with tenofovir alafenamide due to the risk of additive nephrotoxicity as well as an increased risk of severe methotrexate-related adverse reactions. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. Tenofovir alafenamide is a P-gp substrate and sotorasib is a P-gp inhibitor. The Cmax and AUC of another BCRP substrate, sulfasalazine, were increased by 140 percent and 130 percent, respectively, on day 1 with rolapitant, and by 17 percent and 32 percent, respectively, on day 8 after rolapitant administration. Of note, when tenofovir alafenamide is administered as part of a cobicistat-containing product, its availability is increased by cobicistat and a further increase of tenofovir alafenamide concentrations is not expected upon coadministration of an additional P-gp inhibitor. Etodolac: (Moderate) Avoid administering tenofovir-containing medications concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Consider the potential for drug interaction prior to and during concurrent use of these medications. Inhibitors of the drug transporter P-glycoprotein (P-gp), such as felodipine, may increase absorption of tenofovir alafenamide, a P-gp substrate. Concomitant use may also may result in additive nephrotoxicity. If these drugs must be coadministered, carefully monitor the estimated creatinine clearance, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. Concurrent use may result in elevated norgestimate serum concentrations. Diphenhydramine; Naproxen: (Moderate) Avoid administering tenofovir-containing medications concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Consider alternatives to NSAIDs in patients at risk for renal dysfunction. Guidelines from the US Public Health Services (USPHS) recommend considering pre-exposure prophylaxis for adults without HIV who have engaged in sexual activity within the past 6 months, are not in a monogamous sexual relationship with a recently tested HIV-negative partner, and meet at least 1 of the following criteria: ongoing sexual relationship with HIV-positive partner; infrequent use of condoms with at-risk partners of unknown HIV status; sexually active bisexual male; male/male anal sex without condoms within the past 6 months; sexually transmitted infection within the past 6 months. Drugs that decrease renal function may also increase concentrations of tenofovir. Eliglustat: (Major) Coadministration of tenofovir alafenamide and eliglustat may result in increased concentrations of tenofovir. When exposure occurred in the first trimester, the prevalence of defects was 2.6% (95% CI: 2.2 to 3.2) for emtricitabine and 4.2% (95% CI: 2.6 to 6.3) for tenofovir alafenamide. Drugs that decrease renal function may also increase concentrations of tenofovir. Consider the potential for drug interaction prior to and during concurrent use of these medications. A first trimester ultrasound is recommended to confirm gestational age and provide an accurate estimation of gestational age at delivery. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir, and/or the co-administered drug. Tenofovir alafenamide is a P-gp and BCRP substrate and tepotinib is a P-gp inhibitor. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein. If these drugs must be coadministered, carefully monitor the estimated creatinine clearance, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. Ketorolac: (Moderate) Avoid administering tenofovir-containing medications concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). No antagonistic activity was observed with the following HBV nucleoside reverse transcriptase inhibitors in cell: entecavir, lamivudine, telbivudine. Dose does not exceed 200/25 mg (1 tablet) per day. Consider use of an alternative anticonvulsant. Tenofovir alafenamide is highly stable in plasma and, after administration of this prodrug, there is a low concentration of tenofovir in plasma. Nucleoside reverse transcriptase inhibitors (NRTIs) are known to induce mitochondrial dysfunction. Obeticholic Acid: (Minor) Obeticholic acid may increase the exposure to tenofovir alafenamide. Drug interactions: Patients are obliged to inform about all medicines they are taking other than Tafero 25 mg (Tenofovir alafenamide). Ticagrelor is an inhibitor of the drug transporter P-glycoprotein (P-gp).Tenofovir alafenamide is a substrate for P-gp. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Tenofovir alafenamide is a BCRP substrate and regorafenib is a BCRP inhibitor. Tenofovir alafenamide is a substrate of the drug transporter P-glycoprotein (P-gp). Although such interactions remain theoretical, careful patient monitoring and dose adjustment of metformin and/or the interfering cationic drug are recommended. Renal clearance is more than the estimated creatinine clearance; elimination is presumed to be by both glomerular filtration and active tubular secretion. 4. Piroxicam: (Moderate) Avoid administering tenofovir-containing medications concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Found inside – Page 66A |OWer d0Se Of tenofovir alafenamide (TAF) achieves similar/higher intracellular levels and lower Serum levels than ... Contraindicated With Carbamazepine, dexamethaSOne (more than a single dose), OXCarbazepine, phenobarbital, ... Avoid using single-drug therapy to treat HBV (i.e., lamivudine, emtricitabine, tenofovir, or entecavir as the only active agent) as this may result in HIV resistant strains. Nitisinone inhibits OAT1. Concurrent use may result in significant decreases in the plasma concentrations of tenofovir alafenamide, leading to a reduction of antiretroviral efficacy and the potential development of viral resistance. the fixed-dose regimen of coformulated bictegravir 50 mg, emtricitabine 200 mg, and tenofovir alafenamide 25 mg once daily. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. If these medications are administered together, monitor for tenofovir-associated adverse reactions. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. [34362] [46638] [60688], Combination product containing 2 nucleoside analog reverse transcriptase inhibitors (NRTIs)Used as part of a combination regimen to treat HIV-1 in adults and pediatric patients who weigh at least 25 kg and in combination with safe sex practices for HIV pre-exposure prophylaxis in adults and adolescents without HIV who weigh at least 35 kgBlack Box Warning regarding acute exacerbations of hepatitis B in patients with HBV after drug discontinuation. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. (Moderate) According to the manufacturer of orlistat, HIV RNA levels should be frequently monitored in patients receiving orlistat while being treated for HIV infection with anti-retroviral nucleoside reverse transcriptase inhibitors (NRTIs). Food: (Moderate) The pharmacokinetic parameters of anti-retroviral medications (anti-retroviral non-nucleoside reverse transcriptase inhibitors (NNRTIs), anti-retroviral nucleoside reverse transcriptase inhibitors (NRTIs), anti-retroviral nucleotide reverse transcriptase inhibitors, and anti-retroviral protease inhibitors) metabolized through the CYP isoenzyme system are slightly altered by smoked and oral marijuana. Mifepristone: (Moderate) Coadministration of mifepristone and tenofovir alafenamide may result in elevated tenofovir concentrations. Empagliflozin; Metformin: (Moderate) According to the manufacturer, interactions are not expected when metformin is administered with tenofovir alafenamide; however, because tenofovir and metformin can compete for elimination through the kidneys, use of these medications together may increase the risk for side effects, such as lactic acidosis. Thus, if therapy is deferred, resistance testing should still be performed during acute HIV infection with the genotypic resistance test result kept in the patient's medical record until it becomes clinically useful. Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Sotorasib: (Moderate) Coadministration of tenofovir alafenamide with sotorasib may result in increased plasma concentrations of tenofovir leading to an increase in tenofovir-related adverse effects. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir, and/or the co-administered drug. Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Kanamycin: (Moderate) Tenofovir-containing products, should be avoided with concurrent or recent use of a nephrotoxic agent, such as aminoglycosides. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Cabozantinib is also P-gp inhibitor and has the potential to increase plasma concentrations of P-gp substrates such as tenofovir. Isavuconazonium: (Minor) Close clinical monitoring for adverse events is advised when administering tenofovir alafenamide with isavuconazonium. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Found inside – Page 41Profile of bictegravir/emtricitabine/tenofovir alafenamide fixed dose combination and its potential in the treatment of HIV-1 infection: Evidence to date. HIV/AIDS (Auckland, N.Z.), 10, 203e213. https://doi.org/10.2147/ HIV.S145529. Dose reduction or discontinuation of interferon, ribavirin, or both should be considered if worsening clinical toxicities are observed, including hepatic decompensation (e.g., Child-Pugh greater than 6). Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Choline Salicylate; Magnesium Salicylate: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as salicylates. If these drugs must be coadministered, carefully monitor the estimated creatinine clearance, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. Diphenhydramine; Naproxen: (Moderate) Avoid administering tenofovir-containing medications concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Concurrent use may decrease absorption and alter metabolism of tenofovir. If these drugs must be coadministered, carefully monitor the estimated creatinine clearance, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein. 1 mg every 7 days. Monitor viral load and other parameters carefully during therapy. A few pharmacokinetic studies have shown reductions in blood levels of some antiretroviral medications when Echinacea was given, presumably due to CYP induction. If these drugs must be coadministered, carefully monitor the estimated creatinine clearance, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. (Moderate) Tenofovir-containing products, should be avoided with concurrent or recent use of a nephrotoxic agent, such as aminoglycosides. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents.
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