Last update Nov. 16, 2024

Tenofovir (TAF / TDF)

Compatible

Safe product and/or breastfeeding is the best option.

Tenofovir disoproxil fumarate (TDF) and Tenofovir Alafenamide Fumarate are prodrugs of Tenofovir. It is a nucleoside analog reverse transcriptase inhibitor (NRTI) with antiviral activity used to treat human immunodeficiency virus (HIV-1) and Hepatitis B virus (HBV). Indicated in the treatment of AIDS and chronic hepatitis B and pre-exposure HIV prophylaxis. Oral administration once a day for months or years. Its use is authorized in HIV treatment from two years of age and, off-label, in children under 2 years.

It is excreted in breastmilk in clinically insignificant amounts. (Pak 2024, Li 2023, Kayes 2022, Aebi 2022, Yang 2021, Li 2021, Bojun 2020, Erturk 2019, Bierhoff 2019, Mugwanya 2016, Palombi 2016, Benaboud 2011)

No problems have been observed in infants whose mothers take it (Li 2023, Kapito 2021, Wang 2019, Marcellin 2016, Ganne 2013, Gouraud 2012, Pan 2012), except for some cases of mild diarrhea. (Mugwanya 2016)

There was also no involvement of markers of bone mineralization (Floridia 2016 and 2016) or growth rates at 6 and 12 months. (Liotta 2016)

Plasma or urine tenofovir levels in these infants were undetectable or very low. (Pak 2024, Kayes 2022, Aebi 2022, Erturk 2021 & 2019, Waitt 2017 y 2018, Mugwanya 2016, Palombi 2016, Gouraud 2012)

Pre-exposure prophylaxis (PrEP) with tenofovir is acceptable for use in HIV-negative breastfeeding mothers (Hodges 2019). After administration in the form of an intravaginal gel, concentrations in plasma and breastmilk and in the infant's plasma were undetectable or very low and the side effects in the infants were mild or non-existent. (Noguchi 2016)

Several medical associations and experts consider the use of this medication to be safe during breastfeeding. (Pak 2024, Panel 2024, Li 2023, Hu 2019, Wong 2018, Mugwanya 2017, EASL 2017, Seidman 2017, Mofenson 2017, Terrault 2016, UNICEF 2016)


See below the information of these related products:

Alternatives

We do not have alternatives for Tenofovir (TAF / TDF) since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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José María Paricio, founder of e-lactancia.
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Other names

Tenofovir (TAF / TDF) is also known as


Tenofovir (TAF / TDF) in other languages or writings:

Group

Tenofovir (TAF / TDF) belongs to this group or family:

Tradenames

Main tradenames from several countries containing Tenofovir (TAF / TDF) in its composition:

List of 33 tradenames
  • Atripla™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Biktarvy™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Cimduo™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Complera™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Descovy™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Emtenef™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Eviplera™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Leuzan™
  • Lisotyr™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Mivuten™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Odefsey™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Padviram™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Previd™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Remivir™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Ricovir™
  • Simplir™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Symfi™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Symtuza™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Tefala™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Telavir™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Tenof™
  • Tenozet™
  • Tenriltab (Тенрилтаб)™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Trastiva™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Tribuss™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Trivenz™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Truvada™. Contains other elements than Tenofovir (TAF / TDF) in its composition
  • Vemlidy™
  • Vidara™
  • Virakam™
  • Viread™
  • Viread (Виреад)™
  • Viread (韦瑞德)™

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 25 - 40 %
Molecular weight 636 daltons
Protein Binding 7 %
VD 1.2 ± 0.4 l/Kg
pKa 3.75 -
Tmax 1.0 ± 0.4 hours
T½ 12 - 18 hours
M/P ratio 0.02 - 0.08 -
Theoretical Dose 0.0004 – 0.003 mg/Kg/d
Relative Dose 0.01 – 0.06 %
Ped.Relat.Dose 0.01 – 0.04 %

References

  1. Pak K, Ibrahim B, Saab S. Safety of Tenofovir Disoproxil Fumarate Among Breastfeeding Infants of Patients With Chronic Hepatitis B: A Systematic Review. J Viral Hepat. 2024 Nov;31(11):760-767. Abstract
  2. Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States. Department of Health and Human Services. 2024 Abstract Full text (link to original source)
  3. Li S, Jin J, Jiang Y, Shi J, Jiang X, Lin N, Ma Z. Low levels of tenofovir in breast milk support breastfeeding in HBV-infected mothers treated with tenofovir disoproxil fumarate. Int J Antimicrob Agents. 2023 Mar;61(3):106726. Abstract
  4. Kayes T, Crane H, Symonds A, Dumond J, Cottrell M, Di Girolamo J, Manandhar S, Lim TH, Gane E, Kashuba A, Levy MT. Plasma and breast milk pharmacokinetics of tenofovir alafenamide in mothers with chronic hepatitis B infection. Aliment Pharmacol Ther. 2022 May 22. Abstract
  5. Aebi-Popp K, Kahlert CR, Crisinel PA, Decosterd L, Saldanha SA, Hoesli I, Martinez De Tejada B, Duppenthaler A, Rauch A, Marzolini C; Swiss Mother and Child HIV Cohort Study (SHCS). Transfer of antiretroviral drugs into breastmilk: a prospective study from the Swiss Mother and Child HIV Cohort Study. J Antimicrob Chemother. 2022 Nov 28;77(12):3436-3442. Abstract Full text (link to original source)
  6. Kapito-Tembo AP, Bauleni A, Wesevich A, Ongubo D, Hosseinipour MC, Dube Q, Mwale P, Corbett A, Mwapasa V, Phiri S. Growth and Neurodevelopment Outcomes in HIV-, Tenofovir-, and Efavirenz-Exposed Breastfed Infants in the PMTCT Option B+ Program in Malawi. J Acquir Immune Defic Syndr. 2021 Jan 1;86(1):81-90. Abstract
  7. Yang N, Zhou G, Cheng X, He J, Chen Y, Chen C, Li M, Ge J, Wang M, Zhang T, Ge W, Zhu H, Han G. Distribution Evaluation of Tenofovir in the Breast Milk of Mothers With HBeAg-Positive Chronic HBV Infection After Treatment With Tenofovir Alafenamide and Tenofovir Disoproxil Fumarate by a Sensitive UPLC-MS/MS Method. Front Pharmacol. 2021 Aug 13;12:734760. Abstract Full text (link to original source)
  8. Li B, Liu Z, Liu X, Liu D, Duan M, Gu Y, Liu Q, Ma Q, Wei Y, Wang Y. Efficacy and safety of tenofovir disoproxil fumarate and tenofovir alafenamide fumarate in preventing HBV vertical transmission of high maternal viral load. Hepatol Int. 2021 Oct;15(5):1103-1108. Abstract
  9. Erturk US, Mete B, Ozaras R, Saltoglu N, Balkan II, Mert A, Kacmaz B, Saglam O, Guney B, Sayman OA, Tabak F. Plasma and Breast Milk Pharmacokinetics of Tenofovir Disoproxil Fumarate in Nursing Mother with Chronic Hepatitis B-Infant Pairs. Antimicrob Agents Chemother. 2021 Sep 17;65(10):e0111021. Abstract Full text (link to original source)
  10. Bojun L, Ye G, Yan W, et al. Tenofovir (TFV) or tenofovir alafenamide (TAF) concentration in breast milk and infants' cord blood, with tenofovir disoproxil fumarate (TDF) or TAF treatment in pregnancy. Hepatol Int 2020;14 (Suppl 1):S78. Abstract #1444 Full text (link to original source) Full text (in our servers)
  11. Bierhoff M, Smolders EJ, Tarning J, Burger DM, Spijker R, Rijken MJ, Angkurawaranon C, McGready R, White NJ, Nosten F, van Vugt M. Pharmacokinetics of oral tenofovir disoproxil fumarate in pregnancy and lactation: a systematic review. Antivir Ther. 2019;24(7):529-540. Abstract
  12. Hodges-Mameletzis I, Fonner VA, Dalal S, Mugo N, Msimanga-Radebe B, Baggaley R. Pre-Exposure Prophylaxis for HIV Prevention in Women: Current Status and Future Directions. Drugs. 2019 Aug;79(12):1263-1276. Abstract
  13. Wang M, Bian Q, Zhu Y, Pang Q, Chang L, Li R, Tiongson BC, Zhang H, Pan CQ. Real-world study of tenofovir disoproxil fumarate to prevent hepatitis B transmission in mothers with high viral load. Aliment Pharmacol Ther. 2019 Jan;49(2):211-217. Abstract
  14. Hu X, Wang L, Xu F. Guides concerning tenofovir exposure via breastfeeding: A comparison of drug dosages by developmental stage. Int J Infect Dis. 2019 Oct;87:8-12. Abstract Full text (link to original source)
  15. Waitt C, Olagunju A, Nakalema S, Kyohaire I, Owen A, Lamorde M, Khoo S. Plasma and breast milk pharmacokinetics of emtricitabine, tenofovir and lamivudine using dried blood and breast milk spots in nursing African mother-infant pairs. J Antimicrob Chemother. 2018 Abstract Full text (link to original source)
  16. Erturk US, Mete B, Ozaras R, Saltoglu N, Balkan II, Mert A, Kacmaz B, Saglam O, Guney B, Sayman OA, Tabak F. The determination of tenofovir level in breast milk of nursing mothers under tenofovir therapy. AASLD Abstracts, poster 431. Hepatology 2018;68 (Suppl 1):256A-7A. Poster 431. doi:10.1002/hep.30257. Full text (link to original source) Full text (in our servers)
  17. Wong GL, Seto WK, Wong VW, Yuen MF, Chan HL. Review article: long-term safety of oral anti-viral treatment for chronic hepatitis B. Aliment Pharmacol Ther. 2018 Abstract
  18. Mofenson LM, Baggaley RC, Mameletzis I. Tenofovir disoproxil fumarate safety for women and their infants during pregnancy and breastfeeding. AIDS. 2017 Abstract
  19. Mugwanya KK, John-Stewart G, Baeten J. Safety of oral tenofovir disoproxil fumarate-based HIV pre-exposure prophylaxis use in lactating HIV-uninfected women. Expert Opin Drug Saf. 2017 Abstract Full text (link to original source)
  20. Seidman DL, Weber S, Cohan D. Offering pre-exposure prophylaxis for HIV prevention to pregnant and postpartum women: a clinical approach. J Int AIDS Soc. 2017 Abstract Full text (link to original source) Full text (in our servers)
  21. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017 Aug;67(2):370-398. Abstract
  22. Waitt C, Diliiy Penchala S, Olagunju A, Amara A, Else L, Lamorde M, Khoo S. Development, validation and clinical application of a method for the simultaneous quantification of lamivudine, emtricitabine and tenofovir in dried blood and dried breast milk spots using LC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci. 2017 Abstract Full text (link to original source)
  23. Noguchi LM, Montgomery ET, Biggio JR, Hendrix CW, Bogen DL, Hillier SL, Dai JY, Piper JM, Marzinke MA, Dezzutti CS, Isaacs SK, Schwartz JL, Watts DH, Beigi RH. Detectable Tenofovir Levels in Breast-Feeding Infants of Mothers Exposed to Topical Tenofovir. Antimicrob Agents Chemother. 2016 Abstract
  24. Mugwanya KK, Hendrix CW, Mugo NR, Marzinke M, Katabira ET, Ngure K, Semiyaga NB, John-Stewart G, Muwonge TR, Muthuri G, Stergachis A, Celum CL, Baeten JM. Pre-exposure Prophylaxis Use by Breastfeeding HIV-Uninfected Women: A Prospective Short-Term Study of Antiretroviral Excretion in Breast Milk and Infant Absorption. PLoS Med. 2016 Abstract Full text (link to original source) Full text (in our servers)
  25. WHO - World Health Organization Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Guideline. 2016 Abstract Full text (link to original source) Full text (in our servers)
  26. Palombi L, Pirillo MF, Marchei E, Jere H, Sagno JB, Luhanga R, Floridia M, Andreotti M, Galluzzo CM, Pichini S, Mwenda R, Mancinelli S, Marazzi MC, Vella S, Liotta G, Giuliano M. Concentrations of tenofovir, lamivudine and efavirenz in mothers and children enrolled under the Option B-Plus approach in Malawi. J Antimicrob Chemother. 2016 Abstract Full text (link to original source) Full text (in our servers)
  27. Liotta G, Floridia M, Andreotti M, Jere H, Sagno JB, Marazzi MC, Buonomo E, Scarcella P, Mancinelli S, Vella S, Giuliano M, Palombi L. Growth indices in breastfed infants pre and postnatally exposed to tenofovir compared with tenofovir-unexposed infants. AIDS. 2016 Abstract
  28. Marcellin P, Zoulim F, Hézode C, Causse X, Roche B, Truchi R, Pauwels A, Ouzan D, Dumortier J, Pageaux GP, Bourlière M, Riachi G, Zarski JP, Cadranel JF, Tilliet V, Stern C, Pétour P, Libert O, Consoli SM, Larrey D. Effectiveness and Safety of Tenofovir Disoproxil Fumarate in Chronic Hepatitis B: A 3-Year, Prospective, Real-World Study in France. Dig Dis Sci. 2016 Abstract Full text (link to original source) Full text (in our servers)
  29. Floridia M, Liotta G, Andreotti M, Galluzzo CM, Amici R, Jere H, Sagno JB, Marazzi MC, Buonomo E, Scarcella P, Mancinelli S, Vella S, Giuliano M, Palombi L. Levels of bone markers in a population of infants exposed in utero and during breastfeeding to tenofovir within an Option B+ programme in Malawi. J Antimicrob Chemother. 2016 Abstract
  30. Mofenson LM. Tenofovir Pre-exposure Prophylaxis for Pregnant and Breastfeeding Women at Risk of HIV Infection: The Time is Now. PLoS Med. 2016 Abstract
  31. Floridia M, Liotta G, Andreotti M, Galluzzo CM, Jere H, Sagno JB, Mancinelli S, Amici R, Marazzi MC, Vella S, Giuliano M, Palombi L. Serum Phosphate and Creatinine Levels in the First Year of Life in Infants Born to HIV-Positive Mothers Receiving Tenofovir-Based Combination Regimens During Pregnancy and Prolonged Breastfeeding in an Option B+ Program in Malawi. J Acquir Immune Defic Syndr. 2016 Abstract
  32. Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH; American Association for the Study of Liver Diseases.. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016 Jan;63(1):261-83. Abstract Full text (link to original source)
  33. Morrison S, John-Stewart G, Egessa JJ, Mubezi S, Kusemererwa S, Bii DK, Bulya N, Mugume F, Campbell JD, Wangisi J, Bukusi EA, Celum C, Baeten JM; Partners PrEP Study Team.. Rapid Antiretroviral Therapy Initiation for Women in an HIV-1 Prevention Clinical Trial Experiencing Primary HIV-1 Infection during Pregnancy or Breastfeeding. PLoS One. 2015 Abstract
  34. Ehrhardt S, Xie C, Guo N, Nelson K, Thio CL. Breastfeeding while taking lamivudine or tenofovir disoproxil fumarate: a review of the evidence. Clin Infect Dis. 2015 Abstract Full text (link to original source) Full text (in our servers)
  35. Salado-Rasmussen K, Theilgaard ZP, Chiduo MG, Bygbjerg IC, Gerstoft J, Lüneborg-Nielsen M, Lemnge M, Katzenstein TL. Nevirapine, sodium concentration and HIV-1 RNA in breast milk and plasma among HIV-infected women receiving short-course antiretroviral prophylaxis. PLoS One. 2015 Abstract
  36. Pandhi D, Ailawadi P. Initiation of antiretroviral therapy. Indian J Sex Transm Dis. 2014 Abstract Full text (link to original source) Full text (in our servers)
  37. Mirochnick M, Taha T, Kreitchmann R, Nielsen-Saines K, Kumwenda N, Joao E, Pinto J, Santos B, Parsons T, Kearney B, Emel L, Herron C, Richardson P, Hudelson SE, Eshleman SH, George K, Fowler MG, Sato P, Mofenson L; HPTN 057 Protocol Team.. Pharmacokinetics and safety of tenofovir in HIV-infected women during labor and their infants during the first week of life. J Acquir Immune Defic Syndr. 2014 Abstract
  38. Ganne-Carrie N, Causse X, Zarski JP et al. Efficacy and safety results of tenofovir DF (TDF) treatment from the first trimester in HBV pregnant women in real-life clinical practice. Hepatology. 2013;58 (Suppl 1):664A-5A 2013 Full text (link to original source) Full text (in our servers)
  39. Hirnschall G, Harries AD, Easterbrook PJ, Doherty MC, Ball A. The next generation of the World Health Organization's global antiretroviral guidance. J Int AIDS Soc. 2013 Abstract Full text (link to original source) Full text (in our servers)
  40. A Gouraud, A Millaret, N Bernard, M Bruel, N Paret, J Descotes, T Vial Centre de Pharmacovigilance de Lyon. Tenofovir exposure through breast feeding: serum concentrations in neonates and clinical follow-up. Fundam Clin Pharmacol. 2012;26 (Suppl 1):9. Abstract 11-O017. 2012 Full text (link to original source) Full text (in our servers)
  41. Pan CQ, Mi LJ, Bunchorntavakul C, Karsdon J, Huang WM, Singhvi G, Ghany MG, Reddy KR. Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women: a case series. Dig Dis Sci. 2012 Abstract
  42. Benaboud S, Pruvost A, Coffie PA, Ekouévi DK, Urien S, Arrivé E, Blanche S, Théodoro F, Avit D, Dabis F, Tréluyer JM, Hirt D. Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan, Cote d'Ivoire, in the ANRS 12109 TEmAA Study, Step 2. Antimicrob Agents Chemother. 2011 Abstract Full text (link to original source) Full text (in our servers)
  43. Bateman C. Mothers and babies: widening the HIV safety net. S Afr Med J. 2011 Abstract
  44. Pol S, Corouge M, Fontaine H. Hepatitis B virus infection and pregnancy. Clin Res Hepatol Gastroenterol. 2011 Abstract
  45. Bositis CM, Gashongore I, Patel DM. Updates to the World Health Organization's Recommendations for the Use of Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants. Med J Zambia. 2010 Abstract

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