Adefovir dipivoxil nephrotoxicity

The dose of adefovir dipivoxil is 10 mg once daily. The most common side effects include asthenia, abdominal pain, diarrhea, dyspepsia, headaches, nausea, and flatulence. Lactic acidosis, pancreatitis, and hepatomegaly have been reported rarely. Unlike lamivudine, adefovir dipivoxil is associated with dose-related nephrotoxicity, which was most commonly seen in HIV patients receiving doses larger than 60 mg. Therefore, the dose of adefovir dipivoxil must be adjusted in patients with renal insufficiency (CrCl less than 50 mL/minute). 

Adefovir dipivoxil is well tolerated. A dose-dependent nephrotoxicity has been observed in clinical trials, manifested by increased serum creatinine with decreased serum phosphorous and more common in patients with baseline renal insufficiency and those receiving high doses (60 mg/d). Other potential adverse effects are headache, diarrhea, asthenia, and abdominal pain. As with other NRTI agents, lactic acidosis and hepatic steatosis are considered a risk owing to mitochondrial dysfunction. No clinically important drug-drug interactions have been recognized to date. Pivalic acid, a by-product of adefovir dipivoxil metabolism, can esterify free carnitine and result in decreased carnitine levels. However, it is not felt necessary to administer carnitine supplementation with the low doses used to treat patients with HBV (10 mg/d). 

Adefovir dipivoxil canses dose-related nephrotoxicity and tubular dysfunction, manifested by azotemia and hypophosphatemia, acidosis, glycosnria, and proteinuria that usually are reversible months after discontinuation. The lower dose (10 mg/day) nsed in chronic HBV infection patients has been associated with a few adverse events (e.g., headache, abdominal discomfort, diarrhea, and asthenia) and negligible renal toxicity compared with a threefold higher dose. 

Law ST, Li KK, Ho YY. Nephrotoxicity, including acquired Fanconi s s)mdrome, caused by adefovir dipivoxil - is there a safe dose J Clin... 

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