adefovir dipivoxil
Regulatory sources consulted
Approved indications
- Treatment of chronic hepatitis B in adults with evidence of active viral replication and active liver disease.
Contraindications
Absolute
- Hypersensitivity to adefovir dipivoxil.
Clinical warnings
- Discontinuation may cause severe hepatitis B exacerbation; monitor liver function for several months after stopping. — DailyMed, set_id 08e07fae-3191-b6a3-c894-d3a8cc53923f
- It may cause nephrotoxicity, proximal tubulopathy, and osteomalacia; calculate CrCl before treatment and monitor creatinine and phosphate periodically. — DailyMed, set_id 08e07fae-3191-b6a3-c894-d3a8cc53923f
- Major warning · Before treating HBV, confirm HIV status; monotherapy in coinfection may select HIV resistance. — DailyMed, set_id 08e07fae-3191-b6a3-c894-d3a8cc53923f
Drug interactions
- HighNephrotoxic drugs or drugs cleared by tubular secretion
Mechanism: They may increase adefovir exposure and renal injury.
Recommendation: Avoid if possible; if combined, intensify renal monitoring.
DailyMed, set_id 08e07fae-3191-b6a3-c894-d3a8cc53923f
- ModerateTenofovir-containing products
Mechanism: They duplicate nucleotide analogues and increase renal risk.
Recommendation: Do not combine adefovir with TDF or other tenofovir-containing products.
DailyMed, set_id 08e07fae-3191-b6a3-c894-d3a8cc53923f
Adverse events
Common (≥1%)
Asthenia, headache, abdominal pain, nausea, and diarrhea
Rare but serious
Renal failure, proximal tubulopathy, osteomalacia, lactic acidosis, and severe hepatitis B exacerbation
Pregnancy and lactation
It is not recommended in pregnancy unless benefit outweighs risk; use effective contraception. Do not breastfeed during treatment.
Recent literature (PubMed)
The nephrotoxicity of adefovir dipivoxil (ADV) can induce Fanconi syndrome, which causes hypophosphatemic osteomalacia. We report a case of a 67-year-old postmenopausal woman who had been receiving long-term adefovir dipivoxil therapy for chronic hepatitis B. She presented with severe bone pain and multiple pseudofractures, and was diagnosed with drug-induced hypophosphatemic osteomalacia. Following discontinuation of adefovir and supplementation with vitamin D and phosphate, her biochemical parameters normalized and bone pain significantly improved, indicating that osteomalacia had been essentially corrected. However, although follow-up bone mineral density (BMD) showed significant improvement compared to pretreatment values, it remained markedly below the reference range for age-matched women. Postmenopausal osteoporosis was therefore suspected, and anti-osteoporotic pharmacotherapy was initiated after correction of osteomalacia. This case suggests that BMD can improve substantially after removal of the causative factor in drug-induced osteomalacia; however, if patients have underlying risk factors for osteoporosis, low BMD may persist even after osteomalacia resolution, necessitating further evaluation and intervention.
In this study, we aimed to perform a network meta-analysis to compare the effectiveness of NAs in decreasing the reactivation of HBV, reducing chemotherapy disruption, and improving survival in oncology patients. Relevant randomized controlled trials (RCT) evaluating the impact of NAs in HBV infected-related oncology patients were retrieved from electronic databases. The outcome indicators included reactivation rate, survival rate of 1 to 3 years after treatment, and chemotherapy disruption rate. The studies were evaluated for bias using the RCT risk of bias assessment tool recommended in the Cochrane Handbook. The risk ratio (RR) was used to compare the outcome indicators for the anti-viral treatment, and the surface under the cumulative ranking curves (SUCRA) was used to identify the optimal therapeutic regime. A total of 67 trials containing 5722 patients were included in this study. Regarding the reduction of reactivation rate, entecavir, lamivudine, adefovir alone were less effective than the combination of lamivudine and entecavir (94.9%), with RR values ranging from 3.16 to 3.73. However, based on SUCRA, the efficacy of telbivudine (80.3%) and the combination of lamivudine and adefovir dipivoxil (58.8%) were also acceptable. Entecavir (RR values ranging from 1.25 to 1.50) and lamivudine (RR values ranging from 1.27 to 1.35) can prolong the survival rate of patients at 1-3 years, and were better than adefovir dipivoxil in the comparison of 1-year survival rate. The RR values were 1.18 and 1.19, respectively. And entecavir 's ranking in SUCRA was more stable. Entecavir, lamivudine, and tenofovir all reduced chemotherapy interruption rates compared with no antiviral therapy, especially for tenofovir. Current evidence shows that lamivudine combined with entecavir, telbivudine, and lamivudine combined with adefovir dipivoxil were the most effective in preventing virus reactivation in HBV infected-related cancer patients treated with chemotherapy. Entecavir had the
Many acyclic nucleoside phosphonates such as cidofovir, adefovir dipivoxil, tenofovir disoproxil fumarate, and tenofovir alafenamide have been marketed for the treatment or prophylaxis of infectious diseases. Here, this review highlights potent acyclic nucleoside phosphonates for their potential in the treatment of retrovirus (e.g., human immunodeficiency virus) and DNA virus (e.g., adeno-, papilloma-, herpes- and poxvirus) infections. If properly assessed and/or optimized, some potent acyclic nucleoside phosphonates can be possibly applied in the control of current and emerging infectious diseases.
Adefovir dipivoxil (ADV)-induced Fanconi syndrome associated with hypophosphatemic osteomalacia is an extremely rare disease. Owing to its rarity, it is easily misdiagnosed as cervical spondylotic myelopathy. Here, we present the case of a patient with Fanconi's syndrome associated with hypophosphatemic osteomalacia that was misdiagnosed as having cervical spondylotic myelopathy. A 44-year-old Chinese man with a 10-year history of ADV therapy for chronic hepatitis B presented with progressive bilateral lower extremity weakness for more than 6 months. Cervical magnetic resonance imaging revealed disc herniations at C4/5, C5/6, and C6/7, accompanied by spinal cord compression. Laboratory evaluations revealed glucosuria, proteinuria, hypophosphatemia, and impaired renal function. He was misdiagnosed with cervical spondylotic myelopathy and underwent anterior cervical corpectomy decompression and fusion. However, his lower limb weakness failed to improve 10 months after surgery. On the basis of the patient's clinical symptoms, along with his long history of oral ADV use, hypophosphatemia, and renal insufficiency, he was diagnosed with adefovir dipivoxil-induced Fanconi syndrome. ADV was replaced with entecavir, and the patient was prescribed oral calcitriol 0.25 μg daily and oral calcium carbonate with vitamin D₃ (300 mg calcium and 60 IU vitamin D₃ per tablet) once daily. The patient's lower limb muscle strength returned to normal after 6 months. Fanconi syndrome with hypophosphatemic osteomalacia induced by low-dose adefovir dipivoxil (10 mg/d) is extremely rare. The condition may present with pain, muscle weakness, or numbness, and its nonspecific manifestations can easily lead to a misdiagnosis of cervical spondylotic myelopathy. For patients receiving long-term ADV therapy who develop such symptoms, especially in the presence of cervical disc herniation with spinal cord compression, clinicians should carefully evaluate laboratory findings and physical examination r