Tenofovir Disoproxil

Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026

Tenofovir disoproxil is an oral prodrug of tenofovir, a nucleotide analog reverse-transcriptase inhibitor used to treat HIV-1 infection only in combination with other antiretrovirals and to treat chronic hepatitis B. It is used as a single agent for hepatitis B and as a component of fixed-dose HIV treatment and PrEP combinations. Long-term use is associated with declines in bone mineral density and renal tubular effects that can lower serum phosphate.

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Publication status

Exploratory record, not a reviewed medical publication.

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This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.

In short

What the research says.

A quick, data-only summary. The full evidence, dosing, and sources are below.

Tenofovir disoproxil is an oral prodrug of tenofovir, a nucleotide analog reverse-transcriptase inhibitor used to treat HIV-1 infection only in combination with other antiretrovirals and to treat chronic hepatitis B. NutriStack rates the supporting evidence as strong. Common adult dosing is 300 mg orally once daily for adults (HIV-1 and chronic hepatitis B); dose reduction or extended dosing interval required in renal impairment, though a prescriber sets the actual dose. With long-term use it can deplete phosphorus, phosphate, vitamin d. This profile indexes 2 sources.

What it's good for

Treatment of HIV-1 infection in combination with other antiretroviral agents¹
Treatment of chronic hepatitis B in adults and adolescents²
Component of HIV pre-exposure prophylaxis (PrEP) regimens

What to watch for

Nausea, diarrhea, vomiting, and abdominal pain
Headache and fatigue
Decreased bone mineral density and increased risk of osteomalacia or fractures with long-term use
Known hypersensitivity to tenofovir or any formulation component^1,2
Use with caution and dose adjustment in significant renal impairment (creatinine clearance below 50 mL/min)^2,1

The bottom line

Evidence rating strong. Most-documented uses: treatment of hiv-1 infection in combination with other antiretroviral agents, treatment of chronic hepatitis b in adults and adolescents, component of hiv pre-exposure prophylaxis (prep) regimens. 2 sources indexed (2010–2019), with 0 interaction records on file.

The science

How it works, mechanistically.

Core mechanism

Tenofovir disoproxil is rapidly hydrolyzed to tenofovir, which is then phosphorylated by cellular kinases to its active metabolite tenofovir diphosphate. This active form is an analog of deoxyadenosine 5'-triphosphate and inhibits HIV-1 reverse transcriptase and hepatitis B virus polymerase by competing with the natural substrate and, after incorporation into the growing viral DNA chain, causing chain termination because it lacks the 3'-hydroxyl group needed for further nucleotide addition. The result is suppression of viral replication. Renal proximal tubular accumulation of tenofovir can impair tubular reabsorption, contributing to phosphate wasting, reduced active vitamin D metabolism, and secondary effects on calcium and bone metabolism.^1,2

Class

Nucleotide reverse-transcriptase inhibitor (NRTI)

Dosing

Dosing & protocol.

Common range

300 mg orally once daily for adults (HIV-1 and chronic hepatitis B); dose reduction or extended dosing interval required in renal impairment

Recommended form

Oral tablet (300 mg); also available in fixed-dose combination tablets and as an oral powder for patients who cannot swallow tablets

Can be taken with or without food; a high-fat meal increases oral bioavailability of tenofovir but the drug may be administered regardless of meals. Consistent daily dosing matters more than meal timing.²

Depletions

What it depletes.

Nutrients this medication can lower over time, and what to replace.

Phosphorus

Significant

Tenofovir-associated proximal renal tubulopathy can cause urinary phosphate wasting and hypophosphatemia.

Replace Phosphate replacement only if prescribedMonitor Serum phosphorus, urine protein, urine glucose, renal functionOnset Months to years, or sooner with Fanconi syndrome

Phosphate

Moderate

Tenofovir disoproxil fumarate accumulates in proximal renal tubular cells and impairs mitochondrial function and sodium-phosphate cotransporter activity, causing proximal tubular dysfunction (Fanconi-like syndrome) with renal phosphate wasting and consequent hypophosphatemia.

Replace Phosphate (potassium/sodium phosphate) supplementation under medical supervision if clinically deficientMonitor Serum phosphate, urine phosphate / fractional excretion of phosphate, serum creatinine and eGFROnset Months to years of continued use; subclinical phosphaturia can appear within months

Vitamin D

Mild

Proximal tubular injury reduces renal 1-alpha-hydroxylase activity and impairs conversion of 25-hydroxyvitamin D to active 1,25-dihydroxyvitamin D, while associated secondary hyperparathyroidism further dysregulates vitamin D metabolism, contributing to lower active vitamin D status.

Replace Vitamin D3 (cholecalciferol)Monitor Serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, parathyroid hormone (PTH)Onset Months to years of continued therapy

Calcium

Mild

Renal phosphate wasting, reduced active vitamin D, and secondary hyperparathyroidism increase bone turnover and urinary calcium losses; proximal tubulopathy can also cause hypercalciuria, collectively promoting negative calcium balance and reduced bone mineral density.

Replace Calcium (with vitamin D) supplementation if dietary intake is inadequateMonitor Serum calcium, 24-hour urinary calcium, parathyroid hormone (PTH), bone mineral density (DXA)Onset Months to years; bone mineral density loss is typically detectable within the first 1-2 years

Full Tenofovir Disoproxil depletion and interaction guide →

Safety

Full safety detail.

Side effects

Nausea, diarrhea, vomiting, and abdominal pain
Headache and fatigue
Decreased bone mineral density and increased risk of osteomalacia or fractures with long-term use
Renal toxicity including proximal renal tubulopathy (Fanconi syndrome), acute kidney injury, and decline in estimated GFR
Hypophosphatemia and phosphate wasting
Reduced vitamin D and secondary hyperparathyroidism with chronic use
Rash

Contraindications

Known hypersensitivity to tenofovir or any formulation component^1,2
Use with caution and dose adjustment in significant renal impairment (creatinine clearance below 50 mL/min)^2,1
Avoid concurrent or recent use with other nephrotoxic agents when possible
Coadministration with other tenofovir-containing products is not recommended^1,2
Tenofovir disoproxil should not be used alone to treat HIV-1 infection or as single-agent PrEP; use only as part of a complete recommended antiretroviral regimen for HIV.^1,2

Sources

Sources, by evidence tier.

Numbered references. Citations throughout the page link here.

Meta-analyses & systematic reviews

1Bone and renal effects of tenofovir disoproxil fumarate in antiretroviral therapyCooper RD, et al. · Clinical Infectious Diseases · 2010
Tenofovir disoproxil is associated with greater loss of bone mineral density and a modest increased risk of renal proximal tubular dysfunction compared with comparator regimens.

Reference material

2VIREAD (tenofovir disoproxil fumarate) US Prescribing InformationGilead Sciences · FDA Prescribing Information · 2019
Standard adult dosing is 300 mg orally once daily; long-term use is associated with decreases in bone mineral density and renal adverse effects requiring monitoring.

FAQ

Common questions.

Quick answers about Tenofovir Disoproxil, drawn from the data on this page.

What is Tenofovir Disoproxil?

What is Tenofovir Disoproxil used for?

Commonly cited benefits of Tenofovir Disoproxil include: Treatment of HIV-1 infection in combination with other antiretroviral agents; Treatment of chronic hepatitis B in adults and adolescents; Component of HIV pre-exposure prophylaxis (PrEP) regimens. NutriStack rates the overall evidence as strong.

What is a typical dose of Tenofovir Disoproxil?

A typical adult dose of Tenofovir Disoproxil is 300 mg orally once daily for adults (HIV-1 and chronic hepatitis B); dose reduction or extended dosing interval required in renal impairment. The commonly recommended form is Oral tablet (300 mg); also available in fixed-dose combination tablets and as an oral powder for patients who cannot swallow tablets. These are general ranges, not personalized advice; confirm the right dose with a clinician.

What are the side effects of Tenofovir Disoproxil?

Reported side effects include nausea, diarrhea, vomiting, and abdominal pain, headache and fatigue, decreased bone mineral density and increased risk of osteomalacia or fractures with long-term use, renal toxicity including proximal renal tubulopathy (fanconi syndrome), acute kidney injury, and decline in estimated gfr, hypophosphatemia and phosphate wasting, reduced vitamin d and secondary hyperparathyroidism with chronic use. This is educational information; check with a healthcare professional before use.

How strong is the evidence for Tenofovir Disoproxil?

NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.

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