[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)](https://durgical.com/en/pharmacology/classes/nucleoside-nucleotide-reverse-transcriptase-inhibitors/) › Tenofovir disoproxil [Pharmacology](https://durgical.com/en/pharmacology/) · [Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)](https://durgical.com/en/pharmacology/classes/nucleoside-nucleotide-reverse-transcriptase-inhibitors/) # Tenofovir disoproxil A prodrug of tenofovir, the most widely used antiretroviral. It treats HIV and hepatitis B and prevents HIV; kidney and bone need watching. Updated 2026-11-01 - Class: [Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)](https://durgical.com/en/pharmacology/classes/nucleoside-nucleotide-reverse-transcriptase-inhibitors/) - Enzyme: HIV-1 reverse transcriptase - ATC code: J05AF07 - WHO Model List of Essential Medicines Also called: TDF, tenofovir disoproxil fumarato ✂**HIV-1 reverse transcriptase**Tenofovir disoproxil ⓘ The figure shows tenofovir diphosphate, the active form, as the incoming nucleotide in HIV-1 reverse transcriptase bound to its DNA template. **Target in 3D:** HIV-1 reverse transcriptase. PDB structure 1T05 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/1T05) · Drag to rotate · pinch to zoom ## Mechanism of action A nucleotide analogue (it already carries a phosphate). It is hydrolysed to tenofovir, and cellular kinases turn it into tenofovir diphosphate, which competes with dATP; incorporated into viral DNA, it ends the chain because its sugar ring is incomplete. It also blocks the hepatitis B virus polymerase. - It is hydrolysed to tenofovir and phosphorylated to the diphosphate - It competes with dATP at reverse transcriptase - Its incomplete ring ends the viral DNA chain ## Pharmacokinetics **Absorption** Oral tenofovir bioavailability about 25% when fasting; higher with a high-fat meal **Elimination** By the kidney (filtration and tubular secretion); it builds up in kidney failure **Half-life** Plasma terminal half-life of tenofovir about 17 hours ## Indications - HIV-1 infection, combined with other antiretrovirals [HIV infection and AIDS →](https://durgical.com/en/conditions/hiv-infection-and-aids/) - Chronic hepatitis B [Viral hepatitis →](https://durgical.com/en/conditions/viral-hepatitis/) - HIV pre-exposure prophylaxis (PrEP), alone or with emtricitabine [HIV infection and AIDS →](https://durgical.com/en/conditions/hiv-infection-and-aids/) ## Adverse effects ### Common - Nausea, diarrhoea - Headache - Tiredness - Rash ### Serious (rare, important) - Kidney injury: acute renal failure and Fanconi syndrome (proximal tubulopathy with hypophosphataemia) - Loss of bone mineral density and osteomalacia - Severe hepatitis B flare after stopping - Lactic acidosis with hepatic steatosis (class effect) ## Contraindications - The label lists no absolute contraindications; it is avoided with nephrotoxic drugs and in kidney failure without adjustment ## Key interactions **High-dose or multiple NSAIDs, and other nephrotoxic drugs** Higher risk of kidney failure **Atazanavir** Tenofovir lowers atazanavir: atazanavir is given boosted with ritonavir **Ritonavir or cobicistat** They raise tenofovir concentrations by inhibiting kidney transporters ## What is monitored - HIV and hepatitis B tests before starting - Creatinine, creatinine clearance, urine glucose and protein - Phosphate in people at renal risk - Bone density if there are prior fractures or osteoporosis risk ## Administration and safety - By mouth - Do not confuse tenofovir disoproxil with tenofovir alafenamide: they are different prodrugs and are not swapped without an explicit order - Check fixed-dose combinations that already contain tenofovir so it is not duplicated ## Nursing care - Check kidney function before and during treatment - Ask about over-the-counter anti-inflammatory use - Teach to report bone pain, muscle weakness or urine changes - Explain that in PrEP protection depends on adherence and regular HIV tests ## Pregnancy and breastfeeding Antiretroviral treatment in pregnancy protects the mother and lowers HIV transmission to the baby; the treating team chooses the regimen. ## Memory aid 'TDF: Tubule, Density of bone, Fanconi'. ## Test yourself Think of the answer, then tap the question to see it. ## Which typical kidney lesion does tenofovir disoproxil cause? Proximal tubulopathy (Fanconi syndrome): loss of phosphate, glucose and protein in urine; it can lead to osteomalacia. ## Why is hepatitis B serology done before starting tenofovir? Because it also suppresses hepatitis B: if the person has it and stops the drug, a severe flare can follow. ## How does tenofovir differ structurally from other NRTIs? It is a nucleotide analogue: it already carries a phosphate, so it needs one fewer phosphorylation step. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/tenofovir-disoproxil/) ## Related drugs - [Tenofovir alafenamide](https://durgical.com/en/pharmacology/tenofovir-alafenamide/) - [Emtricitabine](https://durgical.com/en/pharmacology/emtricitabine/) - [Lamivudine](https://durgical.com/en/pharmacology/lamivudine/) - [Dolutegravir + lamivudine + tenofovir disoproxil (TLD)](https://durgical.com/en/pharmacology/dolutegravir-lamivudine-tenofovir-disoproxil/) ## Related conditions - [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/) - [Viral hepatitis](https://durgical.com/en/conditions/viral-hepatitis/) [← Back to the class: Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)](https://durgical.com/en/pharmacology/classes/nucleoside-nucleotide-reverse-transcriptase-inhibitors/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - TENOFOVIR DISOPROXIL FUMARATE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd3120b-60f6-41d8-a512-ed4a62c836b4) (DailyMed (U.S. National Library of Medicine), 2026); [Tenofovir disproxil fumarate: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a625081.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=J05AF07) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 64 (McGraw Hill, 2023). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/tenofovir-disoproxil/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/tenofovir-disoproxil/