Abstract | INTRODUCTION: Several nucleos(t)ide analogs (NUC) are available for the management of patients with chronic hepatitis B (CHB). In most patients, NUC need to be administered on a long-term basis, thus increasing the risk of adverse effects. Adefovir dipivoxil (ADV), the first nucloeotide analog developed to treat CHB, may indeed cause nephrotoxicity. AREAS COVERED: The pharmacokinetic mechanism of action, potential mechanism of renal damage and long-term safety profile of ADV in CHB patients have been reported. The current monitoring modalities, together with dosage adjustments, treatment of patients with ADV-related kidney impairment and the therapeutic algorithm in place at the authors' Liver Center are also summarized. Although, in short-term clinical trials, a daily dose of 10 mg of ADV was safe owing to a low rate of negligible nephrotoxic effects, the same dose may be associated with a usually reversible, proximal renal tubular toxicity as reflected by hypophosphatemia and elevated creatinine levels. Occasionally, Fanconi syndrome occurred in ADV-treated patients. EXPERT OPINION: Renal function at baseline and during treatment should be carefully assessed in all patients receiving ADV to adjust the dose according to creatinine clearance, aimed to prevent or minimize nephrotoxicity.
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Authors | Mauro Viganò, Pietro Lampertico, Massimo Colombo |
Journal | Expert opinion on drug safety
(Expert Opin Drug Saf)
Vol. 10
Issue 5
Pg. 809-18
(Sep 2011)
ISSN: 1744-764X [Electronic] England |
PMID | 21671843
(Publication Type: Journal Article, Review)
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Chemical References |
- Antiviral Agents
- Organophosphonates
- Adenine
- adefovir dipivoxil
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Topics |
- Adenine
(administration & dosage, adverse effects, analogs & derivatives)
- Antiviral Agents
(administration & dosage, adverse effects)
- Clinical Trials, Phase III as Topic
- Hepatitis B, Chronic
(drug therapy)
- Humans
- Organophosphonates
(administration & dosage, adverse effects)
- Randomized Controlled Trials as Topic
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