Tenofovir Dosing for Chronic Hepatitis B

Standard Dosing by Age and Weight

• The American Association for the Study of Liver Diseases recommends a dosing of 300 mg once daily for both HBeAg-positive and HBeAg-negative chronic hepatitis B in adults and pediatric patients ≥12 years of age weighing ≥35 kg 1, 2
• For adolescents (12-18 years), the recommended dose is TDF 300 mg once daily for patients ≥12 years and ≥35 kg, with an alternative option of Tenofovir alafenamide (TAF) 8 mg/kg daily (up to 300 mg) for those ≥12 years 3

Dose Adjustments for Renal Impairment

• The American Association for the Study of Liver Diseases suggests that renal function monitoring is critical as tenofovir is primarily renally eliminated, and recommends assessing baseline creatinine clearance, serum phosphorus, urine glucose, and urine protein before initiating therapy 1

Alternative Tenofovir Formulation: TAF

• The American Association for the Study of Liver Diseases recommends Tenofovir alafenamide (TAF) 25 mg once daily as an alternative prodrug with improved safety profile, which has demonstrated noninferior efficacy to TDF at 48, 96, and 144 weeks 1, 2

Critical Safety Warnings

• The American Association for the Study of Liver Diseases warns that severe acute exacerbations of hepatitis can occur after discontinuing tenofovir, and recommends monitoring hepatic function closely with clinical and laboratory follow-up for at least several months after discontinuation 2

Special Populations

• The American Association for the Study of Liver Diseases recommends that TDF is pregnancy category B, and TAF has more detailed pregnancy/lactation labeling 1, 2

Common Pitfalls to Avoid

• The American Association for the Study of Liver Diseases emphasizes the importance of adequate renal/bone monitoring, which is essential for long-term safety, particularly with TDF 1