Emtricitabine/Tenofovir-DF (FTC/TDF, PrEP)
Quality of Evidence:
Coadministration with emtricitabine has not been studied. Based on metabolism and clearance a clinically significant interaction is unlikely as diclofenac is partly glucuronidated by UGT2B7 and partly oxidized by CYP2C9. However, diclofenac could potentially decrease renal elimination of tenofovir (thereby increasing the risk of nephrotoxicity) as diclofenac is a strong inhibitor of MRP4. A retrospective analysis showed that patients treated with diclofenac together with tenofovir-DF containing regimens were at higher risk of developing an acute kidney injury when compared to patients treated with tenofovir-DF-sparing regimens. Since diclofenac can exacerbate tenofovir-DF nephrotoxicity, diclofenac should be used with caution with emtricitabine/tenofovir-DF and close monitoring of renal function is recommended.
A retrospective analysis of data for patients from the Frankfurt HIV Cohort who had diclofenac prescriptions showed 89 patients with diclofenac use; 61 patients (68.5%) were treated with tenofovir disoproxil fumarate (TDF) and 28 patients (31.5%) were treated with TDF-sparing combination antiretroviral therapy. Thirteen patients (14.6%) developed acute kidney injury (AKI) shortly after initiating diclofenac treatment with AKI occuring exclusively in TDF-treated patients, although all had previously stable renal function.
Acute kidney injury caused by tenofovir disoproxil fumarate and diclofenac co-administration. Bickel M, Khaykin P, Stephan C,et al. HIV Med, 2013, 14(10):633-8.
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