Take tenofovir's precautions
In recent years, oral anti-hepatitis B virus drugs, we use more entecavir and tenofovir. This is a two kinds of non-drug-resistant first-line nucleoside drugs.
The efficacy of entecavir was significantly higher than the second-line drugs, with few adverse reactions, but about 10% of the effects of poor, virus 3,4 hysteria coies / ml hovering down. As long as Prohibition of alcohol, initial treatment rarely resistant, but resistant to lamivudine or telbivudine cross-resistant. In addition, affect fertility, fetal teratogenic can not be excluded.
The efficacy of tenofovir is higher than that of entecavir for treating hepatitis B for 8 years. So far no definite drug resistance report has been reported at home and abroad. Alcoholism, chemotherapy or adrenal cortex hormones significantly affect their efficacy, but also no resistance. Viral and E antigens slightly shorter time, the surface antigen titers slightly lower, foreign reports of liver fibrosis and mild cirrhosis have a high rate of reversal, may significantly reduce the incidence of liver cancer. In addition, this medicine does not affect fertility and breastfeeding. Tenofovir had slightly more adverse reactions than entecavir, with long-term transaminases, rashes, stool frequency and other discomforts, and a few were discontinued due to intolerance.
Many people are concerned about nephrotoxicity of tenofovir, in fact, only a small number of chronic hepatitis B have mild tubular damage, manifested as 24-hour urine β2 microglobulin increased 3 to 6 months after dressing can be restored normal. If you have lamivudine resistance, long-term use of only tenofovir can be used. Small Sanyang "patients with mild cirrhosis, if the cousins have malignant tumors, especially liver cancer, in order to minimize the incidence of liver cancer, it is best to use tenofovir.
How to take tenofovir safely for patients with minor problems in the kidneys?
First, do not switch to tenofovir directly, to avoid continuing adefovir nephrotoxicity, must first use entecavir (once lamivudine-resistant patients must be 2 tablets) 3 months, check the 24-hour urine β2 Microglobulin quantitative normal before you can replace Norfloxein.
Second, these patients may have reduced glomerular filtration rate, if the conventional dose of 1 per day, high plasma concentrations will occur nephrotoxicity. Real-time serum creatinine quantitative calculation of serum creatinine clearance rate can be equivalent to glomerular filtration rate, reduce the daily dose.
Calculation formula: (140-age) x body weight kg / 0.818x serum creatinine
Serum creatinine clearance ≥ 90%: 1 tablet daily.
60-90%: 36 hours 1, the first day at 8 am, the next day at 8 pm, the third day refused to accept, so repeat.
≤ 60% ≥ 30%: half a day.
To ensure accurate quantitative serum creatinine, check the first 2 days to reduce the meat and physical activity.
Third, regular 24-hour urine β2 microglobulin quantitative, usually every 3 months, if necessary, check once a month. If the quantitative increase, to be switched to entecavir 3-6 months, 24 hours urine retest β2 microglobulin quantitative, returned to tenofovir after returning to normal.