title: Severe toxicity associated with the combination of tenofovir and didanosine: case report and review.
abstract: The combination of tenofovir and didanosine results in an increase in the didanosine plasma exposure and might augment the risk for didanosine toxicity. Although pharmacokinetic studies support a didanosine dose reduction to 250 mg when used concurrently with tenofovir in patients weighing at least 60 kg, no data are available in lower-weight patients. We describe a case of lactic acidosis and acute liver failure in a low-weight patient receiving tenofovir and a reduced dose of didanosine (200 mg/day). To our knowledge, this is the first case of severe toxicity associated with a reduced dose schedule of didanosine. Previous cases of severe toxicity associated with the combination of tenofovir and didanosine are reviewed.
authors.affiliation: Infectious Diseases Unit, Hospital General Universitario de Elche, Camí de l'Almazara 11, 03203 Elche, Alicante, Spain. marmasia@ya.com
authors.forename: M
authors.initials: M
authors.lastname: Masiá
authors.forename: F
authors.initials: F
authors.lastname: Gutiérrez
authors.forename: S
authors.initials: S
authors.lastname: Padilla
authors.forename: J M
authors.initials: JM
authors.lastname: Ramos
authors.forename: J
authors.initials: J
authors.lastname: Pascual
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced; D000208:Acute Disease; D000225:Adenine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016049:Didanosine / Q000008:administration & dosage / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D017093:Liver Failure / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000068698:Tenofovir
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D000068698:Tenofovir; D000225:Adenine; D016049:Didanosine