title: Drug safety evaluation of adefovir in HBV infection.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: A. M. and A. Migliavacca Center for Liver Disease, 1st Gastroenterology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università di Milano, Via F. Sforza 35, 20122 Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Viganò
authors.forename: Pietro
authors.initials: P
authors.lastname: Lampertico
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D017326:Clinical Trials, Phase III as Topic; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D063065:Organophosphonates / Q000008:administration & dosage* / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; D000225:Adenine; C106812:adefovir dipivoxil