Updated: January 27, 2026
Adefovir Drug Interactions: What to Avoid and What to Tell Your Doctor
Author
Peter Daggett
ChatGPT
Claude
Gemini
- The Primary Interaction Category: Nephrotoxic Drugs
- Drugs That Must Be Avoided With Adefovir (Contraindicated)
- Drugs Requiring Caution and Close Monitoring (Serious Interactions)
- Drugs That Affect Adefovir Blood Levels
- Why Adefovir Has Fewer Liver-Based Drug Interactions
- What to Tell Your Doctor and Pharmacist
Overview
Adefovir dipivoxil can interact with several medications, especially those that affect the kidneys. Learn which drugs to avoid and what to tell your doctor in 2026.
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Adefovir dipivoxil (Hepsera) does not interact with many drugs through the liver's cytochrome P450 system — which is a pharmacological advantage. However, it does have important interactions involving the kidneys, particularly with other medications that can be toxic to the kidneys. Understanding these interactions helps keep you safe.
The Primary Interaction Category: Nephrotoxic Drugs
Adefovir is excreted primarily by the kidneys and can cause nephrotoxicity (kidney damage) with long-term use. Combining it with other drugs that are also hard on the kidneys multiplies this risk significantly. This is the main drug interaction concern with adefovir.
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Drugs That Must Be Avoided With Adefovir (Contraindicated)
Tenofovir disoproxil fumarate (Viread, TDF): Do not take adefovir and tenofovir DF at the same time. The combination causes additive nephrotoxicity and is contraindicated. These medications should never be used concurrently.
Tenofovir alafenamide (Vemlidy, TAF): Also contraindicated with adefovir for the same reason — additive nephrotoxicity and potential pharmacokinetic interactions.
Cidofovir: Avoid combination with cidofovir (an antiviral used for CMV infection). Both drugs are nephrotoxic.
Drugs Requiring Caution and Close Monitoring (Serious Interactions)
The following medications increase the risk of kidney damage when combined with adefovir. Use with caution, with close monitoring of kidney function:
NSAIDs (ibuprofen, naproxen, aspirin at high doses): Non-steroidal anti-inflammatory drugs reduce blood flow to the kidneys and can compound adefovir's nephrotoxicity. Avoid long-term NSAID use while on adefovir.
Aminoglycoside antibiotics (gentamicin, tobramycin, amikacin, streptomycin): These antibiotics are nephrotoxic on their own. The combination with adefovir increases kidney damage risk.
Vancomycin: This antibiotic can be nephrotoxic at high doses. Monitor renal function closely if both are used.
Cyclosporine: Commonly used after organ transplant; nephrotoxic. Co-administration with adefovir requires close renal monitoring.
Tacrolimus: Another transplant immunosuppressant with nephrotoxic potential. Monitor kidney function closely.
Amphotericin B: An antifungal medication with significant nephrotoxicity potential. Monitor kidney function closely if co-used.
Bacitracin (systemic): Avoid concurrent use; both increase nephrotoxicity.
Drugs That Affect Adefovir Blood Levels
Adefovir is excreted via the kidneys, partly through active tubular secretion. Drugs that compete for renal transport or reduce kidney function can raise adefovir blood levels, increasing toxicity risk:
Pretomanid: This tuberculosis drug inhibits OAT3 (organic anion transporter 3), a renal transporter that handles adefovir. Combination may increase adefovir levels — monitor for adefovir side effects.
Vadadustat: May increase adefovir exposure by inhibiting OAT3. Monitor closely.
Why Adefovir Has Fewer Liver-Based Drug Interactions
Unlike many medications that are metabolized by liver enzymes (cytochrome P450 system), adefovir is NOT metabolized by CYP enzymes. This means it does not interact with the large number of drugs that affect CYP enzymes (like certain antibiotics, antifungals, and anticonvulsants). This is a significant advantage and makes adefovir easier to manage from a drug interaction standpoint — as long as the kidney interaction category is monitored.
What to Tell Your Doctor and Pharmacist
Before starting adefovir, provide your complete medication list including:
All prescription drugs (especially antibiotics, antivirals, and transplant medications)
Over-the-counter medications, especially ibuprofen and naproxen (NSAIDs)
Vitamins, supplements, and herbal products
HIV status and any antiretroviral therapy — critical information for preventing HIV resistance
If you are having trouble filling your adefovir prescription, medfinder can find a pharmacy with it in stock near you. Also read: Adefovir Side Effects: What to Expect and When to Call Your Doctor
Frequently Asked Questions
Never take adefovir with tenofovir disoproxil fumarate (Viread) or tenofovir alafenamide (Vemlidy) — these combinations are contraindicated due to additive kidney toxicity. Also avoid cidofovir and long-term NSAIDs (ibuprofen, naproxen) while on adefovir. Discuss all other nephrotoxic drugs (aminoglycosides, cyclosporine, tacrolimus, amphotericin B) with your doctor.
Use NSAIDs like ibuprofen and naproxen with caution while taking adefovir. Both adefovir and NSAIDs can harm the kidneys, and combining them increases that risk. Avoid long-term NSAID use. For occasional pain relief, acetaminophen (Tylenol) is generally safer than NSAIDs for patients on adefovir.
Yes — some antibiotics interact with adefovir. Aminoglycoside antibiotics (gentamicin, tobramycin, amikacin) and vancomycin are nephrotoxic and increase the risk of kidney damage when combined with adefovir. If you need an antibiotic, tell your doctor you are taking adefovir so they can choose the safest option and monitor your kidney function.
No. Adefovir is not metabolized by cytochrome P450 (CYP) liver enzymes, so it does not have the typical drug interactions seen with many other medications. Its main interactions are kidney-related, not liver-related. This makes it easier to manage alongside many common medications.
With caution. Cyclosporine and tacrolimus — both used after organ transplants — are nephrotoxic, as is adefovir. The combination increases kidney damage risk. If you are taking transplant immunosuppressants, your doctor should monitor your kidney function more closely than usual. In post-liver transplant patients with lamivudine-resistant HBV, adefovir has been used but renal monitoring must be frequent.
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