Comprehensive medication guide to Adefovir including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$10–$75 copay with insurance for generic adefovir dipivoxil; typically Tier 2 or Tier 3 on most commercial plans. Medicare Part D covers the generic but NOT brand-name Hepsera. Prior authorization may be required at some Tier 3 plans.
Estimated Cash Pricing
$520–$1,260 retail for a 30-day supply of generic adefovir dipivoxil 10 mg without insurance; as low as $520–$630 with GoodRx or SingleCare discount cards at participating pharmacies. Mark Cuban Cost Plus Drugs offers even lower pricing for out-of-pocket patients.
Medfinder Findability Score
72/100
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Adefovir dipivoxil — sold under the brand name Hepsera — is an antiviral medication approved by the FDA for the treatment of chronic hepatitis B virus (HBV) infection. It is indicated for adults and adolescents aged 12 and older with evidence of active viral replication and persistent liver inflammation or damage.
Adefovir belongs to the class of nucleotide analog reverse transcriptase inhibitors (NtRTIs). Originally developed by Gilead Sciences and approved in 2002 as brand-name Hepsera, it is now available as a generic from multiple manufacturers. Adefovir suppresses hepatitis B virus replication, helping to prevent liver damage, cirrhosis, and liver cancer associated with chronic HBV infection.
While adefovir was once a frontline treatment for hepatitis B, current clinical guidelines from AASLD and EASL now favor entecavir, tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF) as preferred first-line agents due to superior potency and safety. Adefovir retains an important role for patients with lamivudine-resistant HBV and specific treatment scenarios.
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Adefovir dipivoxil is a prodrug that is converted inside the body to adefovir, which is then phosphorylated by cellular kinases to form the active metabolite adefovir diphosphate. This active form is structurally similar to deoxyadenosine triphosphate (dATP), one of the natural building blocks of DNA.
When hepatitis B virus DNA polymerase (which acts as a reverse transcriptase) attempts to build new viral DNA, it incorporates adefovir diphosphate instead of natural dATP. Once incorporated, adefovir diphosphate acts as a chain terminator — it lacks the chemical structure necessary to continue the DNA chain, halting viral replication at that point.
Adefovir inhibits HBV DNA polymerase at concentrations far lower than those needed to inhibit human DNA polymerases, providing selectivity for the virus. It does not eliminate the hepatitis B cccDNA reservoir from liver cell nuclei, which is why therapy must be maintained long-term to prevent viral rebound.
10 mg — tablet
Standard oral dose for adults and adolescents 12 years and older; taken once daily with or without food. Dose adjustment required for renal impairment.
Adefovir dipivoxil is not on the FDA's official Drug Shortage List as of 2026. However, it is a lower-prescription-volume specialty medication, and many retail pharmacies do not keep it in stock routinely. Patients frequently report calling multiple pharmacies before finding one that has adefovir available to fill that day.
The availability challenge stems from declining market demand as newer, more potent hepatitis B antivirals (entecavir, TDF, TAF) have taken over as first-line treatments. As fewer patients are prescribed adefovir, pharmacies stock it in smaller quantities or not at all. Large chain pharmacies in urban areas with larger hepatitis B patient populations tend to have better availability than rural or smaller independent pharmacies.
Rather than calling pharmacies yourself, medfinder can call pharmacies near you to find which ones have adefovir in stock today, delivering results to you by text.
Adefovir dipivoxil is not a controlled substance, so no special DEA registration is required to prescribe it. Any licensed healthcare provider may write a prescription for adefovir. In practice, it is typically managed by specialists with expertise in liver disease and infectious diseases.
Hepatologists (liver specialists)
Gastroenterologists with hepatology experience
Infectious disease specialists
Primary care physicians (PCPs) and internists
Nurse practitioners (NPs) and physician assistants (PAs) with appropriate scope of practice
Telehealth prescribing is possible for stable established patients on maintenance therapy, as adefovir is not controlled and has no federal telehealth restrictions. However, initial evaluation and regular laboratory monitoring (kidney and liver function, HBV DNA) require in-person lab visits.
No. Adefovir dipivoxil (Hepsera) is not a controlled substance and is not assigned a DEA schedule. It is a prescription-only medication, but any licensed healthcare provider — including physicians, nurse practitioners, and physician assistants — can prescribe it without additional DEA registration or special prescribing authority.
Because adefovir is not controlled, it does not have the same refill restrictions as Schedule II-V medications. Prescriptions can be written for 90-day supplies and can be refilled as authorized by the prescriber. There are no federally mandated limits on refill quantities for this medication.
At the approved 10 mg daily dose, common side effects occurred at rates similar to placebo in clinical trials:
Asthenia (weakness/fatigue) — ~13%
Headache — ~9%
Abdominal pain — ~9%
Nausea — ~5%
Diarrhea, flatulence, and upset stomach (less common)
Nephrotoxicity (kidney damage) — manifests as decreased urine output, swelling, elevated creatinine
Severe hepatitis B flare on discontinuation — jaundice, dark urine, severe fatigue
Lactic acidosis — muscle pain, difficulty breathing, rapid heartbeat (rare but potentially fatal)
Fanconi syndrome and osteomalacia (with long-term use) — bone pain, fractures, low phosphate
HIV resistance in undiagnosed/untreated HIV-positive patients
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Entecavir (Baraclude)
First-line hepatitis B antiviral with high potency, high genetic barrier to resistance, and no nephrotoxicity. Generic widely available. Preferred over adefovir for treatment-naive patients.
Tenofovir Disoproxil Fumarate (Viread)
Highly potent nucleotide analog; superior antiviral efficacy to adefovir. Active against lamivudine-resistant and adefovir-resistant HBV. Cannot be used concurrently with adefovir.
Tenofovir Alafenamide (Vemlidy)
Newer formulation of tenofovir with improved renal and bone safety profile. Preferred for patients with kidney disease or bone concerns. Cannot be used with adefovir.
Lamivudine (Epivir-HBV)
Older first-generation oral antiviral; lower cost but high rate of resistance with long-term use. Adefovir is often specifically used to treat lamivudine-resistant HBV.
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Tenofovir Disoproxil Fumarate (Viread)
majorContraindicated. Additive nephrotoxicity. Never use concurrently with adefovir.
Tenofovir Alafenamide (Vemlidy)
majorContraindicated. Additive nephrotoxicity. Never use concurrently with adefovir.
Cidofovir
majorAvoid combination. Both drugs are nephrotoxic.
NSAIDs (ibuprofen, naproxen)
moderateCaution required. NSAIDs reduce renal blood flow and compound adefovir nephrotoxicity. Avoid long-term use.
Aminoglycoside antibiotics (gentamicin, tobramycin)
moderateCaution required. Additive nephrotoxicity risk. Monitor renal function closely.
Cyclosporine
moderateMonitor closely. Both drugs are nephrotoxic; combination increases renal damage risk, especially in transplant patients.
Tacrolimus
moderateMonitor closely. Additive nephrotoxicity in transplant patients.
Amphotericin B
moderateCaution. Additive nephrotoxicity. Monitor renal function.
Adefovir dipivoxil (Hepsera) remains a valid treatment option for chronic hepatitis B, particularly for patients with lamivudine-resistant HBV or those who cannot use first-line agents. While newer medications like entecavir and tenofovir are now preferred in most clinical guidelines, adefovir continues to be prescribed and plays a role in individualized treatment decisions.
The main practical challenges with adefovir in 2026 are its limited availability at retail pharmacies (due to declining prescription volume) and its relatively high retail cash price without discount cards. Both challenges are manageable with the right strategies: using mail-order or specialty pharmacies for supply, and using discount cards or patient assistance programs for cost.
If you are prescribed adefovir and are having trouble finding it at a pharmacy near you, medfinder can call pharmacies on your behalf to locate it quickly, so you can stay on your treatment without interruption.
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Medfinder is actively checking pharmacy inventory for Adefovir. We don't publish a number until we have enough verified pharmacy checks to be accurate — start a search and our team confirms current availability near you, usually within 24 hours.
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