HepBest Special Precautions

This medicinal product contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially 'sodium-free'.
HBV transmission: Patients must be advised that Tenofovir alafenamide film-coated tablets 25 mg does not prevent the risk of transmission of HBV to others through sexual contact or contamination with blood. Appropriate precautions must continue to be used.
Patients with decompensated liver disease: There are no data on the safety and efficacy of Tenofovir alafenamide film-coated tablets 25 mg in HBV infected patients with decompensated liver disease and who have a Child Pugh Turcotte (CPT) score > 9 (i.e. class C). These patients may be at higher risk of experiencing serious hepatic or renal adverse reactions. Therefore, hepatobiliary and renal parameters should be closely monitored in this patient population (see Pharmacology: Pharmacokinetics under Actions).
Exacerbation of hepatitis: Flares on treatment: Spontaneous exacerbations in chronic hepatitis B are relatively common and are characterised by transient increases in serum alanine aminotransferase (ALT). After initiating antiviral therapy, serum ALT may increase in some patients. In patients with compensated liver disease, these increases in serum ALT are generally not accompanied by an increase in serum bilirubin concentrations or hepatic decompensation. Patients with cirrhosis may be at a higher risk for hepatic decompensation following hepatitis exacerbation, and therefore should be monitored closely during therapy.
Flares after treatment discontinuation: Acute exacerbation of hepatitis has been reported in patients who have discontinued treatment for hepatitis B, usually in association with rising HBV DNA levels in plasma. The majority of cases are self-limited but severe exacerbations, including fatal outcomes, may occur after discontinuation of treatment for hepatitis B. Hepatic function should be monitored at repeated intervals with both clinical and laboratory follow-up for at least 6 months after discontinuation of treatment for hepatitis B. If appropriate, resumption of hepatitis B therapy may be warranted.
In patients with advanced liver disease or cirrhosis, treatment discontinuation is not recommended since post-treatment exacerbation of hepatitis may lead to hepatic decompensation. Liver flares are especially serious, and sometimes fatal in patients with decompensated liver disease.
Patients coinfected with HBV and hepatitis C or D virus: There are no data on the safety and efficacy of Tenofovir alafenamide film-coated tablets 25 mg in patients co-infected with hepatitis C or D virus. Co-administration guidance for the treatment of hepatitis C should be followed (see Interactions).
Hepatitis B and HIV coinfection: HIV antibody testing should be offered to all HBV infected patients whose HIV-1 infection status is unknown before initiating therapy with Tenofovir alafenamide film-coated tablets 25 mg. In patients who are co-infected with HBV and HIV, Tenofovir alafenamide film-coated tablets 25 mg should be co-administered with other antiretroviral agents to ensure that the patient receives an appropriate regimen for treatment of HIV (see Interactions).
Coadministration with other medicinal products: Tenofovir alafenamide film-coated tablets 25 mg should not be co-administered with medicinal products containing tenofovir alafenamide, tenofovir disoproxil or adefovir dipivoxil.
Co-administration of Tenofovir alafenamide film-coated tablets 25 mg with certain anticonvulsants (e.g. carbamazepine, oxcarbazepine, phenobarbital and phenytoin), antimycobacterials (e.g. rifampicin, rifabutin and rifapentine) or St. John's wort, all of which are inducers of P-glycoprotein (P-gp) and may decrease tenofovir alafenamide plasma concentrations, is not recommended.
Co-administration of Tenofovir alafenamide film-coated tablets 25 mg with strong inhibitors of P-gp (e.g. itraconazole and ketoconazole) may increase tenofovir alafenamide plasma concentrations. Co-administration is not recommended.
Lactose intolerance: Tenofovir alafenamide film-coated tablets 25 mg contains lactose monohydrate. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicinal product.
Renal impairment: Patients with creatinine clearance < 30 mL/min: The use of Tenofovir alafenamide film-coated tablets 25 mg once daily in patients with CrCl ≥ 15 mL/min but < 30 mL/min and in patients with CrCl < 15 mL/min who are receiving haemodialysis is based on very limited pharmacokinetic data and on modelling and simulation. There are no safety data on the use of Tenofovir alafenamide film-coated tablets 25 mg to treat HBV infected patients with CrCl < 30 mL/min.
The use of Tenofovir alafenamide film-coated tablets 25 mg is not recommended in patients with CrCl < 15 mL/min who are not receiving haemodialysis (see Dosage & Administration).
Nephrotoxicity: A potential risk of nephrotoxicity resulting from chronic exposure to low levels of tenofovir due to dosing with tenofovir alafenamide cannot be excluded (see Pharmacology: Toxicology: Preclinical safety data under Actions).
Effects on ability to drive and use machines: Tenofovir alafenamide film-coated tablets 25 mg has no or negligible influence on the ability to drive and use machines. Patients should be informed that dizziness has been reported during treatment with tenofovir alafenamide.