From the Guidelines
There is generally no significant contraindication between taking PrEP medications and NSAIDs, and most people can safely take both types of medications concurrently. The common PrEP medications like Truvada (emtricitabine/tenofovir disoproxil fumarate) or Descovy (emtricitabine/tenofovir alafenamide) do not have known major interactions with common NSAIDs such as ibuprofen (Advil, Motrin), naproxen (Aleve), or aspirin 1. However, it's worth noting that both NSAIDs and tenofovir (a component of PrEP) can potentially affect kidney function when used long-term or in high doses, as both medications are processed through the kidneys.
Some key considerations when taking both medications include:
- History of peptic ulcer disease or gastrointestinal bleeding, which may increase the risk of upper gastrointestinal tract bleeding and perforation when taking NSAIDs 1
- Advanced age (≥60 years old), male gender, and concurrent corticosteroid or anticoagulant therapy, which should be considered before NSAID administration to prevent upper gastrointestinal tract bleeding and perforation 1
- Untreated H. pylori infection, which can increase the risk of gastrointestinal bleeding when taking NSAIDs 1
- Chronic use of NSAIDs, which can increase the risk of gastrointestinal bleeding and perforation 1
If you have existing kidney problems or are taking other medications that affect kidney function, your healthcare provider might recommend more frequent monitoring of your kidney function through blood tests. Additionally, if you experience symptoms like decreased urination, swelling in legs or feet, or unusual fatigue while taking both medications, you should contact your healthcare provider promptly as these could indicate kidney issues. It is essential to follow the guidance of a healthcare provider when taking both PrEP and NSAIDs to minimize potential risks and ensure safe use.
From the FDA Drug Label
Tenofovir disoproxil fumarate should be avoided with concurrent or recent use of a nephrotoxic agent (e.g., high-dose or multiple non-steroidal anti-inflammatory drugs [NSAIDs]) [see Drug Interactions (7. 1)]. The use of tenofovir disoproxil fumarate (PrEP) with NSAIDs is not recommended due to the increased risk of renal toxicity. Alternatives to NSAIDs should be considered in patients at risk for renal dysfunction 2.
From the Research
Interaction between PrEP and NSAIDs
- There is evidence to suggest that the use of tenofovir disoproxil fumarate (TDF), a common component of Pre-Exposure Prophylaxis (PrEP), may interact with nonsteroidal anti-inflammatory drugs (NSAIDs) to increase the risk of kidney injury 3.
- A study published in 2013 found that the co-administration of TDF and diclofenac, an NSAID, increased the risk of acute kidney injury (AKI) in patients with previously stable renal function 3.
- The mechanism of this interaction is thought to be related to the increased intracellular concentration of tenofovir in proximal tubular cells, leading to nephrotoxicity 3.
- Another study published in 2016 discussed the renal and bone toxicity associated with the use of TDF, highlighting the importance of monitoring renal function in patients taking this medication 4.
- However, it is worth noting that not all NSAIDs may have the same interaction with TDF, and more research is needed to fully understand the risks associated with co-administration.
Renal Safety of Tenofovir Disoproxil Fumarate
- Several studies have investigated the renal safety of TDF, with mixed results 5, 6, 7.
- A pooled analysis of 26 clinical trials found that tenofovir alafenamide (TAF) had a more favorable renal safety profile compared to TDF, with fewer cases of proximal renal tubulopathy and discontinuations due to renal adverse events 6.
- Another study found that TDF was generally safe for patients with hepatitis B without chronic kidney disease, but may be associated with an increased risk of renal dysfunction in the elderly 7.
Clinical Implications
- Patients taking PrEP should be aware of the potential interaction between TDF and NSAIDs, and should discuss any concerns with their healthcare provider.
- Healthcare providers should monitor renal function in patients taking TDF, especially in those with pre-existing kidney disease or taking other medications that may interact with TDF.
- Further research is needed to fully understand the risks and benefits associated with the use of TDF and NSAIDs, and to inform clinical practice guidelines.