We describe a patient with acute renal failure and irreversible kidney damage after an overdose with the fixed dose combination of efavirenz/tenofovir disoproxil fumarate/emtricitabine (Atripla). The acute kidney injury was most probably caused by tenofovir. Efavirenz and emtricitabine seemed relatively safe in overdose. The pharmacokinetics in overdose of all 3 drugs and the effect of hemodialysis on the tenofovir clearance were studied by measuring the plasma concentrations and by the use of clinical pharmacokinetic software.
*Department of Clinical Pharmacy, Maastricht University Medical Center, Maastricht, the Netherlands;
†Caphri School for Public Health and Primary Care, Maastricht, the Netherlands;
‡Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands; and
Departments of §Medical Microbiology, and
¶Integrated Care, Maastricht University Medical Center, Maastricht, the Netherlands.
Correspondence: Thomas Havenith, PharmD, MSc, Maastricht UMC+, Afdeling Klinische Farmacie, PO Box 5800, 6202 AZ Maastricht, the Netherlands (e-mail: email@example.com).
The authors declare no conflict of interest.
Received July 13, 2016
Accepted November 28, 2016