Clarifying the contraindications of Vemlidy and the risks of drug combination is the core prerequisite for ensuring medication safety. The following is an explanation from three aspects: absolute contraindications, liver and kidney function status that should be used with caution, and high-risk concomitant medication.

1、 Severe renal insufficiency

End stage renal disease (ESRD): Vemlidy is not recommended for dialysis patients with creatinine clearance rates below 15mL/min due to a lack of safety and dose adjustment data.

Severe kidney injury without dialysis: creatinine clearance rate<30mL/min and those who have not received regular dialysis should avoid using it, as it may increase the risk of drug accumulation and renal tubular injury.

2、 Severe liver dysfunction

Decompensated cirrhosis: In Child Pugh C (severe liver dysfunction) patients, the safety and efficacy of using Vemlidy have not been established and are generally not recommended.

Acute deterioration of liver function: If there is an acute hepatitis attack or signs of liver failure (such as jaundice, ascites), it is necessary to decide whether to use it under the close evaluation of a specialist doctor.

3、 The risk of combination therapy with specific antiretroviral drugs

Compound preparations containing tenofovir prodrug: Vemlidy should not be used in combination with other compound tablets containing tenofovir disoproxil or propafenone (such as certain HIV treatment drugs) to avoid overlapping nephrotoxicity.

Strong P-gp or BCRP inducers, such as rifampicin, carbamazepine, phenytoin, and St. John's wort, may significantly reduce the blood concentration of Vemlidy, affecting efficacy, and usually requiring replacement or adjustment of antiviral regimens.

Antiviral drugs with nephrotoxic potential: When used in combination with adefovir dipivoxil, sildenafil, or high-dose nonsteroidal anti-inflammatory drugs, the benefits and risks need to be reassessed, and renal function monitoring needs to be strengthened.