Adefovir & Nutrient Depletion
Also searched as Hepsera. What the clinical evidence reports, what it may mean, and what to discuss with your pharmacist.
Adefovir has been associated with depletion of ACETYL-L-CARNITINE, L-CARNITINE and PROPIONYL-L-CARNITINE. This does not mean a deficiency will occur — it means these are worth knowing about and, if you take Adefovir long-term, worth raising with your pharmacist or healthcare provider.
Take more than one medication? Open the checker with Adefovir pre-loaded and add the rest to see overlapping nutrient signals.
Reported nutrient depletions with Adefovir
Each record below is shown as published in our licensed clinical database, with its evidence rating and citations. Expand a section for food sources and talking points.
ACETYL-L-CARNITINE
Insignificant DepletionADEFOVIR DIPIVOXIL (Hepsera)
Adefovir dipivoxil is a prodrug which is converted to adefovir and pivalate in the body. Pivalate combines with carnitine and is excreted in the urine, which increases L-carnitine losses from the body. Theoretically, losses of acetyl-L-carnitine could also be increased. Adefovir was formerly used for HIV infection at doses of 125-500 mg daily and was associated with significant dose- and duration-related decreases in blood carnitine. After 12 weeks of therapy with 125-250 mg daily, decreases of 42% to 62% were seen, while 500 mg daily was associated with a 66% decrease in L-carnitine after 2 weeks. Some studies used a supplement of L-carnitine 500 mg daily during adefovir therapy. Adefovir is now used at a lower dose of 10 mg daily for treatment of hepatitis B. There are no reports of significant reductions in carnitine blood levels at this dose, and supplements are not necessary.
Acetyl-L-carnitine is a compound your body uses to help produce energy inside cells, and it's closely related to L-carnitine, which your muscles and heart depend on. Here's the interesting backstory: when adefovir is broken down in the body, it releases a byproduct called pivalate, which latches onto carnitine and gets flushed out through the kidneys, pulling carnitine along with it. That said, adefovir is now used at a much lower dose (10 mg daily) for hepatitis B than the high doses studied years ago for HIV, and at this lower dose there are no meaningful reports of carnitine dropping to concerning levels. Most people taking adefovir at today's standard dose don't need to do anything about this, but if you have questions, your pharmacist or doctor is a great place to start.
Learn more about this nutrient: Acetyl-l-carnitine — uses, safety & interactions
References (5)
- Brass EP. Pivalate-generating prodrugs and carnitine homeostasis in man. Pharmacol Rev 2002;54:589-98. PubMed
- Deeks SG, Collier A, Lalezari J, et al. The safety and efficacy of adefovir dipivoxil, a novel anti-human immunodeficiency virus (HIV) therapy, in HIV-infected adults: a randomized, double-blind, placebo-controlled trial. J Infect Dis 1997;176:1517-23. PubMed
- Barditch-Crovo P, Toole J, Hendrix CW, et al. Anti-human immunodeficiency virus (HIV) activitiy, safety, and pharmacokinetics of adefovir dipivoxyl (9-[2-(bis-pivaloyloxymethyl)-phosphonylmethoxyethyl]adenine) in HIV-infected patients. J Infect Dis 1997;1
- Kahn J, Lagakos S, Wulfsohn M, et al. Efficacy and safety of adefovir dipivoxil with antiretroviral therapy. J Am Med Assoc 1999;282:2305-12.
- Noble S, Goa KL. Adefovir dipivoxil. Drugs 1999;58:479-87.
L-CARNITINE
Insignificant DepletionADEFOVIR DIPIVOXIL (Hepsera)
Adefovir dipivoxil is converted to adefovir and pivalate in the body; pivalate combines with carnitine and is excreted in the urine, increasing L-carnitine losses. Adefovir was formerly used at doses of 125-500 mg daily, and was associated with significant dose- and duration-related decreases in blood carnitine. After 12 weeks of therapy with 125-250 mg daily, decreases of 42% to 62% were seen; while 500 mg daily was associated with a 66% decrease in L-carnitine after 2 weeks. Some studies used a supplement of L-carnitine 500 mg daily during adefovir therapy. Adefovir is now used at a lower dose of 10 mg daily for treatment of hepatitis B. There are no reports of significant reductions in carnitine blood levels at this dose, and supplements are not necessary.
L-carnitine is a compound your body uses to help turn fat into energy, and your muscles depend on it to work properly. When adefovir is broken down in the body, one of its byproducts latches onto carnitine and carries it out through the urine, which can gradually reduce your levels. That said, adefovir is now prescribed at a much lower dose (10 mg daily) than in older studies, and at this dose there are no reports of meaningful carnitine loss. For most people taking adefovir today, this is not something that requires action, but feel free to mention it to your pharmacist if you have any concerns.
What Carnitine does & food sources
Carnitine shuttles fatty acids into cells' mitochondria so they can be burned for energy.
Common food sources:
- Red meat (the richest source)
- Poultry and fish
- Dairy products
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Carnitine questions come up with specific medications (for example, valproic acid) and specific situations — this is a conversation for your prescriber, who can weigh testing or supplementation.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Carnitine supplements are usually reserved for clinician-identified situations rather than general use.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Learn more about this nutrient: L-carnitine — uses, safety & interactions
References (5)
- Brass EP. Pivalate-generating prodrugs and carnitine homeostasis in man. Pharmacol Rev 2002;54:589-98. PubMed
- Deeks SG, Collier A, Lalezari J, et al. The safety and efficacy of adefovir dipivoxil, a novel anti-human immunodeficiency virus (HIV) therapy, in HIV-infected adults: a randomized, double-blind, placebo-controlled trial. J Infect Dis 1997;176:1517-23. PubMed
- Barditch-Crovo P, Toole J, Hendrix CW, et al. Anti-human immunodeficiency virus (HIV) activitiy, safety, and pharmacokinetics of adefovir dipivoxyl (9-[2-(bis-pivaloyloxymethyl)-phosphonylmethoxyethyl]adenine) in HIV-infected patients. J Infect Dis 1997;1
- Kahn J, Lagakos S, Wulfsohn M, et al. Efficacy and safety of adefovir dipivoxil with antiretroviral therapy. J Am Med Assoc 1999;282:2305-12.
- Noble S, Goa KL. Adefovir dipivoxil. Drugs 1999;58:479-87.
PROPIONYL-L-CARNITINE
Insignificant DepletionADEFOVIR DIPIVOXIL (Hepsera)
Adefovir pivoxil is a prodrug which is converted to adefovir and pivalate in the body. Pivalate combines with carnitine and is excreted in the urine, which increases L-carnitine losses from the body. Theoretically, losses of propionyl-L-carnitine could also be increased. Adefovir was formerly used for HIV infection at doses of 125-500 mg daily and was associated with significant dose- and duration-related decreases in blood carnitine. After 12 weeks of therapy with 125-250 mg daily, decreases of 42% to 62% were seen, while 500 mg daily was associated with a 66% decrease in L-carnitine after 2 weeks. Some studies used a supplement of L-carnitine 500 mg daily during adefovir therapy. Adefovir is now used at a lower dose of 10 mg daily for treatment of hepatitis B. There are no reports of significant reductions in carnitine blood levels at this dose, and supplements are not necessary.
Propionyl-L-carnitine is a form of carnitine, a compound your muscles and heart use to convert fat into energy. When your body processes adefovir, it produces a byproduct called pivalate, and pivalate latches onto carnitine and pulls it out through the urine. At the low 10 mg daily dose now used for hepatitis B, though, this effect appears to be very small, and no meaningful drops in carnitine levels have been reported at this dose. Most people taking adefovir at this dose do not need to worry about or do anything about this, but feel free to mention it to your pharmacist or doctor if you have questions.
Learn more about this nutrient: Propionyl-l-carnitine — uses, safety & interactions
References (5)
- Brass EP. Pivalate-generating prodrugs and carnitine homeostasis in man. Pharmacol Rev 2002;54:589-98. PubMed
- Deeks SG, Collier A, Lalezari J, et al. The safety and efficacy of adefovir dipivoxil, a novel anti-human immunodeficiency virus (HIV) therapy, in HIV-infected adults: a randomized, double-blind, placebo-controlled trial. J Infect Dis 1997;176:1517-23. PubMed
- Barditch-Crovo P, Toole J, Hendrix CW, et al. Anti-human immunodeficiency virus (HIV) activitiy, safety, and pharmacokinetics of adefovir dipivoxyl (9-[2-(bis-pivaloyloxymethyl)-phosphonylmethoxyethyl]adenine) in HIV-infected patients. J Infect Dis 1997;1
- Kahn J, Lagakos S, Wulfsohn M, et al. Efficacy and safety of adefovir dipivoxil with antiretroviral therapy. J Am Med Assoc 1999;282:2305-12.
- Noble S, Goa KL. Adefovir dipivoxil. Drugs 1999;58:479-87.
This tool is educational and is not a substitute for professional medical advice. An association is not a diagnosis and does not mean a deficiency will occur. Always talk to your pharmacist or healthcare provider before starting, stopping, or changing any medication or supplement.
Disclaimer: This checker finds which nutrients might be depleted by prescription or over-the-counter medications. Each nutrient depletion issue is rated based on clinical significance. Use your own professional judgment prior to making clinical decisions.© 2026 Therapeutic Research Center Licensed records refresh weekly · last updated July 3, 2026.
More about Adefovir
What drug-induced nutrient depletion means
Some medications can, over time, lower the levels of certain vitamins, minerals, or other nutrients — through reduced absorption, increased loss, or changes in how the body uses them.
Association is not deficiency
An entry here means a depletion has been reported or studied — not that it happens to everyone, or that you are deficient. Dose, duration, diet, and your own health all matter.
Evidence varies by pair
Some drug–nutrient links (like metformin and vitamin B12) are well studied; others rest on limited or preliminary research. Each entry shows the evidence rating from our licensed clinical database.
When to ask about labs
If you take an associated medication long-term, ask your healthcare provider whether monitoring is appropriate for you. Not everyone needs testing — your provider can weigh your dose, duration, and symptoms.
Don't self-supplement blindly
Supplements are not risk-free: some can interact with medications, and some (like potassium or magnesium) can be risky with kidney disease. Talk to your pharmacist before adding anything.
Never stop a medication over this
These medications are prescribed for good reasons, and the benefit usually far outweighs a manageable nutrient consideration. Any change belongs in a conversation with your prescriber.
Food first, usually
For many nutrients, a varied diet covers the gap. Each entry lists common food sources; a supplement is a decision to make with your pharmacist or provider, not a default.
Adefovir & nutrients: FAQs
Does Adefovir deplete ACETYL-L-CARNITINE?
Should I take a supplement because I take Adefovir?
Should I stop taking Adefovir?
Where does this information come from?
Questions about Adefovir and your nutrition?
Ask a licensed pharmacist — free, no appointment needed.
Sources & How We Checked
Nutrient depletion records for Adefovir are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for drug-induced nutrient depletions, supplements, and interactions — the basis for this page.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for medication overviews across the site.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.