Hepatitis B medicines and psychoactive substances
Interaction table between hepatitis B medicines (TDF, TAF, entecavir) and psychoactive substances. Table 02A.
How do hepatitis B medicines interact with psychoactive substances?
This table shows the risk level of combining medicines used for hepatitis B with psychoactive substances.
Risk may vary depending on dose, frequency of use, your health status, and other medicines you take.
Risk levels used in this table
- Low: no clinically relevant interaction
- Caution: mild risk, use carefully
- Moderate: important risk
- High: avoid the combination or consult your healthcare team
- Insufficient evidence
Interaction table — Table 02A
| Substance | Tenofovir disoproxil fumarate (TDF) | Tenofovir alafenamide (TAF) | Entecavir | Main mechanism |
|---|---|---|---|---|
| Alcohol | ⚠️ Caution — Liver and kidney risk with heavy or chronic use | ⚠️ Caution — Liver and kidney risk with heavy or chronic use | 🟢 Low — No clinically relevant interaction | Alcohol may increase liver and kidney toxicity |
| Cannabis | 🟢 Low — No clinically relevant interaction | 🟢 Low — No clinically relevant interaction | 🟢 Low — No clinically relevant interaction | No significant interactions have been reported |
| Cocaine | ⚠️ Caution — May increase blood pressure and cardiovascular risk | ⚠️ Caution — May increase blood pressure and cardiovascular risk | 🟢 Low — No clinically relevant interaction | Cocaine may be toxic to the liver and kidneys, and increase cardiovascular strain |
| MDMA / Ecstasy | ⚠️ Caution — Risk of dehydration and kidney overload | ⚠️ Caution — Risk of dehydration and kidney overload | 🟢 Low — No clinically relevant interaction | MDMA may cause dehydration, hyponatraemia, and cardiovascular strain |
| Methamphetamine | 🟡 Moderate — Risk of kidney and cardiovascular damage | 🟡 Moderate — Risk of kidney and cardiovascular damage | ⚠️ Caution — Significant cardiovascular strain | Methamphetamine increases blood pressure, heart rate, and heart attack risk |
| Ketamine | ⚠️ Caution — May affect kidney function at high doses or with frequent use | ⚠️ Caution — May affect kidney function at high doses or with frequent use | 🟢 Low — No clinically relevant interaction | Ketamine may cause bladder and kidney toxicity over time |
| GHB / GBL | ⚠️ Caution — Risk of dehydration and hypotension | ⚠️ Caution — Risk of dehydration and hypotension | 🟢 Low — No clinically relevant interaction | GHB may cause CNS depression, hypotension, and loss of consciousness |
| Poppers (inhaled nitrites) | 🔴 High — Risk of sudden drop in blood pressure | 🔴 High — Risk of sudden drop in blood pressure | 🔴 High — Risk of sudden drop in blood pressure | Nitrites cause intense vasodilation and may trigger fainting or cardiovascular collapse |
| Opioids | ⚠️ Caution — May increase respiratory depression | ⚠️ Caution — May increase respiratory depression | ⚠️ Caution — May increase respiratory depression | Opioids depress the central nervous system and breathing |
| LSD | 🟢 Low — No clinically relevant interaction | 🟢 Low — No clinically relevant interaction | 🟢 Low — No clinically relevant interaction | No significant interactions have been reported |
| Inhalants | ⚠️ Caution — Risk of liver and neurological damage | ⚠️ Caution — Risk of liver and neurological damage | ⚠️ Caution — Risk of liver and neurological damage | Inhalants may be toxic to the liver and nervous system |
General recommendations
- Use your medicines exactly as prescribed by your healthcare team and do not stop them without asking first.
- Stay hydrated and avoid heavy use of alcohol and other substances.
- Do not combine with other medicines without advice; some substances may be “hepatotoxic” or “nephrotoxic.”
- If you have liver or kidney disease, always say so before using substances.
- If you have symptoms such as abdominal pain, jaundice, nausea, dark urine, or extreme fatigue, seek medical care.
Important: This information does not replace consultation with healthcare professionals. Every person is unique and risks may change.