The most common adverse effects reported from the use of tenofovir disoproxil fumarate are mild gastrointestinal effects particularly diarrhea, nausea and anorexia. Serum-amylase concentrations may be raised and pancreatitis has occurred. Hypophosphatemia occurs commonly. Skin rashes may occur. Other adverse effects occurring commonly include peripheral neuropathy, headache, dizziness, insomnia, depression, asthenia, sweating and myalgia. There have been reports of raised liver enzymes, hypertriglyceridemia, hyperglycemia and neutropenia. There have also been reports of renal impairment, acute renal failure, and effects on the renal proximal tubules, including Fanconi Syndrome. Lactic acidosis, usually associated with severe hepatomegaly and steatosis, has been associated with treatment with nucleoside reverse transcriptase inhibitors.