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lamivudine
Epivir, Epivir-HBV

Pregnancy Risk Category: C

How supplied
Tablets:
100 mg, 150 mg
Oral solution:
5 mg/ml, 10 mg/ml

Action
A synthetic nucleoside analogue that inhibits HIV reverse transcription via viral DNA chain termination. RNA- and DNA-dependent DNA polymerase activities are also inhibited.

Indications & dosage
HIV infection concomitantly with zidovudine--

Adults weighing 50 kg (110 lb) or more and children ages 12 and older:
150 mg P.O. b.i.d.
Adults under 50 kg:
2 mg/kg P.O. b.i.d.
Children ages 3 months to 12 years:
4 mg/kg P.O. b.i.d. Maximum dose is 150 mg b.i.d.
Adjust-a-dose:
For patients with renal impairment, if creatinine clearance is 30 to 49 ml/minute, 150 mg P.O. daily. If clearance is 15 to 29 ml/minute, 150 mg P.O. on day 1, then 100 mg daily; if 5 to 14 ml/minute, 150 mg on day 1, then 50 mg daily; if less than 5 ml/minute, 50 mg on day 1, then 25 mg daily.
NEW INDICATION:
Chronic hepatitis B associated with evidence of hepatitis B viral replication and active liver inflammation--
Adults:
100 mg P.O. once daily (Epivir-HBV).
Adjust-a-dose:
For patients with renal impairment, if creatinine clearance is 30 to 49 ml/minute, 100 mg first dose; then 50 mg P.O. once daily. If clearance is 15 to 29 ml/minute, 100 mg first dose; then 25 mg P.O. once daily. If creatinine clearance is 5 to 14 ml/minute, 35 mg first dose; then 15 mg P.O. once daily. If less than 5 ml/minute, 35 mg first dose; then 10 mg P.O. once daily.

Adverse reactions
Adverse reactions pertain to the combination therapy of lamivudine and zidovudine.
CNS:
headache, fatigue, neuropathy, malaise, dizziness, insomnia and other sleep disorders, depressive disorders.
GI:
nausea, diarrhea, vomiting, anorexia, abdominal pain, abdominal cramps, dyspepsia, pancreatitis.
EENT:
nasal symptoms.
Hematologic:
neutropenia, anemia, thrombocytopenia.
Hepatic:
elevated liver enzymes and bilirubin.
Musculoskeletal:
musculoskeletal pain, myalgia, arthralgia.
Respiratory:
cough.
Skin:
rash.
Other:
fever, chills.

Interactions
Drug-drug.
Trimethoprim/sulfamethoxazole: may cause increased blood level of lamivudine because of decreased clearance of lamivudine. Monitor patient closely.
Zidovudine:
increased serum zidovudine level. Monitor patient closely.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to drug.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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