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