Lamivudine
Author: michaelrussell
Author: michaelrussell
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.
Dosage adjustment: 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.
Chronic hepatitis B associated with evidence of hepatitis B viral replication and active liver inflammation-
Adults: 100 mg P.O. once daily (Epivir-HBV).
Dosage adjustment: 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.
SPECIAL CONSIDERATIONS
Alert: Use with extreme caution, if at all, in children with history of pancreatitis or other significant risk factors for development of pancreatitis. Larnivudine treatment is stopped immediately and the health care provider must be notified if clinical signs, symptoms, or laboratory abnormalities suggest pancreatitis. Serum amylase level.must be monitored.
Use cautiously in patients with renal impairment.
Breast-feeding should be discontinued if lamivudine is prescribed.
Drug is administered with zidovudine. It's not currently indicated for use alone unless for chronic hepatitis B virus infection.
Safety and effectiveness of treatment with Epivir-HBV beyond 1 year have not been established; optimum duration of treatment isn't known. Patients should be tested for HIV before initiating treatment and during therapy because formulation and dosage of larnivudine in Epivir-HBV aren't appropriate for those dually infected with hepatitis B virus and HIV. If lamivudine is administered to patients with hepatitis B virus and HIV, the higher dosage indicated for HIV therapy should be used as part of an appropriate combination regimen.
Patient's CBC, platelet count, renal and liver function studies must be monitored.
An Antiretroviral Pregnancy Registry has been established to monitor maternalfetal outcomes of pregnant women exposed to Jamivudine. To register a pregnant patient, the health care provider can call 1-800-258-4263.
Patient teaching
Long-term effects oflamivudine are unknown.
Take larnivudine exactly as prescribed.
If you're the patient's parent, learn the signs and symptoms of pancreatitis, and report them immediately if they occur in the child.
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