Lamivudine
(3TC)
Lamivudine (Epivir)
3TC (Epivir)
Lamivudine
(lah- MIH-vyou-deen)
Pregnancy Category: C 3TC Epivir Epivir HBV (Rx)

Classification: Antiviral drug, nucleoside analog

See Also: See also Antiviral Drugs .

Action/Kinetics: Synthetic nucleoside analog effective against HIV. Converted to active 5'-triphosphate (L-TP) metabolite which inhibits HIV reverse transcription via viral DNA chain termination. L-TP also inhibits the RNA- and DNA-dependent DNA polymerase activities of reverse transcriptase. Rapidly absorbed after PO administration. Most eliminated unchanged through the urine.

Uses: Epivir. In combination with AZT for the treatment of HIV infection, based on clinical or immunologic evidence of progression of the disease. There are no data on the effect of lamivudine and AZT on clinical progression of HIV infection, such as the incidence of opportunistic infections or survival. Epivir-HBV. Chronic hepatitis B associated with evidence of hepatitis B replication and active liver inflammation.

Contraindications: Lactation.

Special Concerns: Clients taking lamivudine and AZT may continue to develop opportunistic infections and other complications of HIV infection. Use with caution and at a reduced dose in those with impaired renal function. Data on the use of lamivudine and AZT in pediatric clients are lacking; however, use the combination with extreme caution in children with pancreatitis.
Epivir-HBV contains a lower dose of lamivudine than Epivir. If Epivir-HBV is used for chronic hepatitis B in a client with unrecognized or untreated HIV infection, rapid emergence of HIV resistance is likely due to subtherapeutic amounts of the drug given.
Safety and efficacy have not been determined in those with decompensated liver disease or organ transplants or in clients dually infected with HBV and HCV, hepatitis delta, or HIV.

Side Effects: When used with AZT for HIV infection. GI: N&V;, diarrhea, anorexia or decreased appetite, abdominal pain, abdominal cramps, dyspepsia, stomatitis, lactic steatosis, severe hepatomegaly with steatosis, pancreatitis, posttreatment worsening of hepatitis. CNS: Neuropathy, insomnia or other sleep disorders, dizziness, depressive disorders, paresthesias, peripheral neuropathies. Hematologic: Neutropenia, anemia, thrombocytopenia. Respiratory: Nasal signs and symptoms, cough, abnormal breath sounds/wheezing. Musculoskeletal: Musculoskeletal pain, myalgia, arthralgia, muscle weakness with CPK elevation. Body as a whole: Headache, malaise, fatigue, fever or chills, skin rashes, weakness. Miscellaneous: Ear, nose, and throat infections; sore throat, anaphylaxis urticaria, rhabdomyolysis, alopecia, pruritus, lymphadenopathy, splenomegaly. NOTE: Pediatric clients have an increased risk to develop pancreatitis.

Laboratory Test Alterations: ALT, AST, amylase, bilirubin, serum lipase, CPK.

Drug Interactions: Trimethoprim-Sulfamethoxazole Significant in lamivudine level Zidovudine / Zidovudine levels

How Supplied: Epivir. Oral Solution: 10 mg/mL; Tablet: 150 mg. Epivir-HBV. Oral solution: 5 mg/mL; Tablet: 100 mg

Dosage
?Oral Solution, Tablets HIV infection.
Epivir. Adults: 150 mg b.i.d. in combination with AZT. For adults with low body weight (less than 50 kg), the recommended dose is 2 mg/kg b.i.d. in combination with AZT. Children, 3 months to 16 years of age: 4 mg/kg b.i.d. (up to a maximum of 150 mg b.i.d.) in combination with AZT. In clients over 16 years of age, adjust the dose as follows in impaired renal function: C _CR 50 mL/min or more: 150 mg b.i.d.; C _CR 30-49 mL/min: 150 mg once daily; C _CR 15-29 mL/min: 150 mg for the first dose followed by 100 mg once daily; C _CR 5-14 mL/min: 150 mg for the first dose followed by 50 mg once daily; C _CR less than 5 mL/min: 50 mg for the first dose followed by 25 mg once daily.
Chronic hepatitis.
Epivir-HBV. Adults: 100 mg once daily. Adjust the dose as follows in impaired renal function: C _CR 50 mL/min or more: 100 mg once daily; C _CR 30-49 mL/min: 100 mg for the first dose followed by 50 mg once daily; C _CR 15-20 mL/min: 100 mg for the first dose followed by 25 mg once daily; C _CR 5-15 mL/min: 35 mg for the first dose followed by 15 mg once daily; C _CR Less than 5 mL/min: 35 mg for the first dose followed by 10 mg once daily.