Drug Index

Lamivudine

 
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Mechanism :

Lamivudine is a synthetic nucleoside analogue. Intracellularly, lamivudine is phosphorylated to its active 5-triphosphate metabolite, lamivudine triphosphate (3TC-TP). The principal mode of action of 3TC-TP is the inhibition of HIV-1 reverse transcriptase (RT) via DNA chain termination after incorporation of the nucleotide analogue into viral DNA.


Indication :

• Combination with other antiretroviral agents is indicated for the treatment of HIV infection

• Chronic Hepatitis B


Contraindications :

Contraindicated in patients with previously demonstrated clinically significant hypersensitivity to any of the components of the products.


Dosing :

HIV:

Neonates (aged <4 weeks): 2 mg/kg orally twice daily.

≥1 month: 4 mg/kg orally every twice daily.

≥3 months: 5 mg/kg orally twice daily or 10 mg/kg orally daily; not to exceed 300 mg/day.

May switch to once daily dosing after age 3 years in clinically stable patients with undetectable viral load and stable CD4 count.

Chronic Hepatitis B:

>2 years: 3 mg/kg PO OD, Max: 100 mg/day.


Adverse Effect :

Shortness of breath, dizziness, severe vomiting or diarrhea, muscle aches, pains, or weakness, weight gain around waist and/or face, pain, tingling, or numbness in the hands or feet, central and peripheral neuropathy, bradycardia, arrhythmias, abdominal pain or discomfort, hyperglycemia, pancreatitis, worsening jaundice or other signs of hepatitis are common side effects.


Interaction :

Zalcitabine: May inhibit the intracellular phosphorylation of one another. Therefore, use of lamivudine in combination with zalcitabine is not recommended.



Renal Dose :

Dose in Renal Impairment GFR (mL/min)
30-50HIV: 150 mg daily. Hepatitis B: 100 mg stat then 50 mg daily
15-30HIV: 150 mg stat then 100 mg daily. Hepatitis B: 100 mg stat then 25 mg daily
5-15HIV: 150 mg stat then 50 mg daily. Hepatitis B: 35 mg stat then 15 mg daily
<5HIV: 150 mg stat then 25–50 mg daily. Hepatitis B: 35 mg stat then 10 mg daily

Dose in Patients undergoing Renal Replacement Therapies
CAPDNot dialysed. Dose as in GFR<5 mL/min
HDDialysed. Dose as in GFR<5 mL/min
HDF/High fluxDialysed. Dose as in GFR<5 mL/min
CAV/VVHDUnknown dialysability. Dose as in GFR=5–15 mL/min

Hepatic Dose :

No dose adjustments are recommended. Treatment should be discontinued if patient develops lactic acidosis or pronounced hepatotoxicity.
07/29/2020 09:13:24 Lamivudine
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