lamivudine

LAMIVUDINE

Complete information on Lamivudine including dosage, side effects, interactions and pregnancy & breast feeding warnings

Overview and uses

Lamivudine is a medicine used for HIV treatment and also for Hepatitis b virus infection. It is available only as a prescription medicine. Lamivudine is prescribed by a doctor in combination with other medicines for HIV treatment. This is done to increase the therapeutic efficacy of the medicines used in the treatment of HIV. Also, combination therapy reduces the risk of virus getting resistant to any one particular medicine.

Lamivudine does not cure HIV, but it slows down the progression of HIV within the body. HIV destroys CD4+ T Lymphocytes – a type of white blood cells (WBC) that gives immunity to the body. In other words, these cells protect the body against the infections or illness caused by various organisms like bacteria, viruses and other germs. Thus, one may conclude that HIV infection, if left untreated, may make the body susceptible to this infections/illness.

Brand names of Lamivudine: Zeffix, Epivir, Epivir-HBV, Lamivir, Lamivir-HBV, Lamidac, Lamuvid.

Brand names of Lamivudine with other medicines:

  • Triumeq contains Abacavir with Dolutegravir and Lamivudine.
  • Epzicom contains Abacavir with Lamivudine.
  • Trizivir contains Abacavir with Lamivudine and Zidovudine.
  • Triavir contains Zidovudine 300 mg with lamivudine 150 mg and nevirapine 200 mg.
  • Duovir contains zidovudine with lamivudine.

Pharmacological classification: Nucleoside reverse transcriptase inhibitor anti-retroviral drug

Indication (used for):

  • For the treatment of HIV-1 infections in adults and children above 3 months of age.
  • For the treatment of Hepatitis B virus (HBV) infection. Dosage for such cases is less than anti-retroviral dose of Lamivudine. Treatment of HBV should be started with Lamivudine only if use of other medicines is not appropriate or are not available.

Dosage

Dosage (for HIV-1 treatment):

  • Adult dose and adolescencts with more than 16 years of age :
    • 150 mg twice a day or 300 mg once a day.
  • Pediatric dose (for more than 3 months to up to 16 years of age):
    • Oral solution: 4 mg/kg twice a day, but not exceeding 150 mg twice a day.
    • Tablets:
      • 14 kg to 21 kg body weight: 75 mg twice a day (total dose – 150 mg/day).
      • More than 21 kg but less than 30 kg body weight: 75 mg in morning and 150 mg in evening (total dose – 225 mg/day).
      • 30 kg or more than 30 kg body weight: 150 mg twice a day (total dose – 300 mg/day).
    • RENAL DOSE ADJUSTMENTS for adults and adolescents with 30 kg or more body weight:
      • Creatinine clearance more than or equal to 50ml/min:
        • 150 mg twice a day or 300 mg once a day.
      • Creatinine clearance 30 ml/min to 49 ml/min:
        • 150 mg once a day.
      • Creatinine clearance 15 ml/min to 29 ml/min:
        • First dose of 150 mg followed by 100 mg once daily.
      • Creatinine clearance 5 ml/min to 14 ml/min:
        • First dose of 150 mg followed by 50 mg once daily.
      • Creatinine clearance less than 5 ml/min:
        • First dose of 50 mg followed by 25 mg once daily.

No additional dose of Lamivudine is required after routine hemodialysis or peritoneal dialysis.

Dosage (for HBV treatment):

  • Adult dose for HBV: 100 mg once a day.
  • Pediatric dose for HBV: for more than 2 years to up to 17 years, dose is 3 mg/kg not exceeding 100 mg/day.
  • RENAL DOSE ADJUSTMENTS for adults and adolescents with 30 kg or more body weight:
    • Creatinine clearance more than or equal to 50ml/min:
      • 100 mg once a day.
    • Creatinine clearance 30 ml/min to 49 ml/min:
      • First dose of 100 mg followed by 50 mg once a day.
    • Creatinine clearance 15 ml/min to 29 ml/min:
      • First dose of 100 mg followed by 25 mg once a day.
    • Creatinine clearance 5 ml/min to 14 ml/min:
      • First dose of 35 mg followed by 15 mg once a day.
    • Creatinine clearance less than 5 ml/min:
      • First dose of 35 mg followed by 10 mg once a day.

Dosage form (for HIV-1): Lamivudine is available as tablets (150 mg and 300 mg) and oral liquid in strength of 10 mg/ml.

Dosage form (for HBV): Lamivudine is available as tablets of 100 mg and oral liquid in strength of 5 mg/ml.

Over dosage:

  • Under circumstances of Lamivudine overdose, patient should be monitored and standard supportive treatment should be applied as and when required.

Pregnancy

Category C, which means that Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Mechanism of action: Lamivudine undergoes intracellular phosphorylation into its active form Lamivudine 5’-triphosphate, which terminates the elongation of proviral DNA. It gets incorporated into nascent DNA by reverse transcriptase.

Unwanted or side effects:

Lamivudine has lesser side effects in comparison to other anti HIV medicines.

  • Occurrence of neutropenia (often does not have any symptom but it is revealed in a blood test), headache and nausea are common if more than recommended doses are used.
  • Pancreatitis in pediatric patients
    • Nausea, vomiting, upper abdominal (tummy) pain that radiates to your back, upper abdominal (tummy) pain that worsens after eating, fever, rapid pulse, weight loss, oily and smelly stool are some of the symptoms. Consult your doctor as soon as possible. This may require termination of therapy with Lamivudine.
  • Fat redistribution or accumulation of body fat including central obesity, dorsocervical fat enlargement (buffalo hump), peripheral wasting, facial wasting, breast enlargement and “cushingoid appearance” have been observed in patients receiving anti HIV therapy.
  • Immune reconstitution syndrome: during the initial phase of the treatment, patients whose immune systems respond may develop an inflammatory response to opportunistic infections, which may necessitate further evaluation and treatment. Auto immune disorders have also been reported to occur in some people at any time after the initiation of the treatment.
  • Lactic acidosis and severe hepatomegaly with steatosis.
    • feeling or being sick, abdominal pain (tummy) pain, loss of appetite, loss of weight, feeling dizzy and fast or gasping breathing, diarrhea, sleepiness, tiredness or weakness, nausea and vomiting, pain in upper right portion of the abdomen, rash, weight loss, yellowing of the skin and whites of the eye are some of the symptoms of the above mentioned condition. Consult your doctor as soon as possible.
    • This may require termination of treatment with Lamivudine.
  • Severe acute exacerbations of Hepatitis B.
    • Fever, joint pain, nausea, vomiting, dark coloured urine, grey coloured stools and yellowing of the skin and whites of the eye (jaundice) are some of the most common symptoms of the above mentioned condition. Consult your doctor as soon as possible.
  • Hepatic decompensation in patients co-infected with HIV-1 and hepatitis C.

Interactions

Drug – drug interactions of Lamivudine:

  • Lamivudine and Zalcitabine: concomitant use of these two medicines should be avoided as one may inhibit the intracellular phosphorylation of the other.
  • Concomitant use of Ribavirin and Lamivudine should be done with caution and under strict monitoring.
  • Mipomersen, leflunomide, teriflunomide, emtricitabine, bexarotene and lomitapide should be avoided with Lamivudine.

Drug – food interactions of Lamivudine:

  • Can be taken regardless of food intake.

Important information on anti HIV and anti AIDS medicines

Benefits of taking your anti HIV medicines regularly

  • Sustained viral suppression.
  • Reduced risk of resistance.
  • Reduced risk of treatment failure.
  • Improved quality of life and overall health.
  • Reduced risk of HIV transmission.

Getting the most from your treatment

  • Precisely follow every advice given to you by your doctor and pharmacist regarding your medications. Take your dose regularly without missing out a single one.
  • Make all the necessary changes in your lifestyle and eating/food habits as advised by your doctor and pharmacist. This may include quitting smoking, alcohol, other substances of abuse, taking up exercise and some/many others that your doctor finds it best in your interest.
  • Do not make any changes in your dose unless suggested/recommended by your doctor.
  • Keep your regular appointments with your doctor so that the progress can be monitored. This may involve blood tests and other test that a doctor finds necessary.
  • Consult your doctor if you develop an infection or an allergy after you start the treatment.
  • Consult your doctor if you feel low or even depressed. This is common especially after diagnosis and during the early stages of treatment.
  • Some people who have taken anti HIV medicines for a long period of time may develop Osteonecrosis – a condition where bone tissue dies due to reduced blood supply. This causes joint pain, stiffness and difficulty in movement. Consult your doctor if you if you notice any of this symptoms.
  • If you are going to take any operation/surgery or a dental treatment, tell doctor who is going to carry out operation/surgery or dental procedure about all the medicines that you are taking. If possible, carry your containers with you to the doctor even if it is empty.
  • If you buy any medicines, supplements including your vitamin supplements, herbal medicines or even the medicines that do not require a prescription, check with your pharmacist whether they can be taken along with your anti HIV medicines or not.
  • Treatment of HIV is life-long. Continue taking your anti HIV medicines even if you feel well. This should be done to keep your immune system healthy.

Forgot to take your medicine?

  • Forgetting a dose/frequent missed out doses may lead to viral resistance or treatment failure.
  • If you forget to take a dose, take it immediately as soon as you remember unless it’s almost the time for your next dose.
  • Do not take two doses at the same time to make up for the missed out dose.
  • If you are forgetting/missing your dose frequently or very often, try using pill boxes that are available as weekly or monthly dose boxes. Alternatively, you can also try posting reminder notes on places like doors of refrigerator, wardrobe, bathroom, side tables of your bed, above or below switch boards etc. You can also set a reminder on your cell phone.
  • If possible, ask your family members and friends to remind you of your dose.

Click here to go to Lamivudine forums.

Note: The sole purpose of every information shared on this article is to bring awareness. Do not use this information as a medical advice or prescription advice or as a tool for the treatment, diagnosis or prevention of the disease.

By | 2017-05-08T15:05:11+00:00 May 2nd, 2017|medicines|0 Comments

About the Author:

B. Pharm (K.L.E. society’s S.V.V. Patil College of Pharmacy, Bengaluru)
M. Pharm (Maharishi Arvind Institute of Pharmacy, Jaipur)

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