lamivudine

Pronunciation

Generic Name: lamivudine (la MIV yoo deen)
Brand Name: Epivir, Epivir HBV

What is lamivudine?

Lamivudine is an antiviral medication that prevents human immunodeficiency virus (HIV) or hepatitis B virus cells from multiplying in your body.

Epivir is for treating HIV, which causes the acquired immunodeficiency syndrome (AIDS). Epivir is not a cure for HIV or AIDS.

Epivir-HBV is for treating hepatitis B. Epivir-HBV should not be used in people who are infected with both hepatitis B and HIV.

Lamivudine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about lamivudine?

You should not take lamivudine if you are allergic to it.

The Epivir brand of lamivudine (for treating HIV) should not be taken together with any HIV combination medicine that contains lamivudine or emtricitabine. This includes Atripla, Combivir, Complera, Emtriva, Epzicom, Trizivir, and Truvada.

The Epivir-HBV brand of lamivudine (for treating hepatitis B) should not be taken together with any other medication that contains lamivudine, which includes Combivir, Epivir, Epzicom, and Trizivir.

Before taking lamivudine, tell your doctor if you have kidney disease, liver disease, a history of pancreatitis, or if you have used a medicine similar to lamivudine in the past, such as abacavir (Ziagen), didanosine (Videx), emtricitabine (Atripla, Complera, Emtriva, Truvada), stavudine (Zerit), tenofovir (Viread), zalcitabine (Hivid), or zidovudine (Retrovir).

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Some people develop lactic acidosis while taking lamivudine. Early symptoms may get worse over time and this condition can be fatal. Get emergency medical help if you have even mild symptoms such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, fast or uneven heart rate, dizziness, or feeling very weak or tired.

If you have hepatitis B you may develop liver symptoms after you stop taking this medication, even months after stopping. Your doctor may want to check your liver function for several months after you stop using lamivudine. Visit your doctor regularly.

Lamivudine can also cause severe or life-threatening effects on your liver or pancreas. Call your doctor at once if you have any of these symptoms while taking lamivudine: severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate, itching, loss of appetite, dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes).

Epivir tablets and liquid contain a higher dose of lamivudine than Epivir-HBV. Each time you get a refill of this medication, be sure you have received the correct brand to treat your condition.

What should I discuss with my healthcare provider before taking lamivudine?

You should not take lamivudine if you are allergic to it.

The Epivir brand of lamivudine (for treating HIV) should not be taken together with any HIV combination medicine that contains lamivudine or emtricitabine. This includes:

  • Atripla (efavirenz, emtricitabine, and tenofovir);

  • Combivir (lamivudine and zidovudine);

  • Complera (rilpivirine, emtricitabine, and tenofovir);

  • Emtriva (emtricitabine);

  • Epzicom (abacavir and lamivudine);

  • Trizivir (abacavir, lamivudine, and zidovudine); and

  • Truvada (emtricitabine and tenofovir).

The Epivir-HBV brand of lamivudine (for treating hepatitis B) should not be taken together with any other medication that contains lamivudine, which includes:

  • Combivir (lamivudine and zidovudine);

  • Epivir (lamivudine) for treating HIV;

  • Epzicom (abacavir and lamivudine); and

  • Trizivir (abacavir, lamivudine, and zidovudine).

To make sure you can safely take lamivudine, tell your doctor if you have any of these other conditions:

  • liver disease (especially hepatitis B if you also have HIV);

  • kidney disease;

  • a history of pancreatitis; or

  • if you have used a medicine similar to lamivudine in the past, such as abacavir (Ziagen), didanosine (Videx), emtricitabine (Atripla, Complera, Emtriva, Truvada), stavudine (Zerit), tenofovir (Viread), zalcitabine (Hivid), or zidovudine (Retrovir).

Some people develop a life-threatening condition called lactic acidosis while taking lamivudine. You may be more likely to develop lactic acidosis if you are overweight or have liver disease, if you are a woman, or if you have taken HIV or AIDS medications for a long time. Talk with your doctor about your individual risk.

FDA pregnancy category C. It is not known whether lamivudine will harm an unborn baby. HIV can be passed to your baby if you are not properly treated during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Take all of your HIV medicines as directed to control your infection.

Lamivudine can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using lamivudine to treat hepatitis B. Women with HIV or AIDS should not breast feed a baby. Even if your baby is born without HIV, the virus may be passed to the baby in your breast milk.

If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of lamivudine on the baby.

If you have diabetes, you should know that the liquid forms of lamivudine contain 3 to 4 grams of sucrose (sugar) per dose.

How should I take lamivudine?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. You should not take Epivir (for treating HIV) together with Epivir-HBV (for treating hepatitis B).

Lamivudine can be taken with or without food.

You may need to break an Epivir tablet in half when giving this medication to a child for HIV. Call your doctor if the child has any trouble swallowing the tablet.

Measure liquid medicine with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

The Epivir brand contains a higher dose of lamivudine than Epivir-HBV brand. Epivir is for treating HIV and Epivir-HBV is for treating hepatitis B. Each time you get a refill of this medication, be sure you have received the correct brand to treat your condition.

If you have hepatitis B you may develop liver symptoms after you stop taking this medication, even months after stopping. Your doctor may want to check your liver function for several months after you stop using lamivudine. Visit your doctor regularly.

To be sure this medicine is helping your condition and is not causing harmful effects, your blood will need to be tested often. Your liver and kidney function may also need to be tested. Visit your doctor regularly.

HIV/AIDS is usually treated with a combination of drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor's advice. Every person with HIV or AIDS should remain under the care of a doctor.

Store at room temperature away from moisture and heat. Do not allow the liquid form of this medicine to freeze. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking lamivudine?

Taking this medication will not prevent you from passing HIV to other people. Avoid having unprotected sex or sharing razors or toothbrushes. Talk with your doctor about safe ways to prevent HIV transmission during sex. Sharing drug or medicine needles is never safe, even for a healthy person.

Lamivudine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

This medication may cause lactic acidosis (a build-up of lactic acid in the body, which can be fatal). Lactic acidosis can start slowly and get worse over time. Get emergency medical help if you have even mild symptoms of lactic acidosis, such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, fast or uneven heart rate, dizziness, or feeling very weak or tired.

Stop using lamivudine and call your doctor at once if you have a serious side effect such as:

  • signs of a new infection such as fever, chills, sore throat, flu symptoms, easy bruising or unusual bleeding, loss of appetite, mouth sores;

  • severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate;

  • nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  • increased sweating, tremors in your hands, anxiety, feeling irritable, sleep problems (insomnia);

  • diarrhea, unexplained weight loss, menstrual changes, impotence, loss of interest in sex;

  • swelling in your neck or throat (enlarged thyroid);

  • problems with walking, breathing, speech, swallowing, or eye movement; or

  • severe lower back pain, loss of bladder or bowel control.

Less serious side effects may include:

  • cough;

  • headache;

  • mild tired feeling;

  • runny or stuffy nose;

  • mild diarrhea; or

  • changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and trunk).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Lamivudine dosing information

Usual Adult Dose for HIV Infection:

150 mg orally twice a day or 300 mg orally once a day

Approved indication: In combination with other antiretroviral agents, for the treatment of HIV-1 infection

Usual Adult Dose for Chronic Hepatitis B:

100 mg orally once a day
Duration of therapy: The optimum duration of therapy is not known.

Approved indication: For the treatment of chronic HBV infection associated with evidence of hepatitis B viral replication and active liver inflammation

Usual Adult Dose for Nonoccupational Exposure:

(Not approved by FDA)

CDC recommendations: 150 mg orally twice a day or 300 mg orally once a day
Duration of therapy: 28 days

Comments:
-Lamivudine should be used in combination with efavirenz plus (zidovudine or tenofovir) or with lopinavir-ritonavir plus zidovudine.
-Prophylaxis should be started as soon as possible, within 72 hours of exposure.

Usual Adult Dose for Occupational Exposure:

(Not approved by FDA)

US Public Health Service working group recommendations:
Preferred dose: 300 mg orally once a day
-Alternative dose: 150 mg orally twice a day
Duration of therapy: 28 days, if tolerated

Comments:
-Lamivudine is recommended as a component in various alternative regimens for HIV postexposure prophylaxis.
-Prophylaxis should be started as soon as possible, preferably within hours after exposure.
-The optimal duration of prophylaxis is unknown and may differ based on the institution's protocol.
-The most current therapeutic guidelines should be consulted for more information.

Usual Pediatric Dose for HIV Infection:

Oral solution:
Less than 4 weeks: 2 mg/kg orally twice a day (for prevention of transmission or treatment)
4 weeks to less than 16 years: 4 mg/kg orally twice a day
Maximum dose: 150 mg/dose

Tablets:
14 to 21 kg: 75 mg orally twice a day (AM and PM)
Greater than 21 to less than 30 kg: 75 mg orally in the AM and 150 mg in the PM
30 kg or more: 150 mg orally twice a day (AM and PM)

16 years or older:
Less than 50 kg: 4 mg/kg orally twice a day
Maximum dose: 150 mg/dose
50 kg or more: 150 mg orally twice a day or 300 mg orally once a day

Comments:
-FDA approved for patients 3 months or older; dosing for all age ranges recommended by the Department of Health and Human Services Panel on Antiretroviral Therapy and Medical Management of HIV-infected Children.

Approved indication: In combination with other antiretroviral agents, for the treatment of HIV-1 infection

Usual Pediatric Dose for Chronic Hepatitis B:

2 years or older: 3 mg/kg orally once a day
Maximum dose: 100 mg/day
Duration of therapy: The optimum duration of therapy is not known.

Approved indication: For the treatment of chronic HBV infection associated with evidence of hepatitis B viral replication and active liver inflammation

What other drugs will affect lamivudine?

Tell your doctor about all other medicines you use, especially interferons (Alferon, Avonex, Betaseron, Extavia, Intron, Rebetron, Rebif, and others).

This list is not complete and other drugs may interact with lamivudine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about lamivudine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 9.01. Revision Date: 2012-02-14, 12:10:24 PM.

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