≤3months: not recommended. 3months–16years: 4mg/kg (max 150mg) twice daily; renal impairment: reduce dose or prolong dosing interval. ≥16years, CrCl ≥50mL/min: 300mg once daily or 150mg twice daily; CrCl 30–49mL/min: 150mg once daily; CrCl 15–29mL/min: 150mg for 1st dose then 100mg once daily; CrCl 5–14mL/min: 150mg for 1st dose then 50mg once daily; CrCl <5mL/min: 50mg for 1st dose then 25mg once daily.
Discontinue if pancreatitis (increased risk in pediatric patients) or lactic acidosis occurs. Suspend therapy if hepatotoxicity (eg, hepatomegaly, steatosis) occurs. Women, obesity, or prolonged nucleoside exposure: increased risk of toxicity (ie, lactic acidosis, steatosis). Hepatitis B (monitor for post-treatment exacerbation). Other liver disease risk factors. Diabetes (oral soln). Children with prior antiretroviral nucleoside exposure, history of pancreatitis or risk factors for pancreatitis. Pregnancy (Cat.C). Nursing mothers: not recommended.
Concomitant zalcitabine: not recommended. Avoid concomitant drugs that contain lamivudine or emtricitabine. Caution with drugs eliminated by active organic cationic secretion (eg, trimethoprim). Increased lamivudine absorption with TMP/SMX (clinical significance unknown). Triple therapy (once daily regimen) with abacavir + tenofovir or with didanosine + tenofovir: high rate of early viral non-response (see literature). Monitor for treatment-associated toxicities with interferon-alpha with or without ribavirin.
Adults: headache, malaise, fever, GI upset, neuropathy, dizziness, sleep or depressive disorders, rash, respiratory effects, musculoskeletal pain, lactic acidosis, severe hepatomegaly with steatosis, fat redistribution, neutropenia, abnormal liver function tests. Children: pancreatitis, paresthesias, peripheral neuropathy, fever, rash, respiratory effects, neutropenia, anemia, abnormal liver function tests.
Register pregnant patients exposed to lamivudine by calling (800) 258-4263.