Dovato

Emergence of lamivudine-resistant HBV variants associated with lamivudine-containing antiretroviral regimens. Discontinuation of lamivudine-containing products and possibly Dovato may be associated with severe acute exacerbations of hepatitis B. Closely monitor patients co-infected with HBV and HIV for several months after stopping treatment; if appropriate, anti-HBV therapy may be warranted (esp. in advanced liver disease or cirrhosis). Discontinue immediately if hypersensitivity reactions develop. Increased risk for worsening/development of elevated transaminases in patients with underlying hepatitis B or C; monitor for hepatotoxicity. Suspend if lactic acidosis or pronounced hepatotoxicity (eg, hepatomegaly, steatosis) occurs. Renal impairment (CrCl <30mL/min): if lamivudine dose reduction is required, use individual components; (CrCl 30–49mL/min): monitor for hematologic toxicities; may need dose adjustment. Severe hepatic impairment (see Adult dose). Elderly. Embryo-fetal toxicity: increased risk of neural tube defects (consider alternative treatment at time of conception through 1^st trimester or if pregnancy is confirmed). Pregnancy: exclude status prior to initiation. Advise individuals of reproductive potential to use effective contraception. Nursing mothers: not recommended.