Lamivudine

CLINICAL USE

Nucleoside reverse transcriptase inhibitor:Treatment of HIV in combination with other antiretroviral drugsTreatment of chronic hepatitis B in adults

DOSE IN NORMAL RENAL FUNCTION

HIV: 150 mg twice daily or 300 mg dailyHepatitis B: 100 mg daily

PHARMACOKINETICS

Molecular weight :229.3

%Protein binding :<36

%Excreted unchanged in urine : 70

Volume of distribution (L/kg) :1.3

half-life – normal/ESRD (hrs) :5–7/20

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

30–50 HIV: 150 mg daily. Hepatitis B: 100 mg stat then 50 mg daily15–30 HIV: 150 mg stat then 100 mg daily. Hepatitis B: 100 mg stat then 25 mg daily5–15 HIV: 150 mg stat then 50 mg daily. Hepatitis B: 35 mg stat then 15 mg daily<5 HIV: 150 mg stat then 25–50 mg daily.1,2 Hepatitis B: 35 mg stat then 10 mg daily

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in GFR<5 mL/min

HD :Dialysed. Dose as in GFR<5 mL/min

HDF/high flux :Dialysed. Dose as in GFR<5 mL/min

CAV/VVHD :Unknown dialysability. Dose as in GFR=5–15 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsTrimethoprim: inhibits excretion of lamivudine – avoid concomitant use of high dose co-trimoxazole

Antivirals: avoid concomitant use with foscarnet, emtricitabine and IV ganciclovir

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

Administer with or without food

OTHER INFORMATION

15 mL of oral suspension contains 3 g of sucroseDosage from Bennett (4th edition): GFR>50 mL/min: 100% of doseGFR=10–50 mL/min: 150 mg loading dose then 50–150 mg dailyGFR <10 mL/min: 50 mg loading dose then 25–50 mg daily

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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