Epivir


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Related to Epivir: Prevacid, lansoprazole, lamivudine

lamivudine

Epivir, Epivir-HBV, 3TC (CA), Heptovir (CA), Zeffix (UK)

Pharmacologic class: Nucleoside reverse transcriptase inhibitor

Therapeutic class: Antiretroviral

Pregnancy risk category C

FDA Box Warning

• Lactic acidosis and severe hepatomegaly with steatosis (including fatal cases) have occurred when drug was used alone or in combination with other nucleoside analogues.

• Epivir tablets and oral solution (used to treat human immunodeficiency virus [HIV] infection) contain higher dose of active ingredient (lamivudine) than Epivir-HBV tablets and oral solution (used to treat chronic hepatitis B). Patients with HIV should receive only dosing forms appropriate for HIV treatment.

• After Epivir discontinuation, severe acute hepatitis B exacerbations have occurred in patients co-infected with hepatitis B virus (HBV) and HIV. Monitor hepatic function closely for at least several months in these patients. If appropriate, begin anti-hepatitis B therapy.

Action

Inhibits HIV reverse transcription by viral DNA chain termination. Impedes RNA- and DNA-dependent DNA polymerase activities.

Availability

Oral solution: 5 mg/ml and 10 mg/ml in 240-ml bottles

Tablets: 100 mg, 150 mg, 300 mg

Indications and dosages

HIV infection (given with other antiretrovirals)

Adults and children older than age 16: 150 mg P.O. b.i.d. or 300 mg P.O. daily

Children ages 3 months to 16 years: 4 mg/kg P.O. b.i.d. to a maximum of 150 mg P.O. b.i.d.

Chronic HBV

Adults: 100 mg (Epivir-HBV) P.O. once daily

Children ages 2 to 17: 3 mg/kg (Epivir-HBV) P.O. once daily, to a maximum of 100 mg P.O. daily

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:

• impaired renal function, history of hepatic disease, obesity, granulocyte count below 1,000/mm3

• long-term therapy

• elderly patients

• women (especially if pregnant)

• children.

Administration

• Give with or without food.

Be aware that Epivir contains 150 mg lamivudine and Epivir-HBV contains 100 mg lamivudine. Strengths are not interchangeable.

Know that when given to patients with unrecognized or untreated HIV, Epivir-HBV is likely to cause rapid emergence of HIV resistance.

Adverse reactions

CNS: fatigue, headache, insomnia, malaise, asthenia, depression, dizziness, paresthesia, peripheral neuropathy, seizures

GI: nausea, vomiting, diarrhea, anorexia, abdominal discomfort, dyspepsia, splenomegaly, pancreatitis

Hematologic: anemia, neutropenia

Hepatic: hepatomegaly with steatosis

Metabolic: hyperglycemia, lactic acidosis

Musculoskeletal: muscle, joint, or bone pain; muscle weakness; myalgia; rhabdomyolysis

Respiratory: cough, abnormal breath sounds, wheezing

Skin: alopecia, rash, urticaria, erythema multiforme, Stevens-Johnson syndrome

Other: lymphadenopathy, body fat redistribution, hypersensitivity reactions including anaphylaxis; immune reconstitution syndrome

Interactions

Drug-drug. Co-trimoxazole: increased lamivudine blood level

Zalcitabine: interference with effects of both drugs

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, creatine kinase, liver function tests: increased levels

Hemoglobin, hematocrit, neutrophils: decreased levels

Patient monitoring

• Check vital signs regularly.

• Monitor CBC and platelet count frequently. Watch for evidence of bone marrow toxicity.

• Monitor blood glucose level and kidney and liver function test results.

• Assess neurologic and mental status. Report signs or symptoms of depression.

• Closely monitor obese patients, women, and patients with a history of hepatic disease; they're at increased risk for lactic acidosis and severe hepatomegaly with steatosis.

• Monitor HIV patients for co-infection with HBV (which may recur when drug is withdrawn).

Monitor patients for signs and symptoms of immune reconstitution syndrome.

Patient teaching

• Tell patient he may take with or without food.

• Advise patient to minimize GI upset by eating small, frequent servings of healthy food and drinking plenty of fluids.

• Tell HIV patient that drug doesn't cure virus or prevent its transmission and that opportunistic infections may occur. Advise him to take appropriate precautions during sex.

• Teach patient how to recognize and immediately report signs and symptoms of immune reconstitution syndrome.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• Caution HIV patient not to breastfeed, because of risk of passing infection to infant.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

Epivir

(ĕp′ĭ-vîr′)
A trademark for the drug lamivudine.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

Epivir®

Heptodin®, Lamivudine Virology An antiviral used with other agents–eg, zidovudine–Retrovir®, to manage HIV and HBV infections Toxicity Renal toxicity. See HAART, Lamivudine.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

Epivir

A brand name for LAMIVUDINE.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
References in periodicals archive ?
* The FDA approves Combivir, a combination of zidovudine (Retrovir, AZT) and lamivudine (Epivir, 3TC).
* Epzicom--Ziagen (abacavir) + Epivir (3TC, lamivudine), and
The findings here indicate that the introduction of Epivir (a nucleoside reverse transcriptase inhibitor or NRTI) and protease inhibitors in late 1995 explain virtually all of the mortality improvement during the past decade.
Viramune, Epivir, Crixivan, Norvir, Zerit--those are just a few of the names.
NRTIs--Ziagen, Trizivir, Videx, Epivir, 3TC, Combivir, Zerit, d4T, Viread, Hivid, Retrovir, AZT
It was pharmaceutical giant GlaxoSmithKline that pushed hardest for the proposal after seeing Euro 18 million worth of batches of HIV/AIDS drugs Combivir, Epivir and Trizivir return to the European market.
It was also involved in the manufacture of anti-Aids drug Epivir, seen as a milestone in the battle against Aids.
His medications for HIV treatment include sustiva, epivir, AZT, bactrim and valtrex -- all critical for his continued health care maintenance.
Recent successful drugs from biotech companies include Epivir in the treatment of AIDS, Rituxan for Lymphoma and Herceptin for breast cancer.
All of them work best in combination with other drugs, including AZT (zidovudine), ddC (HIVID), and 3TC (Epivir), which cripple a different viral enzyme.