3TC (lamivudine) is an NRTI (Nucleoside Reverse Transcriptase Inhibitor) which is an anti-viral drug that is used to treat HIV in combination with other antiretroviral medications, and for the treatment of chronic Hepatitis B virus (HBV) infection.
Dosing & Administration
The medication is available in various preparations and brand names. 3TC is used to treat adults and children (weighing at least 14 kg) with HIV. This drug is also used to treat infants under three months for HBV. 3TC is also used off-label for HIV vertical transmission prophylaxis in neonates and HIV post-exposure prophylaxis for occupational and non-occupational exposures. Refer to the package insert for dosage and administration details.
For patients with a creatinine clearance, 3TC requires dose adjustment of <= 50 mL/min. There are no dose adjustments indicated for those with liver dysfunction, however, caution should be used with these patients.
3TC is contraindicated in patients with hypersensitivity to the drug. Additional information about contraindications is available in the package insert.
Possible side effects linked to 3TC are light-headedness, myalgias, generalized weakness, abdominal pain, fatigue, nausea/vomiting, and palpations. A complete list of side effects is available in the package insert.
3TC has been associated with fatal cases of lactic acidosis and hepatomegaly with steatosis, specifically in the obese and women. Refer to the package insert for additional screening and monitoring recommendations.
Laboratory and clinical liver parameters need to be carefully watched once the drug is no longer being used as discontinuing the drug can cause severe acute exacerbations of hepatitis. More details are given in the package insert.
3TC should only be used if another antiviral HBV drug because of its high rate of drug resistance in HBV.
Comorbidity between HBV and Hepatitis C virus (HCV) infection and HIV should be screened for. If found to be co-infected, patients should be started on an antiretroviral regimen targeting co-infected viruses, regardless of CD4 counts or viral loads. Drug regimens and prescribing considerations are outlined within the current HIV treatment guidelines.
There are quite a few drug-to-drug and herbal interactions and contraindications associated with 3TC. A more detailed list is available in the package insert. Specifically, 3TC should not be used in with emtricitabine or cladribine.
Pregnancy & Lactation
Lamivudine has not been associated with an increase in the incidence of major birth defects above baseline. If patients stop treatment because of pregnancy, they should be watched for worsening symptoms of an HBV infection. As lamivudine is transmitted through breast milk, it is recommended that all HIV-positive women avoid breastfeeding to prevent transmission of the virus.
In the case of an overdose of 3TC, standard supportive care should be used. Lamivudine may be dialyzable.
Alternative Brand Names
3TC is available under different brand names. These include Heptovir, Epivir, and Epivir-HBV. 3TC is also available as a part of the combination medications Cimduo, Combivir, Epzicom, Triumeq, and Trizivir.
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