lamivudine (Rx)

Brand and Other Names:Epivir, Epivir HBV, more...3TC

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 100mg (Epivir HBV)
  • 150mg (Epivir)
  • 300mg (Epivir)

oral solution

  • 5mg/mL (Epivir HBV)
  • 10mg/mL (Epivir)

HIV Infection

Epivir: 300 mg PO qDay or 150 mg PO q12hr

Chronic Hepatitis B

Epivir HBV: 100 mg PO qDay

Renal Impairment

CrCl ≥ 50 mL/min: 150 mg PO q12hr or 300 mg PO qDay

CrCl 30-49 mL/min: 150 mg PO qDay

CrCl 15-29 mL/min: 150 mg first dose, then 100 mg qDay

CrCl 5-14 mL/min: 150 mg first dose, then 50 mg qDay

CrCl <5 mL/min: 50 mg first dose, then 25 mg qDay

See Also Combos

with zidovudine (Combivir)

with abacavir (Epzicom)

with abacavir/zidovudine

Dosing Considerations

Monitor amylase q4-8week

Dosage Forms & Strengths

tablet

  • 100mg (Epivir HBV)
  • 150mg (Epivir)
  • 300mg (Epivir)

oral solution

  • 5mg/mL (Epivir HBV)
  • 10mg/mL (Epivir)

HIV Infection

Indicated for treatment of HIV infection in combination with other antiretroviral agents

Epivir oral solution

  • Neonates (aged <4 weeks): 2 mg/kg PO q12hr (for prevention of transmission or treatment)
  • ≥1 month: 4 mg/kg PO q12hr  
  • ≥3 months: 5 mg/kg PO q12hr or 10 mg/kg PO qDay; not to exceed 300 mg/day
  • May switch to once daily dosing after age 3 yr in clinically stable patients with undetectable viral load and stable CD4 count (NIH HIV guidelines)
  • Also see Dosing Considerations

Epivir tablet

  • Weight-based dosing
    • 14 to <20 kg: 75 mg PO q12hr, OR 150 mg qDay
    • ≥20 to <25 kg: 75 mg AM and 150 mg PM PO, OR 220 mg qDay
    • ≥25 kg: 150 mg PO q12hr, OR 300 mg PO qDay
    • The NIH pediatric HIV treatment guideline (March, 2016) does not recommend initiating once-daily lamivudine liquid formulation for HIV-infected infants and young children

Chronic Hepatitis B

Use Epivir HBV

<2 years: Safety and efficacy not established

≥2 years: 3 mg/kg PO qDay; not to exceed 100 mg/day  

Dosing Considerations

Monitor amylase q4-8week

Lamiduvine 150-mg scored tablet is the preferred formulation for HIV-1 infected children and adolescents ≥14kg and whom a solid dosage form is appropriate

Tablet regimens are recommended when possible to avoid potential interactions with sorbitol

Consider more frequent monitoring of HIV-1 viral load when treating with lamiduvine (Epivir) oral solution; see also warnings and precautions section

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Interactions

Interaction Checker

and lamivudine

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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             activity indicator 

            Contraindicated (2)

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              lamivudine, elvitegravir/cobicistat/emtricitabine/tenofovir DF. Other (see comment). Contraindicated. Comment: Elvitegravir/cobicistat/emtricitabine/tenofovir is a complete regimen for HIV and should not be administered with other antiretrovirals.

            • emtricitabine

              emtricitabine and lamivudine both increase risk of immune reconstitution syndrome. Contraindicated. Coadministration of emtricitabine containing products and lamivudine containing products should be avoided. Combination will result in therapeutic duplication.

              emtricitabine, lamivudine. Other (see comment). Contraindicated. Comment: Coadministration of emtricitabine containing products and lamivudine containing products should be avoided. Combination will result in therapeutic duplication.

            Serious - Use Alternative (6)

            • betibeglogene autotemcel

              lamivudine, betibeglogene autotemcel. Other (see comment). Avoid or Use Alternate Drug. Comment: Do not take antiretroviral medications for at least 1 month before mobilization or expected duration for elimination of the medications, and until all cycles of apheresis are completed. Antiretroviral medications may interfere with manufacturing of apheresed cells.

            • cabotegravir

              lamivudine, cabotegravir. Other (see comment). Avoid or Use Alternate Drug. Comment: Cabotegravir plus rilpivirine is a complete regimen. Coadministration with other antiretroviral medications for treating HIV-1 infection is not recommended.

            • elivaldogene autotemcel

              elivaldogene autotemcel, lamivudine. Either decreases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Patients should not take antiretroviral medications for at least 1 month before initiating medications for stem cell mobilization, for the duration of the medications? elimination, and until all cycles of apheresis are completed.

            • sorbitol

              sorbitol will decrease the level or effect of lamivudine by Other (see comment). Avoid or Use Alternate Drug. Sorbitol-containing solution decreased systemic exposure of lamivudine oral solution in a pediatric study (ARROW trial). Results showed lower rates of virologic suppression, lower plasma lamivudine exposure, and development of viral resistance more frequently than children receiving lamivudine tablets.

            • tafenoquine

              tafenoquine will increase the level or effect of lamivudine by Other (see comment). Avoid or Use Alternate Drug. Tafenoquine inhibits organic cation transporter-2 (OCT2) and multidrug and toxin extrusion (MATE) transporters in vitro. Avoid coadministration with OCT2 or MATE substrates. If coadministration cannot be avoided, monitor for substrate-related toxicities and consider dosage reduction if needed based on product labeling of the coadministered drug.

            • trilaciclib

              trilaciclib will decrease the level or effect of lamivudine by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of trilaciclib (OCT2, MATE1, and MATE-2K inhibitor) with substrates where minimal increased concentration in kidney or blood may lead to serious or life-threatening toxicities.

            Monitor Closely (25)

            • abacavir

              abacavir and lamivudine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • atazanavir

              atazanavir and lamivudine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • cabozantinib

              lamivudine will increase the level or effect of cabozantinib by Other (see comment). Use Caution/Monitor. MRP2 inhibitors increase cabozantinib toxicity

            • efavirenz

              efavirenz and lamivudine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • enfuvirtide

              enfuvirtide and lamivudine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • erdafitinib

              lamivudine increases levels of erdafitinib by decreasing renal clearance. Modify Therapy/Monitor Closely. Consider alternatives that are not OCT2 substrates or consider reducing the dose of OCT2 substrates based on tolerability.

            • fosamprenavir

              fosamprenavir and lamivudine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • ganciclovir

              ganciclovir, lamivudine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Increased risk of hematologic toxicity.

            • indinavir

              indinavir and lamivudine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • interferon alfa 2b

              interferon alfa 2b, lamivudine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of liver decompensation.

            • nelfinavir

              nelfinavir and lamivudine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • nevirapine

              lamivudine and nevirapine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • orlistat

              orlistat will decrease the level or effect of lamivudine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Loss of virological control reported in HIV-infected patients taking orlistat concomitantly. Exact mechanism is unclear, but may include a drug-drug interaction that inhibits systemic absorption of the antiretroviral drug. Monitor HIV RNA levels frequently and if increased HIV viral load confirmed, discontinue orlistat.

            • peginterferon alfa 2a

              peginterferon alfa 2a, lamivudine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of liver decompensation.

            • peginterferon alfa 2b

              peginterferon alfa 2b, lamivudine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of liver decompensation.

            • ribavirin

              ribavirin increases toxicity of lamivudine by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Use alternatives if available. Increased risk of lactic acidosis.

            • ritonavir

              ritonavir and lamivudine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • saquinavir

              saquinavir and lamivudine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • stavudine

              lamivudine and stavudine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • tenofovir DF

              lamivudine and tenofovir DF both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • tipranavir

              tipranavir and lamivudine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            • trimethoprim

              trimethoprim increases effects of lamivudine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor. Potential for increased toxicity.

            • ublituximab

              ublituximab decreases effects of lamivudine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely.

            • valganciclovir

              valganciclovir, lamivudine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Use alternatives if available. Increased risk of hematologic toxicity.

            • zidovudine

              lamivudine and zidovudine both increase risk of immune reconstitution syndrome. Use Caution/Monitor.

            Minor (3)

            • isavuconazonium sulfate

              isavuconazonium sulfate will increase the level or effect of lamivudine by Other (see comment). Minor/Significance Unknown. Isavuconazonium sulfate, an OCT2 inhibitor, may increase the effects or levels of OCT2 substrates.

            • sulfamethoxazole

              sulfamethoxazole increases levels of lamivudine by decreasing renal clearance. Minor/Significance Unknown.

            • zidovudine

              lamivudine increases effects of zidovudine by pharmacodynamic synergism. Minor/Significance Unknown. Beneficial synergism.

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            Adverse Effects

            >10%

            Cough

            Diarrhea

            Fatigue & malaise

            Fever (peds)

            Headache

            Musculoskeletal pain

            Nausea

            Nervous system neuropathy

            Pancreatitis

            Peripheral neuropathy

            Nasal S/S

            Vomiting

            1-10%

            Abdominal cramps, abdominal pain

            Anorexia &/or decr appetite

            Arthralgia

            Chills

            Depression

            Dizziness

            Dyspepsia

            Insomnia

            Myalgia

            Rash

            Thrombocytopenia

            Creatine phosphokinase increased

            Frequency Not Defined

            Body fat redistribution

            Elevated amylase

            Neutropenia

            Hepatitis B exacerbation

            Postmarketing reports

            Immune reconstitution

            Blood and lymphatic system disorders

            Anemia (including pure red cell aplasia and severe anemias progressing on therapy), lymphadenopathy, splenomegaly, thrombocytopenia

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            Warnings

            Black Box Warnings

            Epivir-HBV is not FDA approved for treatment of HIV-1 infection; lamivudine dosage in EPIVIR-HBV is subtherapeutic and monotherapy is inappropriate for the treatment of HIV-1 infection and the safety and efficacy of this drug have not been established in patients co-infected with HBV and HIV; severe acute exacerbations of hepatitis B reported in patients who have discontinued anti-hepatitis B therapy (including HBV formulation); hepatic function should be monitored closely with both clinical and laboratory follow-up for at least several months in patients who discontinue anti-hepatitis B therapy; if appropriate, initiation of anti-hepatitis B therapy may be warranted

            Tablets and oral solution formulations used to treat HIV infection contain a higher dose of lamivudine than formulations indicated for chronic hepatitis B infection; HBV is not approved for treatment of HIV-1 infection because lamivudine dosage in HBV formulation is subtherapeutic and monotherapy is inappropriate for treatment of HIV-1 infection; patients with HIV should receive only formulation specific for HIV

            Contraindications

            Hypersensitivity

            Cautions

            Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, reported with use of nucleoside analogues, including lamivudine; a majority of these cases have been in women; female sex and obesity may be risk factors for development of lactic acidosis and severe hepatomegaly with steatosis in patients treated with antiretroviral nucleoside analogues; suspend treatment in any patient who develops clinical or laboratory findings suggestive of lactic acidosis or pronounced hepatotoxicity, which may include hepatomegaly and steatosis even in the absence of marked transaminase elevations

            In pediatric patients with a history of prior antiretroviral nucleoside exposure, a history of pancreatitis, or other significant risk factors for the development of pancreatitis, this drug should be used with caution; discontinue immediately if signs or symptoms of pancreatitis occur in patients with history of pancreatitis

            In order to reduce risk of resistance in patients receiving monotherapy, consider a switch to alternative regimen if serum HBV DNA remains detectable after 24 weeks of treatment; optimal therapy should be guided by resistance testing

            Patients with HIV-1 infection should receive only dosage forms of lamivudine appropriate for treatment of HIV-1

            Emergence of lamivudine-resistant HBV variants associated with lamivudine-containing antiretroviral regimens reported

            Concomitant administration of emtricitabine with lamivudine-containing products not recommended

            Hepatic decompensation (some fatal) reported in HIV-1/HCV co-infected patients receiving interferon and ribavirin-based regimens; monitor for treatment-associated toxicities; discontinue therapy as medically appropriate and consider dose reduction or discontinuation of interferon alfa, ribavirin, or both

            Use with caution in pediatric patients with a history of pancreatitis or other significant risk factors for pancreatitis; discontinue treatment as clinically appropriate

            Differences among lamivudine-containing products

            • Formulation and dosage of lamivudine in EPIVIR-HBV are not appropriate for patients co-infected with HIV-1 and HBV; safety and efficacy of lamivudine have not been established for treatment of chronic hepatitis B in patients co-infected with HIV-1 and HBV
            • If treatment with EPIVIR-HBV is prescribed for chronic hepatitis B for a patient with unrecognized or untreated HIV-1 infection, rapid emergence of, HIV-1 resistance is likely to result because of the subtherapeutic dose and the inappropriateness of monotherapy HIV-1 treatment
            • If a decision is made to administer lamivudine to patients co-infected with HIV-1 and HBV, EPIVIR tablets, EPIVIR oral solution, or another product containing the higher dose of lamivudine should be used as part of an appropriate combination regimen

            Posttreatment exacerbation of hepatitis

            • Clinical and laboratory evidence of exacerbations of hepatitis have occurred after discontinuation of lamivudine; exacerbations have been detected primarily by serum ALT elevations in addition to re-emergence of HBV DNA
            • Although most events appear to have been self-limited, fatalities have been reported in some cases; similar events have been reported from postmarketing experience after changes from lamivudine-containing HIV-1 treatment regimens to non-lamivudine-containing regimens in patients infected with both HIV-1 and HBV
            • The causal relationship to discontinuation of lamivudine treatment is unknown; patients should be closely monitored with both clinical and laboratory follow-up for at least several months after stopping treatment

            Immune reconstitution

            • Immune reconstitution syndrome reported in patients treated with combination antiretroviral therapy; during the initial phase of combination antiretroviral treatment, patients whose immune systems respond may develop an inflammatory response to indolent or residual opportunistic infections (such as Mycobacterium avium infection, cytomegalovirus, Pneumocystis jirovecii pneumonia [PCP], or tuberculosis), which maynecessitate further evaluation and treatment
            • Autoimmune disorders (such as Graves’ disease, polymyositis, and Guillain-Barré syndrome)also reported to occur in setting of immune reconstitution, however, the time to onset is more variable, and can occur many months after initiation of treatment

            Lower Virologic Suppression Rates and Increased Risk of Viral Resistance with Oral Solution

            • Pediatric subjects who received lamivudine (Epivir) oral solution concomitantly with other antiretroviral oral solutions at any time in the ARROW trial had lower rates of virologic suppression, lower plasma lamivudine exposure, and developed viral resistance more frequently than those receiving lamivudine (Epivir) tablets; lamivudine (Epivir) scored tablet is the preferred formulation for HIV-1-infected pediatric patients who weigh at least 14 kg and for whom a solid dosage form is appropriate; consider more frequent monitoring of HIV-1 viral load when treating with lamivudine (EPIVIR) oral solution
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            Pregnancy & Lactation

            Pregnancy

            A pregnancy registry has been established to monitor maternal-fetal outcomes of women exposed to lamivudine: 1-800-258-4263

            Available data from the APR show no difference in the overall risk of birth defects for lamivudine or zidovudine compared with background rate for birth defects of 2.7% in the Metropolitan Atlanta Congenital Defects Program (MACDP) reference population; APR uses the MACDP as the U.S. reference population for birth defects in the general population; MACDP evaluates women and infants from a limited geographic area and does not include outcomes for births that occurred at less than 20 weeks gestation; rate of miscarriage is not reported in the APR

            Lactation

            The Centers for Disease Control and Prevention recommend that HIV-1-infected mothers in the United States not breastfeed infants to avoid risking postnatal transmission of HIV-1 infection; lamivudine is present in human milk; there is no information on effects of lamivudine or zidovudine on breastfed infant or effects of drugs on milk production; because of potential for (1) HIV-1 transmission (in HIV-negative infants), (2)developing viral resistance (in HIV-positive infants), and (3) serious adverse reactions in a breastfed infant, instruct mothers not to breastfeed if they are receiving therapy

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Nucleoside Reverse Transcriptase Inhibitor (NRTI); following phosphorylation, inhibits HIV reverse transcriptase by viral DNA chain termination; cytosine analog

            Useful in combination with ZDV

            ZDV-induced codon mutations result in viral sensitivity to drug

            Pharmacokinetics

            Absorption: Rapid

            Vd: 1.3 L/kg

            Protein Bound: <36%

            Metabolism: 5.6% to trans-sulfoxide metabolite

            Bioavailability: Absolute; Cp max decreased with food although AUC not significantly affected, 66% (children); 87% (adults)

            Half-life elimination: 2 hr (children); 5-7 hr (adults)

            Excretion: Primarily urine

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            lamivudine oral
            -
            100 mg tablet
            lamivudine oral
            -
            300 mg tablet
            lamivudine oral
            -
            150 mg tablet
            lamivudine oral
            -
            150 mg tablet
            lamivudine oral
            -
            100 mg tablet
            lamivudine oral
            -
            300 mg tablet
            lamivudine oral
            -
            10 mg/mL solution
            lamivudine oral
            -
            150 mg tablet
            lamivudine oral
            -
            10 mg/mL solution
            lamivudine oral
            -
            150 mg tablet
            lamivudine oral
            -
            100 mg tablet
            lamivudine oral
            -
            300 mg tablet
            lamivudine oral
            -
            300 mg tablet
            lamivudine oral
            -
            150 mg tablet
            lamivudine oral
            -
            300 mg tablet
            Epivir oral
            -
            150 mg tablet
            Epivir oral
            -
            10 mg/mL solution
            Epivir oral
            -
            300 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            lamivudine oral

            LAMIVUDINE - ORAL

            (la-MIV-ue-deen)

            COMMON BRAND NAME(S): Epivir

            WARNING: If you have hepatitis B infection along with HIV, your hepatitis symptoms may get worse or become very serious if you stop taking lamivudine. Talk with your doctor before stopping this medication. Your doctor will perform liver function tests for several months after you stop lamivudine. Tell your doctor right away if you develop symptoms of worsening liver problems.Different brands of this drug have different amounts of drug. Do not switch brands of this medication without first checking with your doctor. If you have HIV infection (with or without hepatitis B infection), you should be taking the higher-strength dosage. Consult your doctor or pharmacist.

            USES: This drug is used with other HIV medications to help control HIV infection. It helps to decrease the amount of HIV in your body so your immune system can work better. This lowers your chance of getting HIV complications (such as new infections, cancer) and improves your quality of life. Lamivudine belongs to a class of drugs known as nucleoside reverse transcriptase inhibitors-NRTI.Lamivudine is not a cure for HIV infection. To decrease your risk of spreading HIV disease to others, continue to take all HIV medications exactly as prescribed by your doctor. Use an effective barrier method (latex or polyurethane condoms/dental dams) during sexual activity as directed by your doctor. Do not share personal items (such as needles/syringes, toothbrushes, and razors) that may have contacted blood or other body fluids. Consult your doctor or pharmacist for more details.

            HOW TO USE: Read the Patient Information Leaflet provided by your pharmacist before you start taking lamivudine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food, usually once or twice daily or as directed by your doctor.The dosage is based on your medical condition and response to treatment. In children, the dosage is also based on weight.It is very important to continue taking this medication (and other HIV medications) exactly as prescribed by your doctor. Do not skip any doses. Do not increase your dose, take this drug more often than prescribed, or stop taking it (or other HIV medicines) even for a short time unless directed to do so by your doctor. Skipping or changing your dose without approval from your doctor may cause the amount of virus to increase, make the infection more difficult to treat (resistant), or worsen side effects.For the best effect, take this medication at evenly spaced times. To help you remember, take this medication at the same time(s) every day.

            SIDE EFFECTS: See also Warning section.Headache, dizziness, nausea, diarrhea, or trouble sleeping may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Rarely, lamivudine has caused severe (sometimes fatal) liver problems and a buildup of lactic acid in the blood (lactic acidosis). These serious side effects may occur more often in women and obese patients. Get medical help right away if you have any of the following serious symptoms, including: symptoms of liver problems (such as nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine), symptoms of lactic acidosis (such as deep/rapid breathing, drowsiness, nausea/vomiting).As your immune system gets stronger, it can begin to fight off infections you already had, possibly causing disease symptoms to come back. You could also have symptoms if your immune system becomes overactive. This reaction may happen at any time (soon after starting HIV treatment or many months later). Get medical help right away if you have any serious symptoms, including: unexplained weight loss, severe tiredness, muscle aches/weakness that doesn't go away, headaches that are severe or don't go away, joint pain, numbness/tingling of the hands/feet/arms/legs, vision changes, signs of infection (such as fever, chills, swollen lymph nodes, trouble breathing, cough, non-healing skin sores), signs of an overactive thyroid (such as irritability, nervousness, heat intolerance, fast/pounding/irregular heartbeat, bulging eyes, unusual growth in the neck/thyroid known as a goiter), signs of a certain nerve problem known as Guillain-Barre syndrome (such as unsteadiness, loss of coordination, trouble swallowing/speaking/chewing, trouble moving your eyes).Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as depression), stomach/back pain with nausea (pancreatitis), easy bleeding/bruising, signs of anemia (unusual tiredness, rapid heartbeat, pale/bluish skin).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking lamivudine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: pancreatitis, kidney problems, liver problems (such as hepatitis B or C, cirrhosis), alcohol use.Avoid alcoholic beverages because they may increase your risk for liver problems and/or pancreatitis.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Caution is advised when using this drug in children because they may be more sensitive to the effects of the drug, especially the increased risk of pancreatitis.Tell your doctor if you are pregnant before using this medication. Treatment can lower the risk of passing HIV infection to your baby. Discuss the risks and benefits with your doctor.Lamivudine passes into breast milk. Because breast milk can transmit HIV, do not breast-feed.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: orlistat, sorbitol.Emtricitabine is similar to lamivudine and should not be taken with this medication. Check the labels on all your HIV medicines because they may contain the same ingredients as found in this product. Taking too much of these drugs will not necessarily improve your condition, and may cause more side effects.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.Lab and/or medical tests (such as kidney function, liver tests, viral load, T-cell counts) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised December 2022. Copyright(c) 2023 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.