Lamivudine

Brand names of lamivudine

  • Combivir
  • Epivir
  • Epivir HBV
  • Heptovir

Lamivudine is used to treat infections caused by the human immunodeficiency (HIV) virus and the hepatitis B virus. This medication received FDA approval in 1995 and belongs to the class of medicines known as reverse transcriptase inhibitors.

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When a person is infected with HIV the virus multiplies in the body's cells. When the viruses are released from the cell they infect all the other healthy cells that are spread throughout the body and so HIV spreads to new uninfected cells. As the body keeps making new cells all the time the HIV infection also continues to spread to all newly produced cells. The HIV virus has to make a new DNA each time a new virus is produced by it. This new DNA is formed by reverse transcriptase which acts as the virus' enzyme.

At first lamivudine is converted in the body to its active form known as lamivudine triphosphate where it is chemically similar to deoxycytidine triphospate and new DNA is made when reverse transcriptase use it. When lamivudine is administered the reverse transcriptase begins to use this instead of deoxycytidine triphosphate but DNA cannot be made as lamivudine triphosphate interferes with reverse transcriptase.

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Things you need to tell your physician before taking lamivudine

Before you take lamivudine communicate to your doctor if you are allergic to it or to any other medication. Also inform the doctor if you are taking any prescription vitamins or non-prescription drugs particularly trimethoprim/sulfamethoxazole (Bactrim or Septra).
If the patient is a child and has suffered from kidney disease or a disease of the pancreas then this must be told to the doctor.

Lamivudine might need to be adjusted with these conditions and additionally some test might be required to take this medicine safely.

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Lamivudine can cause lactic acid to build up in the body. The lactic acidosis symptoms can get worse even though they may begin slowly and can even become fatal. Call your doctor immediately even if the symptoms like the following are mild, muscle pain that is unusual and weakness, numbness or cold feeling in the arms and legs, stomach pain, nausea, vomiting.

The liver and pancreas can also be severely affected by lamivudine and can even lead to loss of life. Lamivudine is known to cause pancreatitis in women more often then men. The doctor needs to be called urgently if after taking lamivudine severe pain occurs in the upper stomach and leads to the back, if the heart rate increases, there is nausea, vomiting, diarrhea, loss of appetite, low fever, dark urine, clay colored stool or jaundice when eyes and skin turn yellow.

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Lamivudine can be harmful to the baby but if left untreated, HIV can pass on to the unborn child from the pregnant mother. So it is necessary to tell the doctor if you are pregnant or plan to become pregnant while the treatment is going on. However you must take all HIV medicines to control infection while you are pregnant. Also your name will need to be registered for an antiviral pregnancy registry when you start on lamivudine. This is required in order to keep a track of the pregnancy and evaluate any effects lamivudine might have had on the baby.

While on lamivudine you should not breast feed the baby. In fact women who have AIDS or HIV should not breast feed at all. Even if the baby has no HIV at birth, breast feeding might help to pass the virus to the baby.

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In case you are diabetic then the liquid form of lamivudine should be avoided as it contains 3 to 4 grams of sucrose in one dose.

Usage

Lamivudine is used to treat severe hepatitis B viral infection patients, who do not have an HIV infection. Along with other drugs it helps to control HIV infection to give a better quality of life to the patient. It could help to lower the complications of new infections and cancer, in HIV affected patients. Lamivudine does not cure HIV nor does it stop HIV infection from spreading to others through sexual contact or through blood contamination via shared needles.

How to use lamivudine

All patients must read the information pamphlet given by the pharmacist at the start of the medication and also at each refill of lamivudine. Direct all questions to the pharmacist or doctor.

The medication is taken once or twice a day with or without food as directed by the doctor. The dosage is based on how you respond to treatment and also on the state of your medical condition. It could happen that an old infection flares up when you take HIV medicines for the first time. Do not worry as it just means your immune system is working again.

In case you have fever, headaches, skin, vision or breathing problems or a new cough, notify your doctor immediately. It is important you take all HIV medicines including lamivudine exactly as prescribed and without missing a single dose. The dose should neither be increased, nor decreased or taken more frequently than prescribed.

Under no circumstances should you stop taking the medications even for a short while unless the doctor says to stop. Missing or changing the dosage might cause the virus to increase and the infection might become resistant and difficult to treat. It could also lead to more severe side effects.

Lamivudine works best when the level of medication in the body is constant. It must therefore be taken at exact intervals and at the same time daily. If the condition worsens or shows no improvement inform the doctor.

How lamivudine works

The DNA in the viral cell needs to be replicated in order to reproduce and increase infection. But lamivudine interferes with the activity of the enzymes needed for replication and so HBV is prevented from reproducing.

Side effects

Serious:
Less common:

Possible interactions

Herbal medicines like milk thistle is a known antioxidant that promotes liver cell regeneration. So talk to your doctor if you are thinking of taking milk thistle for hepatitis B along with lamivudine. Echinacea is taken to boost the immune system but in patients with a damaged immune system Echinacea is not recommended as this herb could actually weaken the immune system if taken frequently and for too long.

Discontinuation

No medication for HIV must be stopped without the doctor's approval and guidance.

Storage instructions

Lamivudine must be kept in a tightly closed container and out of reach of children. It should be stored at room temperature and away from heat and moisture and so the bathroom should not be used for storage. Store the liquid in a cool place but not in the refrigerator. Talk to your pharmacist about proper disposal of the medicine before throwing away all outdated and unused medicines.

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