Lamivudine Teva Pharma B.V. (Lamivudine)

Lamivudine is an antiretroviral nucleoside analogue used to inhibit viral replication in specific infections.

• HIV infection: reduces viral load and helps restore immune function in adults and children.
• Chronic hepatitis B infection: suppresses HBV DNA replication and improves liver enzyme levels.
• Prevention of mother‑to‑child transmission of HIV: lowers the risk of vertical transmission when administered to pregnant women.

• Lamivudine is phosphorylated intracellularly to its active triphosphate form, which competes with the natural nucleoside deoxy‑cytidine triphosphate for incorporation into viral DNA by reverse transcriptase. Incorporation causes premature chain termination, halting synthesis of proviral DNA and thereby preventing replication of HIV and hepatitis B virus. The drug exhibits high selectivity for viral enzymes, resulting in minimal impact on host cellular DNA synthesis.

Lamivudine may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea: mild stomach upset often transient.
• Headache: occasional tension‑type headaches.
• Fatigue: general tiredness without specific cause.
• Diarrhea: loose stools that may be self‑limiting.
• Insomnia: difficulty falling or staying asleep.
• Dizziness: light‑headed sensation, especially on standing.

Serious or Rare Side Effects

• Lactic acidosis: buildup of lactate leading to metabolic disturbance.
• Severe hepatotoxicity: marked elevation of liver enzymes or liver failure.
• Pancreatitis: inflammation of the pancreas with abdominal pain.
• Stevens‑Johnson syndrome: severe skin reaction with blistering.
• Anemia: significant drop in red blood cell count.
• Neutropenia: marked reduction in neutrophil count increasing infection risk.

Before initiating lamivudine therapy, several safety considerations should be reviewed.

• Renal function: assess creatinine clearance and adjust dose in impairment.
• Hepatic impairment: monitor liver enzymes and use cautiously in severe disease.
• Pregnancy and breastfeeding: weigh potential benefits against unknown fetal risk.
• Concomitant NRTIs: avoid combining with didanosine or stavudine due to increased toxicity.
• Adherence: ensure consistent daily intake to prevent resistance development.
• Store below 25°C: keep in the original container, protect from moisture and direct sunlight.

Lamivudine can interact with other medicines, altering efficacy or toxicity.

Major Interactions (Avoid)

• Didanosine: co‑administration increases risk of pancreatitis and peripheral neuropathy.
• Stavudine: combined use may exacerbate mitochondrial toxicity and neuropathy.

Moderate Interactions (Monitor Closely)

• Efavirenz: may reduce lamivudine plasma concentrations; monitor viral load.
• Nevirapine: potential for additive liver toxicity; check hepatic function regularly.
• Alcohol: excessive intake can worsen hepatotoxic risk.
• Rifampicin: may lower lamivudine levels; consider dose adjustment.