Discontinue if didanosine-associated adverse events; lactic acidosis or pronounced hepatotoxicity develops. Not recommended to use as component of triple nucleoside regimen. Lactic acidosis & severe hepatomegaly w/ steatosis; severe acute exacerbations of hepatitis B; osteomalacia associated w/ proximal renal tubulopathy. Immune reconstitution syndrome. Redistribution or accumulation of body fat in patients receiving antiretroviral therapy. Perform test for presence of chronic HBV prior to antiretroviral therapy; routine monitoring of calculated CrCl & serum P in patients at risk for renal impairment. Closely monitor hepatic function w/ both clinical & lab follow up for at least several mth in patients who are co-infected w/ HIV & HBV. Consider bone monitoring for HIV infected patients w/ history of pathologic bone fracture or at risk for osteopenia. Avoid concurrent or recent use of nephrotoxic agent. Not to co-administered w/ Atripla, Emtriva, or Viread; other lamivudine-containing drugs eg, Combivir (lamivudine/zidovudine), Epivir or Epivir-HBV (lamivudine), Epzicom (abacavir sulfate/lamivudine), or Trizivir (abacavir sulfate/lamivudine/zidovudine); atazanavir. Acute renal failure & Fanconi syndrome (renal tubular injury w/ severe hypophosphatemia). Not to be administered in patients w/ CrCl <30 mL/min & ESRD requiring hemodialysis. Hepatic impairment. Pregnancy. Not to breastfeed during treatment. Not recommended in childn <18 yr. Elderly >65 yr.
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