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# Tabovoihep (Entecavir) ## Overview Entecavir is a nucleoside analog reverse transcriptase inhibitor used in the management of chronic hepatitis B virus (HBV) infection. ## Primary Indications Chronic hepatitis B virus (HBV) infection in adults and pediatric patients. ## Adult Dosing * **Treatment-naive patients or those with detectable HBV DNA and ALT < 2x ULN:** 0.5 mg orally once daily. * **Patients with prior lamivudine or telbivudine treatment, or detectable HBV DNA and ALT >= 2x ULN:** 1 mg orally once daily. * **Maximum dose:** 1 mg once daily. ## Pediatric Dosing * **Age 16 years to < 18 years:** 0.5 mg orally once daily. * **Weight 10 kg to < 20 kg:** 0.1 mg/kg orally once daily. * **Weight 20 kg to < 30 kg:** 0.2 mg/kg orally once daily. * **Weight 30 kg to < 40 kg:** 0.3 mg/kg orally once daily. * **Weight >= 40 kg:** 0.5 mg orally once daily. * **Note:** Specific pediatric dosing may depend on local protocols and HBV DNA levels. ## Dose Adjustments * **Renal Impairment:** Dose adjustment is necessary based on calculated creatinine clearance. Refer to specific guidelines or drug information resources for detailed adjustment recommendations. * **Hepatic Impairment:** No dose adjustment is generally required in patients with hepatic impairment. ## Contraindications * Hypersensitivity to entecavir or any component of the formulation. ## Adverse Effects * **Common:** Headache, fatigue, nausea, abdominal pain, diarrhea, dizziness. * **Serious:** Lactic acidosis, severe hepatomegaly with steatosis (potentially fatal), exacerbation of hepatitis B upon discontinuation. ## Key Drug Interactions * **Drugs requiring dose adjustment for renal impairment:** Concomitant use may increase entecavir exposure and risk of toxicity. Monitor renal function closely. * **Didanosine:** Increased didanosine AUC; monitor for increased didanosine-related adverse effects. Co-administration is generally not recommended. ## Monitoring * HBV DNA levels. * Liver function tests (ALT, AST). * Renal function (creatinine clearance). * HBeAg and anti-HBe status. * Monitoring for signs and symptoms of lactic acidosis and severe hepatomegaly. ## Clinical Pearls * Entecavir should be taken on an empty stomach. Separate dosing from antacids or other medications that may affect gastric pH. * Discontinuation of entecavir may lead to severe acute exacerbation of hepatitis B. Gradual withdrawal and close monitoring are recommended, especially in patients with advanced liver disease. * Treatment duration is individualized and guided by clinical response, HBV DNA levels, and HBeAg status. **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.