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# Tab volihep ## Overview Tab volihep is a brand name for lamivudine, an NRTI (nucleoside reverse transcriptase inhibitor) used in the treatment of HIV-1 infection and chronic hepatitis B virus (HBV) infection. It works by inhibiting viral DNA polymerase. ## Primary Indications * Treatment of HIV-1 infection (in combination with other antiretroviral agents). * Treatment of chronic hepatitis B virus (HBV) infection. ## Adult Dosing * **HIV-1 Infection:** 300 mg orally once daily. * **Chronic Hepatitis B:** 100 mg orally once daily. ## Pediatric Dosing * **HIV-1 Infection:** * 2 years to < 17 years: 10 mg/kg orally once daily, not to exceed 300 mg/day. * Dosing for infants and children < 2 years is complex and depends on weight and formulation; consult specific pediatric guidelines. * **Chronic Hepatitis B:** Dosing for pediatric patients with HBV is not established. ## Dose Adjustments * **Renal Impairment (CrCl < 30 mL/min):** Dose reduction is necessary. * CrCl 15-30 mL/min: 100 mg once daily. * CrCl 5-14 mL/min: 50 mg once daily. * CrCl < 5 mL/min: 25 mg once daily. * Hemodialysis: 25 mg once daily, followed by a 1-hour dialysis session. * Continuous ambulatory peritoneal dialysis (CAPD): 25 mg once daily. * *Note:* For HIV treatment, these dose adjustments apply to the 300 mg daily regimen. For HBV treatment, these adjustments apply to the 100 mg daily regimen. ## Contraindications * Hypersensitivity to lamivudine or any component of the formulation. ## Adverse Effects * **Common:** Headache, nausea, vomiting, diarrhea, fatigue, cough, rash, nasopharyngitis, upper respiratory tract infection. * **Serious:** Lactic acidosis, severe hepatomegaly with steatosis, pancreatitis (especially in children with a history of pancreatitis or other risk factors), peripheral neuropathy, exacerbation of hepatitis B upon discontinuation, redistribution/accumulation of body fat. ## Key Drug Interactions * **Emtricitabine:** Lamivudine and emtricitabine are both cytosine analogs and should not be used together due to additive toxicity and lack of added clinical benefit. * **Trimethoprim/Sulfamethoxazole:** Increased lamivudine concentrations may occur. Dose adjustment of lamivudine may be needed. * **Interferon alfa and Ribavirin:** Increased risk of anemia. ## Monitoring * Liver function tests (AST, ALT, bilirubin). * Renal function (creatinine, BUN, CrCl). * Complete blood counts (CBC). * Viral load and CD4 count for HIV-1. * Hepatitis B viral DNA for chronic HBV. * Pancreatic enzymes (amylase, lipase) if pancreatitis is suspected. * Lactic acid levels if symptoms suggest. ## Clinical Pearls * Lamivudine should be taken with or without food. * For HIV treatment, it must be used as part of a combination antiretroviral regimen. * Discontinuation of lamivudine in patients with chronic HBV may lead to severe exacerbation of hepatitis. If lamivudine is discontinued, patients should be monitored for signs and symptoms of hepatitis exacerbation. * Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported. Risk factors include obesity, prolonged nucleoside therapy, and female sex. *** **Disclaimer:** This information is intended for clinical use and does not replace comprehensive drug information resources. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.