entecavir

ROUTE	ONSET	PEAK	DURATION
PO	rapid	0.5–1 hr	24 hr

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

Renal impairment (↓ dose if CCr <50 mL/min;
Liver transplant recipients (careful monitoring of renal function recommended);
Patients coinfected with HIV (unless receiving highly active antiretroviral therapy; at ↑ risk for resistance)
;
OB: Other agents preferred for treatment of HBV during pregnancy;
Lactation: Use during breastfeeding only if benefit to patient outweighs potential risk to infant;
Pedi: Children <2 yr (safety and effectiveness not established);
Geri: ↑risk of toxicity in older adults due to age-related ↓ in renal function.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: alopecia, rash

F and E: LACTIC ACIDOSIS

GI:

hepatomegaly (with steatosis)

, dyspepsia, nausea

Neuro: dizziness, fatigue, headache

Interactions ⬆ ⬇

Drug-drug:

Concurrent use of drugs that may impair renal function may ↑ levels and risk of toxicity.

Route/Dosage ⬆ ⬇

PO (Adults ): Compensated liver disease: 0.5 mg once daily; Decompensated liver disease or history of lamivudine resistance: 1 mg once daily.
PO (Children ≥2 yr and >30 kg): 0.5 mg once daily (1 mg once daily if history of lamivudine resistance).
PO (Children ≥2 yr and >26–30 kg): 0.45 mg once daily (0.9 mg once daily if history of lamivudine resistance).
PO (Children ≥2 yr and >23–26 kg): 0.4 mg once daily (0.8 mg once daily if history of lamivudine resistance).
PO (Children ≥2 yr and >20–23 kg): 0.35 mg once daily (0.7 mg once daily if history of lamivudine resistance).
PO (Children ≥2 yr and >17–20 kg): 0.3 mg once daily (0.6 mg once daily if history of lamivudine resistance).
PO (Children ≥2 yr and >14–17 kg): 0.25 mg once daily (0.5 mg once daily if history of lamivudine resistance).
PO (Children ≥2 yr and >11–14 kg): 0.2 mg once daily (0.4 mg once daily if history of lamivudine resistance).
PO (Children ≥2 yr and 10–11 kg): 0.15 mg once daily (0.3 mg once daily if history of lamivudine resistance).

Renal Impairment

PO (Adults ): CCr 30–<50 mL/min: 0.25 mg once daily or 0.5 mg every 48 hr (0.5 mg once daily or 1 mg every 48 hr if lamivudine-resistant or decompensated liver disease). CCr 10–<30 mL/min: 0.15 mg once daily or 0.5 mg every 72 hr (0.3 mg once daily or 1 mg every 72 hr if lamivudine-resistant or decompensated liver disease). CCr <10 mL/min, hemodialysis, or CAPD: 0.05 mg once daily or 0.5 mg every 7 days (0.1 mg once daily or 1 mg every 7 days if lamivudine-resistant or decompensated liver disease).

Availability ⬆ ⬇

(Generic available)

Oral solution orange flavor: 0.05 mg/mL
Tablets: 0.5 mg; 1 mg

Assessment ⬆ ⬇

Monitor signs of HBV (jaundice, fatigue, anorexia, pruritus) during and for several months following discontinuation of therapy. Exacerbations may occur when therapy is discontinued.
Monitor patient for signs of lactic acidosis and severe hepatomegaly with steatosis (↑ serum lactate levels, ↑ liver enzymes, liver enlargement on palpation). Suspend therapy if clinical or laboratory signs occur.

Lab Test Considerations:

Monitor liver function tests closely during and for several months following discontinuation of therapy. May ↑ serum AST, ALT, bilirubin, amylase, lipase, creatinine, and glucose. May ↓ albumin.

Implementation ⬆ ⬇

PO: Administer on an empty stomach >2 hr before or after a meal. Use oral solution for dose <0.5 mg and children up to 30 kg. Children >30 kg can use oral solution or tablet. Oral solution is ready to use; do not dilute or mix with water or any other liquid. Hold dosing spoon in a vertical position and fill gradually to mark corresponding to prescribed dose; rinse dosing spoon with water after each daily dose. Store in outer carton at room temperature. After opening, solution can be used until expiration date on bottle.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy. Instruct patient to take as directed. Take missed doses as soon as possible unless almost time for next dose. Do not double doses. Emphasize the importance of compliance with full course of therapy and not taking more than the prescribed amount. Caution patient not to share medication with others.
Do not stop taking without consulting health care provider. Discontinuing therapy may lead to severe exacerbations.
Instruct patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Inform patient that entecavir does not cure HBV but may ↓ the amount of HBV in the body, ↓ the ability of HBV to multiply and infect new liver cells, and improve the condition of the liver. Entecavir does not ↓ the risk of transmission of HBV to others through sexual contact or blood contamination. Caution patient to use a condom during sexual contact and avoid sharing needles or donating blood to prevent spreading HBV to others.
Advise patient to notify health care provider promptly if signs of lactic acidosis (weakness or tiredness; unusual muscle pain; trouble breathing; stomach pain with nausea and vomiting; feeling cold, especially in arms or legs; dizziness; fast or irregular heartbeat) or hepatotoxicity (jaundice, dark urine, light-colored bowel movements, anorexia, nausea, lower stomach pain) occur.
May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Discuss the possibility of hair loss with patient. Explore methods of coping.
Emphasize the importance of regular follow-up exams and blood tests to determine progress and monitor for side effects.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected and to avoid breastfeeding during therapy. Encourage pregnant women to enroll in the Antiretroviral Pregnancy Registry by calling 1-800-258-4263.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇