Nucleoside reverse transcriptase inhibitor
Lamivudine
Brand names: Epivir, Zeffix
Adult dose
Dose: HIV: 300mg OD or 150mg BD. HBV: 100mg OD
Route: PO
Frequency: OD-BD
Dose adjustments
Renal
Mandatory — refer to BNF
Clinical pearls
- HIV-1 (with other antiretrovirals); chronic HBV (lower-dose, but high resistance — entecavir/tenofovir preferred)
- HIV/HBV co-infection: do not use lamivudine alone
Contraindications
- Hypersensitivity
Side effects
- Headache
- Fatigue
- GI upset
- Lactic acidosis with hepatic steatosis (rare, NRTI class)
- HBV flare on discontinuation
- Pancreatitis
Interactions
- Co-trimoxazole (raised lamivudine)
- Sorbitol (reduced exposure — clinically relevant in low BMI)
Monitoring
- Viral load
- LFTs
- U&E
- Lipase if symptoms
Reference: BNF; BHIVA/EASL guidelines; https://bnf.nice.org.uk/drugs/lamivudine/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
- BALL Score for Relapsed/Refractory CLL · Leukaemia
Pathways
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023