Lamivudine

INTRODUCTION

Indications

HIV infection (with other antiretrovirals). Chronic hepatitis B infection. Unlabeled Use: Part of HIV-postexposure prophylaxis with zidovudine and indinavir.

Action

After intracellular conversion to its active form (lamivudine-5-triphosphate), inhibits viral DNA synthesis by inhibiting the enzyme reverse transcriptase. Therapeutic Effects: Slows the progression of HIV infection and decreases the occurrence of its sequelae. Increases CD4 cell counts and decreases viral load. Protection from liver damage caused by chronic hepatitis B infection; decreases viral load.

Adverse Reactions/Side Effects

Noted for combination of lamivudine plus zidovudine

CNS: SEIZURES, fatigue, headache, insomnia, malaise, depression, dizziness. Resp: cough. GI: HEPATOMEGALY WITH STEATOSIS, PANCREATITIS (↑ IN PEDIATRIC PATIENTS), anorexia, diarrhea, nausea, vomiting, abdominal discomfort, abnormal liver function studies, dyspepsia. Derm: alopecia, erythema multiforme, rashes, urticaria. Endo: hyperglycemia. F and E: lactic acidosis. Hemat: anemia, neutropenia, pure red cell aplasia. MS: musculoskeletal pain, arthralgia, muscle weakness, myalgia, rhabdomyolysis. Neuro: neuropathy. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS AND STEVENS-JOHNSON SYNDROME.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Be alert for signs of enlarged, fatty liver (hepatomegaly with steatosis) that can progress to liver dysfunction and liver failure. Signs of liver disease include anorexia, abdominal pain, abdominal swelling (ascites), severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Notify physician of these signs immediately.

• Monitor signs of pancreatitis, including upper abdominal pain (especially after eating), indigestion, weight loss, and oily stools. Report these signs to the physician immediately.

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions that could indicate Stevens-Johnson syndrome (rash, pruritus, urticaria, dermatitis, exfoliation). Notify physician or nursing staff immediately if these reactions occur.

• Monitor signs of lactic acidosis, including confusion, lethargy, stupor, shallow rapid breathing, tachycardia, hypotension, nausea, and vomiting. Notify physician immediately if these signs occur.

• Assess any musculoskeletal pain, muscle tenderness, or weakness, especially if accompanied by fever, malaise, and dark-colored urine. These symptoms may represent drug-induced myopathy, and that myopathy can progress to severe muscle damage (rhabdomyolysis). Report any unexplained musculoskeletal symptoms to the physician immediately.

• Be alert for signs of peripheral neuropathy (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to assess drug-induced changes ...