Trade Names:Hepsera- Tablets 10 mg
Inhibits hepatitis B virus (HBV) DNA polymerase (reverse transcriptase) by competing with the natural substrate deoxyadenosine triphosphate and by causing DNA chain termination after its incorporation into viral DNA.
Bioavailability of adefovir is approximately 59%. C max is approximately 18.4 ng/mL, and T max is approximately 1.75 h.
Up to 4% is protein bound. Vd is approximately 352 to 392 mL/kg (IV doses at steady state).
Adefovir dipivoxil (prodrug) is rapidly converted to adefovir (active).
The terminal elimination half-life is approximately 7.48 h; 45% of dose is recovered as adefovir in the urine over 24 h. Adefovir is renally excreted by a combination of glomerular filtration and active tubular secretion.
C max , AUC, and half-life increased in those with moderate or severe renal function impairment or with end-stage renal disease. Dosing interval modification is recommended.Hepatic Function Impairment
No changes in pharmacokinetics were observed in patients with moderate and severe hepatic function impairment. No dosage adjustment is required.Elderly
Pharmacokinetics have not been studied.Children
Pharmacokinetics in children 12 to 18 yr of age are comparable with those observed in adults.
Treatment of chronic hepatitis B in patients 12 yr of age and older with evidence of active viral replication and evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease.
PO 10 mg daily.Renal Function ImpairmentAdults
PO For CrCl 50 mL/min or more, 10 mg daily; for CrCl 30 to 49 mL/min, 10 mg every 48 h; for CrCl 10 to 29 mL/min, 10 mg every 72 h; for hemodialysis patients, 10 mg every 7 days following dialysis. No dosing recommendations are available for nonhemodialysis patients with CrCl below 10 mL/min. No clinical data are available for dosing recommendations in adolescent patients with renal function impairment.
Store tablets at controlled room temperature (59° to 86°F).
May increase plasma concentrations of adefovir.
None well documented.
Asthenia (13%); headache (9%).
Abdominal pain (9%); nausea (5%); flatulence (4%); diarrhea, dyspepsia (3%).
Fanconi syndrome, proximal renal tubulopathy, renal failure (postmarketing).
Decreased serum phosphorous, increased serum creatinine.
Myopathy, osteomalacia (postmarketing).
Acute exacerbations have occurred in patients who have discontinued antihepatitis B therapy, including adefovir. Monitor hepatic function closely with clinical and laboratory follow-up for at least several months in patients who discontinue antihepatitis B therapy. Resumption of antihepatitis B therapy may be warranted.HIV resistance
May emerge in unrecognized or untreated HIV infection. Offer HIV antibody testing to all patients prior to initiating therapy.Lactic acidosis/hepatomegaly
Lactic acidosis and hepatomegaly with steatosis (including fatal cases) have been reported with use of nucleoside analogs alone or in combination with other antiretrovirals.Nephrotoxicity
Chronic administration of adefovir in patients at risk of or having underlying renal function impairment may result in nephrotoxicity. Close monitoring is required. Dosage adjustment may be necessary.
Monitor renal function in all patients during treatment, especially those with preexisting or other risk factors for renal impairment. Monitor patients for evidence of lactic acidosis or pronounced hepatotoxicity and steatosis; suspend therapy in patients who develop clinical or laboratory findings suggestive of these conditions. Monitor hepatic function at repeated intervals with both clinical and laboratory follow-up for at least several months in patients discontinuing therapy; closely monitor patients after stopping therapy. Prior to starting therapy, offer HIV antibody testing to all patients.
Category C .
Safety and efficacy not established in children younger than 12 yr of age.
Select dose with caution, reflecting greater frequency of decreased hepatic, renal, or cardiac function and comorbidity.
Dosage adjustments may be necessary. No data are available for making dosing recommendations in patients younger than 18 yr of age with renal function impairment.
Resistance to adefovir can result in viral load rebound, which may result in exacerbation of hepatitis B and, in patients with hepatic function impairment, may lead to liver decompensation and possible death. To reduce the risk of resistance in patients with lamivudine-resistant HBV, use adefovir dipivoxil combined with lamivudine; do not use adefovir dipivoxil monotherapy. To reduce the risk of resistance in patients receiving adefovir dipivoxil monotherapy, consider modifying treatment if serum HBV DNA levels remain above 1,000 copies/mL with continued treatment.
GI adverse reactions.
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