Dinara Davipharm Treatment Treatment of chronic hepatitis B (4 blisters x 7 tablets)

or the virus partially responds to Tenofovir Disoproxil Fumarat.

Standard treatment of treatment:

Be cautious when using

Need to evaluate compliance with treatment and reliability of HBV DNA test before conclusion of failure. In the absence of HBV DNA test, if ALT does not decrease or increase, it is necessary to evaluate the problem of compliance with treatment. If the patient follows well, it is necessary to transfer the patient to the upline for HBV DNA test).

If possible, the virus should be determined by gene sequence for the next direction.

In people with renal and child functions, do not use a fixed combination preparation containing lamivudine and tenofovir disoproxil fumarat, because it is not possible to adjust each medicine separately.

tenofovir disoproxil fumarat

Tenofovir disoproxil fumarat must be discontinued when the transaminase level increases rapidly, liver gradually or fatty liver, or metabolic acidosis or lactic acid for unknown reasons. It must be very cautious when using tenofovir for people with large liver disease, or other risks of liver disease. Especially, it is very careful in patients with hepatitis C using interferon alpha and ribavirin. In patients with hepatitis B, when the Tenofovir stops, there may be a risk of severe hepatitis.

Tenofovir must be used with kidney damage.

Kidney function and serum phosphate must be monitored before starting treatment, every 4 weeks to do it for people with stones with kidney damage. If the serum phosphate concentration decreases or clears creatinine below 50 ml/min, the renal function must be assessed for 1 week, and may stop the drug if necessary.

Adiperatoma: The redistribution or the accumulation of fat in the body, including central obesity, front -neck hypertrophy ("buffalo hunchback"), peripheral nerves, face, mammary hypertrophy, Cushing syndrome may be encountered when taking antacimetal drugs.

Effects on bone: When using Tenofovir simultaneously with lamivudin and efavirenz in HIV -infected patients showing a decrease in the mineral density of lumbar spine, the increase in the concentration of 4 factors in bone metabolism, increased hormonal hormone in serum.

Need to monitor bone closely in patients with a history of fractures, or at risk of osteoporosis. Although the effectiveness of calcium and vitamin D supplementation has not been proven, the addition may be useful for these patients. When bone abnormalities need to consult a physician.

lamivudin

Stop lamivudin in patients with abdominal pain, nausea, or vomiting or abnormal biochemical test results until pancreatitis is excluded. Lamivudine treatment can lead to lactic acidosis and should be stopped if the concentration of aminotransferase increases rapidly, progressive liver disease, metabolic acidosis or lactic acidosis of unknown reasons. Lamivudin should be used cautiously in patients with large liver or risk factors for liver disease.

Patients simultaneously infected with HIV and chronic hepatitis B and C and treated with a combination of antiviral drugs at risk of unwanted effects on the liver and is likely to cause death. In patients with chronic hepatitis B, there is a risk of recurrence of hepatitis when stopping lamivudine, liver function should be monitored for these patients. The ability to infect with HIV should be excluded before starting with lamivudine treatment for hepatitis B, due to low doses for treatment for treatment may allow the development of HIV's Lamivudine strains.

Dose reduction may be necessary in patients with renal function.

Dinara contains yellow iron -colored excipients, which can cause skin allergies.

The ability to drive and operate machinery

Unwanted effects such as headache, insomnia, dizziness can affect concentration. Be careful if you have to drive and operate machinery while taking the drug.

Pregnancy

There is no sufficient data in pregnant women.

Do not recommend taking medication during pregnancy.

Lactation period

There is no information on the excretion of Tenofovir Disoproxil Fumarat through breast milk. Lamivudin is secreted into milk at a concentration equivalent to serum concentration. Therefore, or to stop taking the drug or to stop breastfeeding, depending on the importance of the drug for the mother.

Drug interaction

tenofovir disoproxil fumarat

adefovir dipivoxil

Tenofovir is not used with Adefovir Dipivoxil.

Medications affected or metabolized by liver enzymes

Tenofovir's pharmacokinetic interaction with inhibitors or substrates of liver enzymes is unknown. Tenofovir and precursors are not the substrate of CYP450, do not inhibit the isomers 3A4, 2D6, 2C9, or 2E1 but slightly inhibit slightly over 1A.

Medications are influenced or eliminated through the kidneys

Tenofovir interacts with drugs that reduce kidney function or competition eliminated through the renal tubules (for example: Acyclovir, Cidofovir, Ganciclovir, Valacyclovir, Val Comganciclovir), increasing plasma tenicovir concentrations or shared drugs.

HIV protease inhibitors

Interactive or co -operating between Tenofovir and HIV proteases such as Amprenavir, Atazanavir, Indinavir, Ritonavir, Saquinavir.

Nucleosid -free enzyme inhibitors

Interactive or co -operating between tenofovir and nucleosid -free copy enzyme inhibitors such as delavirdin, Efavirenz, Nevirapin.

Nucleosid enzyme inhibitors

Interactive or co -operating between tenofovir and nucleosid enzyme inhibitors such as abacavir, didanosin, emtricitabin, lamivudin, stavudin, zalcitabin, zidovudin.

Oral contraceptives

Unknown pharmacokinetic interaction with oral contraceptives containing Ethinyl Estradiol and Norgestimat.

didanosin

Tenofovir increases the concentration of didanosin in plasma. If using Didanosin simultaneously, take Tenofovir before taking Tenofovir 2 hours or after 1 hour didanosin.

lamivudin

Backward -code enzyme inhibitors are not nucleosid (Delavirdin, Efavirenz, Nevirapin)

Has a combination effect with lamivudin. No need to adjust the dose when simultaneously use Efavirenz and Lamivudin. There is no pharmacokinetic interaction when simultaneously used lamivudin and rilpivirin.

Nucleosid and nucleotid inhibitors inhibit the reverse code enzyme

Zidovudine concentration in plasma increases (about 13% when used in combination with lamivudine but do not need to adjust the dose when used simultaneously.

Abacavir, Stavudine reduces lamivudin's AUC but has no clinical significance.

Tenofovir reduces 24% of the plasma peak concentration of lamivudin but lamivudin's AUC and plasma peak, AUC of Tenofovir are not affected.

Do not simultaneously use lamivudin and emtricitabin (Emtricitabin is the same substance as lamivudin, simultaneously not beneficial because the two drugs are equally resistant and have no mutual strengthening effect).

Not simultaneously zalcitabin because lamivudin strongly inhibits the phosphorylation Zalcitabin in the cell.

trimethoprim/sulfamethoxazole increases the bioavailability of lamivudin (44%), reflected in the measurement of the area under the concentration - time (AUC) curve and reduces the clearance of the kidney (30%). However, no dose adjustment.