Patients should be counseled on the importance of testing for hiv to avoid inappropriate therapy and development of resistant hiv, and hiv counseling and testing should be offered before starting epivir-hbv and periodically during therapy.

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Childrenespecially those with pancreatitismay be more sensitive to the effects of this drug.

Coadministration of single doses of lamivudine and sorbitol resulted in a sorbitol dose-dependent reduction in lamivudine exposuresWhen possibleavoid use of sorbitol-containing medicines with lamivudinesee Clinical Pharmacology12.3Consider more frequent monitoring of HBV viral load when chronic coadministration cannot be avoided.

Administer using a calibrated oral syringe to give an accurate dosageAvoid chronic coadministration of lamivudine oral solution with sorbitol-containing medicines as decreased lamivudine concentrations may occur.

In controlled clinical trialsYMDD-mutant HBV was detected in subjects with on-Epivir-HBV re-appearance of HBV DNA after an initial decline below the solution-hybridization assay limitsee Microbiology12.4Subjects treated with Epivir-HBVadults and childrenwith YMDD-mutant HBV at 52 weeks showed diminished treatment responses in comparison with subjects treated with Epivir-HBV without evidence of YMDD substitutionsincluding the followinglower rates of HBeAg seroconversion and HBeAg lossno greater than placebo recipientsmore frequent return of positive HBV DNAand more frequent ALT elevationsIn the controlled trialswhen subjects developed YMDD-mutant HBVthey had a rise in HBV DNA and ALT from their own previous on-treatment levelsProgression of hepatitis Bincluding deathhas been reported in some subjects with YMDD-mutant HBVincluding subjects from the liver transplant setting and from other clinical trialsIn clinical practicemonitoring of ALT and HBV DNA levels during treatment with Epivir-HBV may aid in treatment decisions if emergence of viral mutants is suspected.

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pediatric patients the recommended oral dose of epivir-hbv for pediatric patients 2 to 17 years of age with chronic hepatitis b is 3 mg kg once daily up to a maximum daily dose of 100 mg.