Makindo Medical Notes

Adefovir dipivoxil should not normally be given before the person has had lamivudine treatment. It may be given on its own or with lamivudine when: the person hepatitis B virus has become resistant to lamivudine, or the virus is likely to become resistant to lamivudine quickly and the resistance could cause problems for the person, such as serious liver disease.

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• Nucleotide analogue used in the treatment of chronic Hepatitis B infection
• Adefovir is structurally related to the purine base adenine.

Mode of action

• It is converted intracellularly to the diphosphate, which inhibits the synthesis of hepatitis B virus DNA through competition for the enzyme reverse transcriptase and incorporation into the viral DNA.
• Adefovir is not well absorbed after oral administration so is given by mouth as the prodrug adefovir dipivoxil.

Indications

Guidance

• NICE guidance is for Chronic hepatitis B providing
• Treatment with peginterferon alfa-2a or interferon alfa has not worked for that person
• Treatment with interferon worked at first, but the person has had a relapse,
• The person can't take peginterferon alfa-2a or interferon alfa
• Person has had serious side effects from taking these medicines.

Interactions

• Nil significant

Cautions

• Adjust dose with renal failure. Nephrotoxicity may be seen

Contraindications

• Breastfeeding

Side effects

• Nausea, flatulence, diarrhoea and dyspepsia
• Rash, headache, low phosphate
• Lactic acidosis, hepatitis, renal failure
• Severe Hepatomegaly with Steatosis

Dose

• Chronic Hepatitis B : Adefovir 10 mg, once daily (normal renal function)

References

• Adefovir in BNF