Epivir

Black Box Warnings .

Adult Dosing .

Dosage forms:  TAB: 150 mg, 300 mg; SOLUTION: 10 mg per mL

HIV infection

[300 mg PO qd]

Alt: 150 mg PO bid

HIV post-exposure prophylaxis (off-label)

[300 mg PO qd]

Alt: 150 mg PO bid; Info: part of multi-drug regimen; refer to HIV Post-Exposure Prophylaxis, Occupational and HIV Post-Exposure Prophylaxis, Nonoccupational tables

renal dosing

[HIV infection]

CrCl 30-49: 150 mg qd; CrCl 15-29: 150 mg x1, then 100 mg qd; CrCl 5-14: 150 mg x1, then 50 mg qd; CrCl <5: 50 mg x1, then 25 mg qd

HD: 50 mg x1, then 25 mg qd, on dialysis days administer after dialysis; no supplement; PD: 10 mg qd; no supplement

[HIV post-exposure prophylaxis]

CrCl 15-29: 150 mg x1, then 100 mg qd; CrCl 5-14: 150 mg x1, then 50 mg qd; CrCl <5: 50 mg x1, then 25 mg qd

HD: 50 mg x1, then 25 mg qd, on dialysis days administer after dialysis; no supplement; PD: not defined

hepatic dosing

[no adjustment]

Peds Dosing .

Dosage forms:  TAB: 150 mg, 300 mg; SOLUTION: 10 mg per mL

HIV infection

[>32 wk gestation, <4 wk old (off-label)]

Dose: 2 mg/kg/dose PO bid

[4 wk old-3 mo (off-label)]

Dose: 4 mg/kg/dose PO bid; Max: 300 mg/day

[3 mo-16 yo, 14-19.9 kg]

Dose: 150 mg PO qd; Max: 300 mg/day; Alt: 75 mg PO bid; 10 mg/kg/day PO divided qd-bid; Info: tabs preferred over oral solution

[3 mo-16 yo, 20-24.9 kg]

Dose: 225 mg PO qd; Max: 300 mg/day; Alt: 75 mg PO qam, 150 mg PO qpm; 10 mg/kg/day PO divided qd-bid; Info: tabs preferred over oral solution

[3 mo-16 yo, >25 kg]

Dose: 300 mg PO qd; Max: 300 mg/day; Alt: 150 mg PO bid; 10 mg/kg/day PO divided qd-bid; Info: tabs preferred over oral solution

[>16 yo]

Dose: 300 mg PO qd; Alt: 150 mg PO bid

HIV infection prevention, low-risk neonates (off-label)

[2-3 wk old]

Dose: 4 mg/kg/day PO divided q12h; Info: for breastfed patients on extended prophylaxis; continue x6wk post-weaning; refer to DHHS guidelines

[4 wk old-12 mo, 2-2.9 kg]

Dose: 10 mg PO bid; Info: for breastfed patients on extended prophylaxis; continue x6wk post-weaning; refer to DHHS guidelines

[4 wk old-12 mo, 3-3.9 kg]

Dose: 15 mg PO bid; Info: for breastfed patients on extended prophylaxis; continue x6wk post-weaning; refer to DHHS guidelines

[4 wk old-12 mo, 4-7.9 kg]

Dose: 25 mg PO bid; Info: for breastfed patients on extended prophylaxis; continue x6wk post-weaning; refer to DHHS guidelines

[4 wk old-12 mo, >8 kg]

Dose: 50 mg PO bid; Info: for breastfed patients on extended prophylaxis; continue x6wk post-weaning; refer to DHHS guidelines

HIV infection prevention, high-risk neonates (off-label)

[>32 wk gestation, <4 wk old]

Dose: 4 mg/kg/day PO divided bid x2-6wk; Start: within 6h after birth; Info: give with zidovudine and either nevirapine or raltegravir; if <6wk multidrug regimen, continue zidovudine alone to complete 6wk total duration; refer to DHHS guidelines

[>32 wk gestation, 4-6 wk old]

Dose: 8 mg/kg/day PO divided bid x2-6wk; Start: within 6h after birth; Info: give with zidovudine and either nevirapine or raltegravir; if <6wk multidrug regimen, continue zidovudine alone to complete 6wk total duration; refer to DHHS guidelines

HIV post-exposure prophylaxis, nonoccupational (off-label)

[<27 days old-3 wk old]

Dose: 2 mg/kg/dose PO bid; Info: part of multi-drug regimen; refer to HIV Post-Exposure Prophylaxis, Nonoccupational table

[4 wk old-2 mo]

Dose: 4 mg/kg/dose PO bid; Max: 150 mg/dose; Info: part of multi-drug regimen; refer to HIV Post-Exposure Prophylaxis, Nonoccupational table

[3 mo and older]

Dose: 5 mg/kg/dose PO bid; Max: 300 mg/day; Alt: 10 mg/kg/dose PO qd; Info: part of multi-drug regimen; refer to HIV Post-Exposure Prophylaxis, Nonoccupational table

[<16 yo, 14-19.9 kg]

Dose: 75 mg PO bid; Info: part of multi-drug regimen; refer to HIV Post-Exposure Prophylaxis, Nonoccupational table

[<16 yo, 20-24.9 kg]

Dose: 75 mg PO qam and 150 mg tabPO qpm; Info: part of multi-drug regimen; refer to HIV Post-Exposure Prophylaxis, Nonoccupational table

[<16 yo, >25 kg]

Dose: 150 mg PO bid; Info: part of multi-drug regimen; refer to HIV Post-Exposure Prophylaxis, Nonoccupational table

[16 yo and older, <50 kg]

Dose: 4 mg/kg/dose PO bid; Max: 150 mg/dose; Info: part of multi-drug regimen; refer to HIV Post-Exposure Prophylaxis, Occupational and HIV Post-Exposure Prophylaxis, Nonoccupational tables

[16 yo and older, >50 kg]

Dose: 150 mg PO bid; Alt: 300 mg PO qd; Info: part of multi-drug regimen; refer to HIV Post-Exposure Prophylaxis, Occupational and HIV Post-Exposure Prophylaxis, Nonoccupational tables

renal dosing

[see below]

CrCl 30-49: give usual dose q24h; CrCl 15-29: give usual dose x1, then give 66% usual dose q24h; CrCl 5-14: give usual dose x1, then give 33% usual dose q24h; CrCl <5: give 50% usual dose x1, then give 17% usual dose q24h

HD: give 17% usual dose q24h, on dialysis days administer after dialysis; no supplement; PD: give 17% usual dose q24h; no supplement

hepatic dosing

[no adjustment]