Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Nucleoside and Nucleotide Analogue Reverse Transcriptase Inhibitors

Lamivudine (Epivir, 3TC)

Last Updated: December 7, 2018; Last Reviewed: December 7, 2018

Excerpt from Table 10a

Note: When using FDCs, refer to other sections in Appendix B and Table 10 for information about the dosing and safety of individual drug components of the FDC during pregnancy.

Generic Name
(Abbreviation)
Trade Name
Formulation Dosing Recommendations Use in Pregnancy
Lamivudine
(3TC)
Epivir

(3TC/TDF)
Cimduo

(3TC/ZDV)
Combivir

(3TC/DOR/TDF)
Delstrigo

(3TC/ABC)
Epzicom

(3TC/EFV/TDF)
Symfi

(3TC/EFV/TDF)
Symfi Lo

(3TC/TDF)
Temixys

(3TC/ABC/DTG)
Triumeq

(3TC/ABC/ZDV)
Trizivir

Note:
Generic available for some formulations
3TC (Epivir)d
Tablets:
  • 150 mgd
  • 300 mgd
Oral Solution:
  • 10 mg/mL
3TC/TDF (Cimduo):
  • 3TC 300 mg plus TDF 300 mg tablet
3TC/ZDV (Combivir):d
  • 3TC 150 mg plus ZDV 300 mg tablet
3TC/DOR/TDF (Delstrigo):
  • 3TC 300 mg plus DOR 100 mg plus TDF 300 mg tablet
3TC/ABC (Epzicom):d
  • 3TC 300 mg plus ABC 600 mg tablet
3TC/EFV/TDF (Symfi):
  • 3TC 300 mg plus EFV 600 mg plus TDF 300 mg tablet
3TC/EFV/TDF (Symfi Lo):
  • 3TC 300 mg plus EFV 400 mg plus TDF 300 mg tablet
3TC/TDF (Temixys)
  • 3TC 300 mg plus TDF 300 mg tablet
3TC/ABC/DTG (Triumeq):
  • 3TC 300 mg plus ABC 600 mg plus DTG 50 mg tablet
3TC/ABC/ZDV (Trizivir):d
  • 3TC 150 mg plus ABC 300 mg plus ZDV 300 mg plus tablet
Standard Adult Dose
3TC (Epivir):
  • 3TC 150 mg twice daily or 300 mg once daily, without regard to food
3TC/TDF (Cimduo):
  • 1 tablet twice daily without regard to food
3TC/ZDV (Combivir):
  • 1 tablet twice daily without regard to food
3TC/DOR/TDF (Delstrigo):
  • 1 tablet twice daily without regard to food
3TC/ABC (Epzicom):
  • 1 tablet once daily without regard to food
3TC/EFV/TDF (Symfi or Symfi Lo):
  • 1 tablet once daily on an empty stomach and preferably at bedtime
3TC/ABC/DTG (Triumeq):
  • 1 tablet once daily without regard to food
3TC/TDF (Temixys):
  • 1 tablet once daily without regard to food
3TC/ABC/ZDV (Trizivir):
  • 1 tablet twice daily without regard to food

PK in Pregnancy:
  • PK not significantly altered in pregnancy.

Dosing in Pregnancy:
  • No change in dose indicated.

For guidance about use of combination products in pregnancy, please see the specific sections on other components (i.e., ABC, DOR, DTG, EFV, TDF, ZDV)

High placental transfer to fetus.b

No evidence of human teratogenicity (can rule out 1.5-fold increase in overall birth defects).

If patient has HIV/HBV coinfection, it is possible that an HBV flare may occur if the drug is stopped; see ; see HIV/Hepatitis B Virus Coinfection.

Note: 3TC products developed specifically for treatment of HBV (e.g., Epivir-HBV) contain a lower dose of 3TC that is not appropriate for treatment of HIV.

a Individual ARV drug dosages may need to be adjusted in patients with renal or hepatic insufficiency (for details, see the Adult and Adolescent Guidelines Appendix B, Table 8).
b Placental transfer categories—Mean or median cord blood/maternal delivery plasma drug ratio:
          High: >0.6
          Moderate: 0.3–0.6
          Low: <0.3
d Generic formulation available

  Key to Acronyms: 3TC = lamivudine; ABC = abacavir; DOR = doravirine; DTG = dolutegravir; EFV = efavirenz; HBV = hepatitis B virus; PK = pharmacokinetic; TDF = tenofovir disoproxil fumarate; ZDV = zidovudine

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