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 24, 2019; Last Reviewed: December 24, 2019

Excerpt from Table 8

Note: When using FDCs, refer to other sections in Appendix B and Table 8 for information about the dosing and safety of individual drug components of the FDC during pregnancy.

Excerpt from Table 8
Generic Name
(Abbreviation)
Trade Name
Formulation Dosing Recommendationsa Use in Pregnancy
Lamivudine
(3TC)
Epivir

(3TC/TDF)
Cimduo

(3TC/ZDV)
Combivir

(3TC/DOR/TDF)
Delstrigo

(3TC/DTG)
Dovato

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

Pregnancy
PKs in Pregnancy:
  • PKs 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 HBV/HIV coinfection, it is possible that an HBV flare may occur if the drug is stopped; see Hepatitis B Virus/HIV Coinfection.

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 Antiretroviral Guidelines Appendix B, Table 10).
b Placental transfer categories are determined by 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: 3TC = lamivudine; ABC = abacavir; ARV= antiretroviral; DOR = doravirine; DTG = dolutegravir; EFV = efavirenz; FDC= fixed-dose combination; HBV = hepatitis B virus; PK = pharmacokinetic; TDF = tenofovir disoproxil fumarate; ZDV = zidovudine

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