adefovir

adefovir

Hepsera

Indications

Action

Pharmacokinetics

Time/action profile (blood levels)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• headache

Respiratory

• cough
• pharyngitis
• sinusitis

Gastrointestinal

• dyspepsia
• hepatomegaly with steatosis (life-threatening)
• abdominal pain
• diarrhea
• flatulence
• ↑ liver enzymes
• nausea
• vomiting

Genitourinary

• hematuria
• nephrotoxicity

Dermatologic

• pruritus
• rash

Fluid and Electrolyte

• lactic acidosis (life-threatening)

Musculoskeletal

• weakness

Miscellaneous

• fever
• HIV resistance

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• May cause lactic acidosis and severe hepatomegaly with steatosis. Monitor patient for signs (increased serum lactate levels, elevated liver enzymes, liver enlargement on palpation). Therapy should be discontinued if clinical or laboratory signs occur.
• Lab Test Considerations: Monitor viral load and CD4 cell count regularly during therapy in patients with HIV infection.Monitor liver function tests and hepatitis B virus levels throughout and following therapy. If therapy is discontinued, may cause severe exacerbation of hepatitis B.
  • Calculate creatinine clearance to determine dose prior to starting therapy.
  • Monitor renal function closely. May cause nephrotoxicity.

Potential Nursing Diagnoses

Implementation

• Oral: Administer once daily with or without food.

Patient/Family Teaching

• Instruct patient to take adefovir as directed and not to discontinue medication without consulting health care professional. Take missed dose as soon as it is remembered that day. Do not take more than 1 dose in a day. Consult health care professional if unsure of what to do. Discontinuation may result in exacerbation of hepatitis, usually within 12 wks of stopping. Regular liver function tests and hepatitis B virus levels are required if adefovir is discontinued. Advise the patient that adefovir does not cure hepatitis B, but may lower amount of hepatitis B in the body and decrease the ability of the virus to multiply and infect new liver cells. Instruct patient to read the Patient Information sheet prior to starting therapy.
• Inform patient that an HIV test should be taken before starting adefovir and anytime when there is a chance patient was exposed to HIV.
• Inform patient that adefovir does not reduce the risk of transmission of hepatitis B to others through sexual contact or blood contamination. Caution patient to use a condom and to avoid sharing needles, toothbrushes or razor blades, or donating blood to prevent spreading the hepatitis B virus to others.
• Instruct patient to notify health care professional immediately if signs of lactic acidosis (weakness or tiredness, unusual muscle pain, dyspnea, stomach pain with nausea and vomiting, feelings of coldness especially in arms or legs, dizziness, lightheadedness, fast or irregular heartbeat) occur.
• Caution patient to notify health care professional if signs of hepatotoxicity (jaundice, dark urine, light colored bowel movement, anorexia, nausea, bruising, lower stomach pain) occur.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
• Advise female patient to avoid breastfeeding and to notify health care professional if pregnancy is planned or suspected.
• Emphasize the importance of regular blood tests to check hepatitis B virus levels, as well as renal and hepatic function.

Evaluation/Desired Outcomes

• Decrease in progression of chronic hepatitis B. Patients with serum HBV levels >1000 copies/mL at week 48 of treatment are at greater risk for developing resistance and modification of therapy should be considered.