natgillin/translations-raw huggingface dataset:
Plasma adefovir concentrations declined in a biexponential manner with a median terminal elimination half-life of 7.22 h (4.72-10.70 h).
Upadanje plazemske koncentracije adefovirja je bilo bieksponentno in mediani končni razpolovni čas izločanja 7,22 h (4,72-10,70 h).
Animal studies do not indicate harmful effects of adefovir dipivoxil on male and female fertility.
Študije na živalih ne kažejo škodljivih učinkov dipivoksiladefovirata na plodnost samcev in samic.
In HBeAg positive patients, the incidence of adefovir-associated resistance mutations was 3 % (2/65), 17 % (11/65) and 20 % (13/65) after a median duration exposure of 135, 189 and 235 weeks respectively.
Pri HBeAg pozitivnih bolnikih je bila incidenca mutacij za rezistenco, povezanih z adefovirjem, 3% (2/65) po medianem trajanju izpostavljenosti, 17% (11/65) po 189 tednih in 20% (13/65) po 235 tednih.
Your doctor should run tests to check your kidneys and liver are working properly, before and during your treatment.
Zdravnik mora pred zdravljenjem in med njim opraviti preiskave, s katerimi preveri, ali ledvice in jetra primerno delujejo.
What Hepsera is and what it is used for What you need to know before you take Hepsera How to take Hepsera
Kaj je zdravilo Hepsera in za kaj ga uporabljamo Kaj morate vedeti, preden boste vzeli zdravilo Hepsera Kako jemati zdravilo Hepsera Možni neželeni učinki
Table 1: Tabulated summary of adverse reactions associated with adefovir dipivoxil based on clinical study and post-marketing experience
Preglednica 1: Povzetek neželenih učinkov, povezanih s dipivoksiladefoviratom na podlagi izkušenj iz kliničnih študij in izkušenj v obdobju trženja zdravila
No studies on the effects on the ability to drive and use machines have been performed.
4.7 Vpliv na sposobnost vožnje in upravljanja s stroji Študij o vplivu na sposobnost vožnje in upravljanja s stroji niso izvedli.
Treatment with 10 mg adefovir dipivoxil showed similar efficacy regardless of the patterns of lamivudine-resistant HBV DNA polymerase mutations at baseline.
Zdravljenje z 10 mg dipivoksiladefovirata je pokazalo podobno učinkovitost ne glede na začetni vzorec polimeraznih mutacij HBV DNA rezistentnih na lamivudin.
When adefovir was administered intravenously to pregnant rats at doses associated with notable maternal toxicity (systemic exposure 38 times that achieved in humans at the therapeutic dose) embryotoxicity and an increased incidence of foetal malformations (anasarca, depressed eye bulge, umbilical hernia and kinked tail) were observed.
Ko je bil adefovir dan intravenozno brejim podganam v odmerkih povezanih z opazno maternalno toksičnostjo (sistemska izpostavljenost 38 krat večja kot je dosežena pri terapevtski dozi pri ljudeh) je bila opažena povečana incidenca malformacij ploda (anasarka, reduciranje izbočenosti očesa, umbilikalna kila in deformacija repka).
EU/1/03/251/001 30 tablets EU/1/03/251/002 90 (3 bottles of 30) tablets
EU/1/03/251/002 90 (3 plastenke po 30) tablet
• After stopping Hepsera tell your doctor immediately about any new, unusual or worsening symptoms that you notice after stopping treatment.
• Po prekinitvi jemanja zdravila Hepsera nemudoma povejte zdravniku, če po prenehanju zdravljenja opazite nove ali nenavadne simptome ali poslabšanje simptomov.
Co-infection with HIV: Limited data are available on the safety and efficacy of 10 mg adefovir dipivoxil in patients with chronic hepatitis B, co-infected with HIV.
Sočasna okužba s HIV: Na voljo je omejeno število podatkov o varnosti in učinkovitosti 10 mg dipivoksiladefovirata pri bolnikih s kroničnim hepatitisom B, ki so sočasno okuženi s HIV.
• Inflammation of the pancreas (pancreatitis)
• vnetje trebušne slinavke (pankreatitis)
In that case, the limited data available suggest that for patients with creatinine clearance between 10 and 29 ml/min, adefovir dipivoxil (one 10 mg tablet) may be administered every 72 hours; for haemodialysis patients, adefovir dipivoxil (one 10 mg tablet) may be administered every 7 days following 12 hours continuous dialysis (or 3 dialysis sessions, each of 4 hours duration).
V tem primeru omejeni podatki, ki so na voljo, kažejo, da se lahko pri bolnikih z očistkom kreatinina od 10 do 29 ml/min, dipivoksiladefovirat (ena 10-miligramska tableta) uporabi vsakih 72 ur; pri bolnikih na hemodializi se lahko dipivoksiladefovirat (ena 10-miligramska tableta) uporabi vsakih 7 dni po 12-urni neprekinjeni dializi (ali po treh dializah po 4 ure).
In the adolescent population (n=83) (aged from 12 to < 18 years), significantly more patients treated with adefovir dipivoxil achieved the primary efficacy endpoint and obtained significant reductions in serum HBV DNA (23 %) compared to placebo-treated patients (0 %).
V populaciji mladostnikov (n=83) (starih od 12 do < 18 let) je pomembno več bolnikov, ki so prejemali dipivoksiladefovirat, doseglo primarni cilj učinkovitosti in pomembno zmanjšanje serumske HBV DNA (23%) v primerjavi z bolniki, ki so prejemali placebo (0%).
In long-term carcinogenicity studies in rats and mice with adefovir dipivoxil, no treatment-related increase in tumour incidence was found in mice or rats (systemic exposures approximately 10 and 4 times those achieved in humans at the therapeutic dose of 10 mg/day, respectively).
V dolgoročnih karcinogenetskih raziskavah dipivoksiladefovirata na podganah in miših niso odkrili z zdravljenjem povezanega povečanja incidence tumorjev (sistemska izpostavljenost je bila pri miših približno 10 krat oziroma pri podganah 4 krat večja od dosežene izpostavljenosti pri človeku s terapevtskimi odmerki 10 mg na dan).
If treatment with adefovir dipivoxil is considered essential, then the dosing interval should be adjusted (see section 4.2).
Če zdravnik oceni, da je zdravljenje z dipivoksiladefoviratom nujno, je treba interval med odmerki prilagoditi (glejte poglavje 4.2).
In clinical studies of wait-listed and post-liver transplantation patients, four percent (19/467) of patients discontinued treatment with adefovir dipivoxil due to renal adverse events.
V kliničnih študijah z bolniki na čakalni listi in bolnikih po transplantaciji jeter je 4% (19/467) bolnikov prekinilo zdravljenje z dipivoksiladefoviratom zaradi neželenih učinkov na ledvicah.
Due to the high pharmacokinetic variability of pegylated interferon, no definitive conclusion can be drawn regarding the effect of adefovir and pegylated interferon co-administration on the pharmacokinetic profile of either medicinal product.
Zaradi visoke farmakokinetske variabilnosti pegiliranega interferona ni mogoče dokončno sklepati glede učinka sočasne uporabe adefovirja in pegiliranega interferona na njune farmakokinetične lastnosti.
Method of administration Hepsera tablets should be taken once daily, orally with or without food.
Tablete Hepsera je treba jemati enkrat na dan, peroralno, s hrano ali brez nje.
• amphotericin B, for fungal infections
• amfotericin B proti glivičnim okužbam;
Very few patients developed adefovirassociated mutations up to 5 years; however, the number of patients who remained on drugs above week 96 was limited.
Pri zelo malo bolnikih so se do 5. leta razvile mutacije, povezane z adefovirjem (n=2), vendar je bilo število bolnikov, ki so se po 96. tednu še naprej zdravili z zdravilom, malo (n=26).
Taking into account the PRAC Assessment Report on the PSUR(s) for adefovir, the scientific conclusions of the CHMP are as follows:
Upoštevajoč poročilo Odbora za oceno tveganja na področju farmakovigilance (PRAC) o oceni rednih posodobljenih poročil o varnosti zdravila (PSUR) za adefovir je Odbor za zdravila za uporabo v humani medicini (CHMP) sprejel naslednje znanstvene zaključke:
ANNEX IV SCIENTIFIC CONCLUSIONS AND GROUNDS FOR THE VARIATION TO THE TERMS OF THE MARKETING AUTHORISATION(S)
ZNANSTVENI ZAKLJUČKI IN PODLAGA ZA SPREMEMBO POGOJEV DOVOLJENJA (DOVOLJENJ) ZA PROMET Z ZDRAVILOM
Therefore, use of adefovir dipivoxil is not recommended in these patients and should only be considered if the potential benefits outweigh the potential risks.
Uporaba dipivoksiladefovirata pri teh bolnikih zato ni priporočena, možnost uporabe se lahko pretehta samo, če morebitne koristi odtehtajo morebitna tveganja.
After repeated administration of 10 mg adefovir dipivoxil, 45 % of the dose is recovered as adefovir in the urine over 24 hours.
Po večkratnem vnosu 10 mg dipivoksiladefovirata se lahko 45% odmerka zazna v seču kot adefovir v obdobju 24 ur.
In addition, renal function should be closely monitored with a frequency tailored to the individual patient's medical condition.
Poleg tega je treba ledvično funkcijo skrbno nadzorovati in prilagoditi pogostnost nadzora zdravstvenemu stanju posameznega bolnika.
Hepsera 10 mg tablets are supplied in bottles of 30 tablets with silica gel desiccant.
Tablete Hepsera 10 mg so na voljo v plastenkah po 30 tablet s sušilno sredstvo iz silikagela.
What Hepsera looks like and contents of the pack
Izgled zdravila Hepsera in vsebina pakiranja
The currently available data both in vitro and in patients suggest that HBV expressing the adefovirassociated resistance mutation rtN236T is susceptible to lamivudine.
Podatki, ki so trenutno na voljo tako in vitro kot pri bolnikih, kažejo, da je HBV z mutacijo rtN236T, povezano z rezistenco proti adefovirju, občutljiv za lamivudin.
The effect of peritoneal dialysis on adefovir removal has not been evaluated.
Vpliv peritonealne dialize na izločanje adefovirja ni bil ovrednoten.
Nevertheless, given that tacrolimus and cyclosporin can affect renal function, close monitoring is recommended when either of these agents is coadministered with adefovir dipivoxil (see section 4.4).
Ker lahko takrolimus in ciklosporin vplivata na ledvično funkcijo, je kljub temu priporočljiv skrben nadzor, če se katero od teh zdravil jemlje sočasno z dipivoksiladefoviratom (glejte poglavje 4.4).
In the majority of these studies adefovir dipivoxil 10 mg was added to ongoing lamivudine treatment in patients failing lamivudine therapy.
V večini teh raziskav je bilo 10 mg dipivoksiladefovirata dodano k tekočemu zdravljenju z lamivudinom, bolnikom, pri katerih je bilo zdravljenje z lamivudinom neuspešno.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
6.6 Posebni varnostni ukrepi za odstranjevanje Neuporabljeno zdravilo ali odpadni material zavrzite v skladu z lokalnimi predpisi.
There are no safety and efficacy data to support the use of adefovir dipivoxil in patients with a creatinine clearance < 30 ml/min or on dialysis.
Podatkov o varnosti in učinkovitosti, ki podpirajo uporabo dipivoksiladefovirata pri bolnikih z očistkom kreatinina < 30 ml/min ali bolnikih na dializi, ni.
• The recommended dose is one 10 mg tablet each day, taken with or without food.
Priporočeni odmerek je ena 10-miligramska tableta na dan, s hrano ali brez nje.
The cumulative probabilities of developing these adefovir-associated resistance mutations in all patients treated with adefovir dipivoxil were 0 % at 48 weeks and approximately 2 %, 7 %, 14 % and 25 % after 96, 144, 192 and 240 weeks, respectively.
Kumulativne verjetnosti razvoja teh mutacij za rezistenco povezanih z adefovirjem so bile pri vseh bolnikih zdravljenih z dipivoksiladefoviratom 0% v 48. tednu in približno 2% po 96 tednih, 7% po 144 tednih, 14% po 192 tednih in 25% po 240 tednih.
At week 48, all placebo-treated subjects who did not exhibit HBeAg or HBsAg seroconversion, plus all adefovir dipivoxil-treated subjects, were offered the opportunity to receive open-label adefovir dipivoxil from study week 49 through to week 240.
V 48. tednu so vsem bolnikom, ki so prejemali placebo in pri katerih ni prišlo do HBeAg ali HBsAg serokonverzije, plus vsem bolnikom, ki so bili zdravljeni z dipivoksiladefoviratom, ponudili možnost prejemanja dipivoksiladefovirata v odprti študiji od 49. tedna do vključno 240. tedna študije.
HBV that contains the rtA181T mutation, consideration should be given to alternative treatment regimens due to the risk of reduced susceptibility to adefovir (see section 5.1).
Vendar je treba pomisliti na alternativni režim zdravljenja bolnikov, ki so nosilci HBV z mutacijo rtA181T zaradi tveganja za zmanjšano občutljivost za adefovir (glejte poglavje 5.1).
• two placebo-controlled studies in which 522 patients with chronic hepatitis B and compensated liver disease received double-blind treatment with 10 mg adefovir dipivoxil (n=294) or placebo (n=228) for 48 weeks.
• dveh placebo kontroliranih študijah, v katerih je 522 bolnikov s kroničnim hepatitisom B in kompenzirano boleznijo jeter 48 tednov prejemalo dvojno slepo zdravljenje z 10 mg dipivoksiladefovirata (n=294) ali placebo (n=228).
Hepsera contains lactose
Zdravilo Hepsera vsebuje laktozo
The renal function of these patients should be closely monitored with a frequency tailored to the individual patient's medical condition.
Ledvično funkcijo se mora pri teh bolnikih skrbno nadzorovati in prilagoditi pogostnost nadzora zdravstvenemu stanju posameznega bolnika.
Two novel conserved site mutations were identified in the HBV polymerase gene (rtN236T and rtA181V), which conferred clinical resistance to adefovir dipivoxil.
Na genu HBV-polimeraze, na konzervativnem mestu, sta bili identificirani dve novi mutaciji (rtN236T in rtA181V), ki sta povzročili klinično odpornost proti dipivoksiladefoviratu.
Hepsera belongs to a group of medicines called antiviral medicines.
Kaj je zdravilo Hepsera Zdravilo Hepsera spada v skupino zdravil, imenovanih protivirusna zdravila.
Lactic acidosis and severe hepatomegaly with steatosis: Occurrences of lactic acidosis (in the absence of hypoxaemia), sometimes fatal, usually associated with severe hepatomegaly and hepatic steatosis, have been reported with the use of nucleoside analogues.
Laktacidoza in resna oblika hepatomegalije z steatozo: Ob uporabi analogov nukleozidov so poročali o pojavu laktacidoze (brez hipoksemije), ki je bila včasih smrtna in običajno združena z resno hepatomegalijo in jetrno steatozo.
In most patients who stopped treatment with adefovir dipivoxil, serum HBV DNA and ALT levels returned towards baseline.
Pri večini bolnikov, ki so prenehali z zdravljenjem z dipivoksiladefoviratom, so se serumske vrednosti HBV DNA in ALT vrnile proti začetni vrednosti.
General: Patients should be advised that therapy with adefovir dipivoxil has not been proven to reduce the risk of transmission of hepatitis B virus to others and therefore appropriate precautions should still be taken.
Splošno: Bolniki morajo biti obveščeni, da ni dokazov, da bi zdravljenje z dipivoksiladefoviratom zmanjšalo tveganje za prenos virusa hepatitisa B na druge.
Concomitant administration of 10 mg adefovir dipivoxil and 100 mg lamivudine did not alter the pharmacokinetic profile of either medicinal product.
Sočasno jemanje 10 mg dipivoksiladefovirata in 100 mg lamivudina ni spremenilo njunih farmakokinetičnih lastnosti.
(may affect up to 1 in 10,000 people)
(pojavijo se lahko pri največ 1 od 10.000 bolnikov)
In patients with decompensated liver disease or cirrhosis, treatment cessation is not recommended (see section 4.4).
Pri bolnikih z dekompenziranim obolenjem jeter ali cirozo prenehanje zdravljenja ni priporočljivo (glejte poglavje 4.4).
Adefovir may be used in combination with lamivudine in lamivudine-refractory patients and in patients harbouring HBV with mutations at rtL180M and/or rtM204I/V.
Adefovir se lahko uporablja v kombinaciji z lamivudinom pri bolnikih, ki se ne odzivajo na zdravljenje z lamivudinom in pri bolnikih, ki so nosilci HBV z mutacijami na rtL180M in/ali rtM204I/V.
Assessment of the change in fibrosis after 48 weeks treatment using the Knodell scores confirms that patients treated with adefovir dipivoxil 10 mg had more regression and less progression of fibrosis than patients treated with placebo.
Ocena sprememb fibroze po 48 tednih zdravljenja glede na Knodellovo lestvico potrjuje, da je fibroza pri bolnikih zdravljenih z 10 mg dipivoksiladefovirata bolj nazadovala in manj napredovala kot pri bolnikih zdravljenih s placebom.
Biotransformation: Following oral administration, adefovir dipivoxil is rapidly converted to adefovir.
Biotransformacija: Po peroralnem vnosu se dipivoksiladefovirat hitro pretvori v adefovir.
During therapy, serum HBV DNA levels were significantly lower compared to baseline for up to 48 weeks of treatment while ALT levels declined progressively from week 12.
Med zdravljenjem so bile vrednosti serumske HBV DNA do 48 tednov zdravljenja pomembno nižje od izhodiščnih vrednosti, vrednosti ALT pa so se progresivno nižale od 12. tedna naprej.
Proximal renal tubulopathy (including Fanconi syndrome) General disorders and administration site conditions: Very common:
proksimalna ledvična tubulopatija (vključno s Fanconijevim sindromom) Splošne težave in spremembe na mestu aplikacije: Zelo pogosto:
Adefovir dipivoxil was mutagenic in the in vitro mouse lymphoma cell assay (with or without metabolic activation), but was not clastogenic in the in vivo mouse micronucleus assay.
Dipivoksiladefovirat je bil mutagen v in vitro poskusu na celicah mišjega limfoma (z ali brez presnovne aktivacije), vendar ni bil klastogen v in vivo poskusu na mišjem mikronukleusu.
Most post-treatment exacerbations of hepatitis were seen within 12 weeks of discontinuation of 10 mg adefovir dipivoxil.
Večina poslabšanj hepatitisa, ki so nastopila po zdravljenju, so se pojavila v prvih 12 tednih po prekinitvi zdravljenja z 10 mg dipivoksiladefovirata.
However, on-treatment HBV DNA response was not maintained off-therapy since all the patients had a rebound in HBV DNA after adefovir dipivoxil and pegylated interferon alpha-2a discontinuation.
Vendar pa se odziv HBV DNA dosežen med zdravljenjem ni vzdrževal po prekinitvi zdravljenja, saj se je pri vseh bolnikih po prekinitvi dipivoksiladefovirata in pegiliranega interferona alfa-2a pojavil povratni odziv
Due to the small sample size and the study design, in particular the lack of treatment arms with pegylated interferon alpha-2a monotherapy and with adefovir monotherapy, it is not possible to draw formal conclusions on the best therapeutic management of HIV co-infected patients with lamivudine-resistant HBV.
Zaradi majhnega vzorca in načrtovanja študije, predvsem zaradi pomanjkanja krakov zdravljenja, ki bi prejemali monoterapijo s pergiliranim interferonom alfa-2a in monoterapijo z adefovirjem, ni mogoče formalno sklepati o najboljši terapevtski obravnavi bolnikov s HBV odpornim na lamivudin, sočasno okuženih s
Patients with creatinine clearance < 30 ml/min and dialysis patients:
Bolniki z očistkom kreatinina < 30 ml/min in bolniki na dializi:
Pregelatinised starch Croscarmellose sodium Lactose monohydrate Talc
Premreženi natrijev karmelozat Laktoza monohidrat Smukec
In the two studies mentioned above, treatment with 10 mg adefovir dipivoxil was associated with significant reductions in serum HBV DNA (3.52 and 3.91 log10 copies/ml, respectively, versus 0.55 and 1.35 log10 copies/ml), increased proportion of patients with normalisation of ALT (48 and 72 % versus 16 and 29 %) or increased proportion of patients with serum HBV DNA below the limits of quantification (< 400 copies/ml Roche Amplicor Monitor PCR assay) (21 and 51 % versus 0 %) when compared with placebo.
V obeh zgoraj omenjenih študijah je bilo zdravljenje z 10 mg dipivoksiladefovirata v primerjavi s placebom združeno s pomembnim zmanjšanjem serumske HBV DNA (3,52 in 3,91 log10 kopij/ml v primerjavi z 0,55 in 1,35 log10 kopij/ml), z večjim deležem bolnikov z normalizacijo vrednosti ALT (48 in 72% v primerjavi s 16 in 29%) in s povečanim deležem bolnikov s serumsko HBV DNA pod mejo količinske zaznave (< 400 kopij/ml po analizi Roche Amplicor Monitor PCR) (21 in 51% v primerjavi z 0%).
Adefovir is active against hepadnaviruses in vitro, including all common forms of lamivudine-resistant HBV (rtL180M, rtM204I, rtM204V, rtL180M/rtM204V), famciclovir-associated mutations (rtV173L, rtP177L, rtL180M, rtT184S or rtV207I) and hepatitis B immunoglobulin escape mutations (rtT128N and rtW153Q), and in in vivo animal models of hepadnavirus replication.
Adefovir in vitro deluje proti hepadnavirusom, vključujoč vse običajne oblike na lamivudin odpornih HBV (rtL180M, rtM204I, rtM204V, rtL180M/rtM204V), HBV z mutacijami povezanimi s famciklovirom (rtV173L, rtP177L, rtL180M, rtT184S ali rtV207I) in HBV z hepatitis B
Caution should be exercised when prescribing adefovir dipivoxil to the elderly, keeping in mind the greater frequency of decreased renal or cardiac function in these patients, and the increase in concomitant diseases or concomitant use of other medicinal products in the elderly.
Pri predpisovanju dipivoksiladefovirata starejšim je potrebna previdnost, saj je treba upoštevati, da je pri teh bolnikih bolj pogosto slabše delovanje ledvic in srca, da imajo več obolenj sočasno oziroma sočasno jemljejo več zdravil.
However, mild to moderate increases in serum creatinine concentrations, hypophosphatemia and a decrease in carnitine concentrations were reported in 3 %, 4 % and 6 % of patients, respectively, on extended treatment.
Vendar pa so poročali o blagih do zmernih zvišanjih koncentracij serumskega kreatinina pri 3% bolnikov, o hipofosfatemiji pri 4% bolnikov in o znižanju koncentracij karnitina pri 6% bolnikov pri podaljšanem zdravljenju.
• Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
• Preobčutljivost na zdravilno učinkovino ali katero koli pomožno snov, navedeno v poglavju 6.1. 4.4 Posebna opozorila in previdnostni ukrepi
In the HBeAg negative study patients on adefovir dipivoxil (0-48 weeks) were re-randomised in a blinded-manner to continue on adefovir dipivoxil or receive placebo for an additional 48 weeks.
V študiji s HBeAg negativnimi bolniki, ki so jemali dipivoksiladefovirat (0-48 tednov), so bolnike naključno slepo prerazporedili tako, da so nadaljnjih 48 tednov še naprej jemali dipivoksiladefovirat ali pa prejemali placebo.
Long-term treatment with adefovir dipivoxil may increase the risk of renal impairment.
Dolgotrajno zdravljenje z dipivoksiladefoviratom lahko poveča tveganje za motnje v delovanju ledvic.
In patients who develop renal insufficiency and have advanced liver disease or cirrhosis, dosing interval adjustment of adefovir or switch to an alternative therapy for hepatitis B infection should be considered.
Pri bolnikih, ki razvijejo ledvično insuficienco in imajo napredovalo bolezen jeter ali cirozo, je treba razmisliti o prilagajanju intervalov med odmerki adefovirja ali menjavi k alternativni terapiji za hepatitis B. Prenehanje zdravljenja kroničnega hepatitisa B pri teh bolnikih ni priporočljivo.
Following oral administration of a single dose of 10 mg adefovir dipivoxil to chronic hepatitis B patients, the median (range) peak serum concentration (Cmax) was achieved after 1.75 h (0.58-4.0 h).
Po peroralno vzetem enkratnem odmerku 10 mg dipivoksiladefovirata bolnikov s kroničnim hepatitisom B je bila mediana (območje) vrednost najvišje serumske koncentracije (Cmax) dosežena po 1,75 h (0,58-4,0 h).
Clinical resistance: Lamivudine-refractory patients and patients harbouring HBV with evidence of resistance to lamivudine (mutations at rtL180M, rtA181T and/or rtM204I/V) should not be treated with adefovir dipivoxil monotherapy in order to reduce the risk of resistance to adefovir.
Klinična odpornost: Bolnikov, ki se ne odzivajo na zdravljenje z lamivudinom in bolnikov, ki so nosilci HBV z dokazano odpornostjo na lamivudin (mutacija na rtL180M, rtA181T in/ali rtM204I/V), se ne sme zdraviti z monoterapijo dipivoksiladefovirata, zato da bi zmanjšali tveganje za odpornost na adefovir.
Hepatic impairment: No dose adjustment is required in patients with hepatic impairment (see section 5.2).
Motnje v delovanju jeter: Za bolnike z motnjami v delovanju jeter prilagajanje odmerkov ni potrebno (glejte poglavje 5.2).
In these patients, including patients with decompensated liver disease, treatment cessation is not recommended and these patients should be monitored closely during therapy.
Pri teh bolnikih, vključno z bolniki z dekompenzirano boleznijo jeter, prenehanje zdravljenja ni priporočljivo.