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Nucleoside reverse transcriptase inhibitors (NRTIs) are medicines that slow the ability of the hepatitis B virus (HBV) to multiply in the body. They are taken as pills once a day for at least a year, and usually much longer. Entecavir is also available as a liquid that you swallow.
Adefovir, entecavir, telbivudine, and tenofovir are approved by the U.S. Food and Drug Administration (FDA) for use in adults. Lamivudine is approved for use by adults and by children ages 2 to 17.
NRTIs are used to treat long-term (chronic) HBV infection in adults and children who are at risk for liver disease. The American Association for the Study of Liver Disease has made recommendations on who should receive treatment for chronic hepatitis B based on the presence of hepatitis B antigens in your blood, the level of hepatitis B virus DNA (HBV DNA) in your blood, and the levels of your liver enzymes.1
Treatment for HBV infection is considered successful if blood tests show that the virus is no longer multiplying in the body, if liver enzyme levels return to normal, and if liver damage (such as inflammation and scarring) improves. NRTIs work in most of the people who take them, but relapse (the virus starts to multiply again) is common after a medicine is stopped, so you may have to take the medicine for a long time.1, 2
Adefovir is effective against HBV infections that have become resistant to lamivudine, but adefovir costs more than lamivudine.1 A study showed that treatment with adefovir worked better for some people with chronic hepatitis B if the medicine was taken for 144 weeks than if it was taken for only 48 weeks.6
Tenofovir is effective at reducing the amount of hepatitis B virus in the body.7
NRTIs rarely have side effects. If you have any side effects, they may include:
Adefovir and tenofovir may harm your kidneys if you are at risk for or have a kidney problem.
In rare cases, NRTIs have led to severe liver problems or to a buildup of acid in the blood (lactic acidosis). Call your doctor if you develop any symptoms of these problems such as:
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
- Lok ASF, McMahon BJ (2007). Chronic hepatitis B. Hepatology, 45(2): 507–539.
- Hadziyannis SJ, et al. (2003). Adefovir dipivoxil for the treatment of hepatitis B e antigen-negative chronic hepatitis B. New England Journal of Medicine, 348(9): 800–807.
- Chang T-T, et al. (2006). A comparison of entecavir and lamivudine for HBeAg-positive chronic hepatitis B. New England Journal of Medicine, 354(10): 1001–1010.
- Lai C-L, et al. (2006). Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B. New England Journal of Medicine, 354(10): 1011–1020.
- Leung N, et al. (2009). Early hepatitis B virus DNA reduction in hepatitis B e antigen-positive patients with chronic hepatitis B: A randomized international study of entecavir versus adefovir. Hepatology, 49(1): 72–79.
- Hadziyannis, SJ, et al. (2005). Long-term therapy with adefovir dipivoxil for HBeAg-negative chronic hepatitis B. New England Journal of Medicine, 352(26): 2673–2681.
- Reynaud L, et al. (2009). Tenofovir and its potential in the treatment of hepatitis B virus. Therapeutics and Clinical Risk Management, 5(1): 177–185.
- Hann H-W, et al. (2008). Tenofovir (TDF) has stronger antiviral effect than adefovir (ADV) against lamivudine (LAM)-resistant hepatitis B virus (HBV). Hepatology International, 2(2): 244–249.
- Lai C-L, et al. (2007). Telbivudine versus lamivudine in patients with chronic hepatitis B. New England Journal of Medicine, 357(25): 2576–2588.
- Chan HLY, et al. (2005). A randomized, controlled trial of combination therapy for chronic hepatitis B: Comparing pegylated interferon alfa-2b and lamivudine with lamivudine alone. Annals of Internal Medicine, 142(4): 240–250.
- Janssen, H (2005). Pegylated interferon alfa-2b alone or in combination with lamivudine for HBeAg-positive chronic hepatitis B: A randomised trial. Lancet, 365(9454): 123–129.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Primary Medical Reviewer||Kathleen Romito, MD - Family Medicine|
|Specialist Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Steven L. Flamm, MD, MD - Gastroenterology|
|Last Revised||November 11, 2010|
Last Revised: November 11, 2010
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