Home Drug Guide Entecavir

Drug Guide

Generic Name

Entecavir

Brand Names Baraclude

Classification

Therapeutic: Antiviral agent, nucleoside analog, anti-hepatitis B virus

Pharmacological: Nucleoside analogue reverse transcriptase inhibitor

FDA Approved Indications

  • Chronic hepatitis B virus infection

Mechanism of Action

Entecavir is a guanine nucleoside analogue that inhibits hepatitis B virus (HBV) DNA polymerase, leading to effective suppression of viral replication.

Dosage and Administration

Adult: 0.5 mg once daily on an empty stomach; can increase to 1 mg once daily for treatment-experienced patients with resistance or high viral load.

Pediatric: Not approved for children under 16 years old.

Geriatric: No specific dosage adjustment necessary; monitor renal function.

Renal Impairment: Dose adjustment required based on renal function, eGFR <50 mL/min: 0.5 mg every 48-72 hours.

Hepatic Impairment: No specific adjustment needed, but caution advised.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Extensively distributed in tissues.

Metabolism: Minimal hepatic metabolism.

Excretion: Primarily renal excretion.

Half Life: approximately 128-149 hours in plasma.

Contraindications

  • Hypersensitivity to entecavir.

Precautions

  • Renal impairment, lactic acidosis, risk of hepatic flares upon discontinuation, monitoring for resistance.

Adverse Reactions - Common

  • Headache (Often)
  • Nausea (Often)
  • Fatigue (Often)

Adverse Reactions - Serious

  • Lactic acidosis (Rare)
  • Hepatic decompensation (Rare)

Drug-Drug Interactions

  • Cobicistat, raltegravir (possible decrease in effectiveness)

Drug-Food Interactions

  • No significant interactions noted.

Drug-Herb Interactions

  • Limited data; consult current guidelines.

Nursing Implications

Assessment: Monitor hepatic function, renal function, and viral load periodically.

Diagnoses:

  • Risk for hepatic flare after discontinuation.
  • Impaired liver function related to HBV.

Implementation: Administer on an empty stomach, monitor labs regularly, educate patient about adherence and potential side effects.

Evaluation: Effectiveness assessed by reduction in HBV DNA levels, normalization of liver function tests.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report signs of lactic acidosis (e.g., muscle pain, weakness, unusual tiredness).
  • Maintain regular follow-up appointments.

Special Considerations

Black Box Warnings:

  • Risk of lactic acidosis and severe hepatomegaly with steatosis.
  • Potential for resistance development; adherence is crucial.

Genetic Factors: No specific pharmacogenetic considerations identified.

Lab Test Interference: May cause transient elevations in liver enzymes.

Overdose Management

Signs/Symptoms: Nausea, vomiting, increased hepatic enzymes, lactic acidosis.

Treatment: Supportive care, hemodialysis in severe cases, no specific antidote.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable in original container up to expiration date on package.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.