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Adjustment of adult dose of nucleos(t)ide analogues for treatment of chronic hepatitis B in accordance with creatinine clearance

Adjustment of adult dose of nucleos(t)ide analogues for treatment of chronic hepatitis B in accordance with creatinine clearance
Creatinine clearance (mL/min)* Recommended oral dose
Entecavir (nucleoside)
NA treatment naïve
≥50 0.5 mg daily
30 to 49 0.25 mg daily or 0.5 mg every 48 hours
10 to 29 0.15 mg daily or 0.5 mg every 72 hours
<10 or hemodialysisΔ or continuous ambulatory peritoneal dialysis 0.05 mg daily or 0.5 mg every 7 days
Lamivudine refractory/resistant
≥50 1 mg daily
30 to 49 0.5 mg daily or 1 mg every 48 hours
10 to 29 0.3 mg daily or 1 mg every 72 hours
<10 or hemodialysisΔ or continuous ambulatory peritoneal dialysis 0.1 mg daily or 1 mg every 7 days
Tenofovir disoproxil fumarate (TDF, nucleotide)
≥50 300 mg daily
30 to 49 300 mg every 48 hours
10 to 29 300 mg every 72 to 96 hours
<10 with hemodialysisΔ 300 mg once a week or after a total of approximately 12 hours of dialysis
<10 without hemodialysis Insufficient data; no recommendation
Continuous ambulatory peritoneal dialysis Insufficient data; no recommendation
Tenofovir alafenamide (TAF, nucleotide)
≥15 25 mg daily
<15 with hemodialysis 25 mg on hemodialysis days; dose after dialysis
<15 without hemodialysis Insufficient data; no recommendation
Lamivudine (3TC, nucleoside)
≥50 100 mg daily
30 to 49 100 mg first dose, then 50 mg daily
15 to 29 100 mg first dose, then 25 mg daily
5 to 14 35 mg first dose, then 15 mg daily
<5 or hemodialysisΔ or continuous ambulatory peritoneal dialysis 35 mg first dose, then 10 mg daily
Adefovir dipivoxil (nucleotide)
≥50 10 mg daily
30 to 49 10 mg every 48 hours
10 to 29 10 mg every 72 hours
<10 (not receiving hemodialysis) Insufficient data; no recommendation
Hemodialysis 10 mg every seven days following dialysis
Continuous ambulatory peritoneal dialysis Insufficient data; no recommendation
Telbivudine (LdT, nucleoside)§
≥50 600 mg daily
30 to 49 600 hours mg every 48 hours
10 to 29 (not receiving hemodialysis) 600 mg every 72 hours
Hemodialysis 600 mg every 96 hours following dialysisΔ
Continuous ambulatory peritoneal dialysis Insufficient data; no recommendation
Doses are for patients without HIV coinfection.

NA: nucleoside or nucleotide analogue.

* Can be estimated by using the Cockroft-Gault equation. Separate calculators for creatinine clearance using conventional and SI units are available in UpToDate.

¶ For doses <0.5 mg, entecavir oral solution is recommended.

Δ Administer after intermittent hemodialysis.

◊ Data establishing the safety, efficacy, and optimal dosing in end-stage kidney disease (with or without dialysis) are not available.

§ Discontinued in the United States; may be available in other countries.
Data from:
  1. Terrault NA, Bzowej NH, Chang KM, et al. AASLD guidelines for treatment of chronic hepatitis B. Hepatology 2016; 63:261.
  2. UpToDate Lexidrug. More information available at https://online.lexi.com/.
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