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 hemodialysis^Δ 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 hemodialysis^Δ 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 hemodialysis^Δ	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 hemodialysis^Δ 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 dialysis^Δ
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:

Terrault NA, Bzowej NH, Chang KM, et al. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016 Jan; 63:261.

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