多替阿巴拉米片需注意什么事项？

It is a drug for the treatment of AIDS. Dolutegravir tablets are currently the only three-in-one compound drug containing dolutegravir (DTG). It has the characteristics of good tolerance, high resistance barrier, and few drug interactions. One tablet per day can significantly reduce the medication burden of AIDS patients, thereby improving patients' medication compliance and significantly improving their quality of life. In 2018, GSK announced the launch of integrase DTG (Tervica) in China. The dolutea palamid tablet treatment has the advantages of small drug dosage, low resistance to drug resistance, and low probability of drug side effects. Today let’s learn about what should be paid attention to with Dote Abalamid Tablets?

1. Liver disease: The safety and effectiveness of this product have not been established in patients with pre-existing severe liver disease. For patients with moderate to severe hepatic impairment, the use of doptabalamid tablets is not recommended. Patients with pre-existing hepatic dysfunction, including those with chronic active hepatitis, develop hepatic dysfunction with increased frequency during combined antiretroviral therapy and should be monitored according to standard protocols. If in these patients there is evidence of worsening liver disease, withholding or discontinuing treatment should be considered.

2. Patients with chronic hepatitis B or hepatitis C: Patients with chronic hepatitis B or hepatitis C who receive combination therapy with antiretroviral drugs are at increased risk of severe and potentially fatal liver adverse reactions. If you are also taking antiviral treatment for hepatitis B or hepatitis C, please refer to the relevant product information for these medicines. This product contains lamivudine, which is effective against hepatitis B. Abacavir and dolutegravir lack such effects. It is generally believed that lamivudine monotherapy is not an adequate treatment for hepatitis B because of the high risk of developing hepatitis B virus resistance. Therefore, if this product is used to treat patients co-infected with hepatitis B, another antiviral drug is generally required. Treatment guidelines should be consulted. If patients co-infected with hepatitis B virus discontinue this product, regular monitoring of liver function and HBV replication markers is recommended, as discontinuation of lamivudine may lead to an acute exacerbation of hepatitis. 

3. Immune reconstitution inflammatory syndrome: In patients with severe immunodeficiency infected with HIV, when starting combination antiretroviral therapy (CART), an inflammatory response to asymptomatic or residual opportunistic pathogens may occur, leading to severe clinical conditions or worsening of symptoms. Such reactions are usually observed in the weeks or months before starting CART therapy. Relevant examples include cytomegalovirus retinitis, systemic and/or focal mycobacterial infections, and Pneumocystis jiroveci pneumonia. Symptoms of inflammation should be evaluated and treated if necessary. Autoimmune disorders (e.g., Graves' disease) have also been reported during immune reconstitution; however, the reported timing of onset is inconsistent and these events may occur many months after initiation of therapy. In patients with co-infection with hepatitis B or hepatitis C virus, elevated liver chemistries consistent with immune reconstitution inflammatory syndrome have been observed upon initiation of dolutegravir therapy. In patients with hepatitis B and/or hepatitis C virus infection, monitoring of liver chemistry test values ​​is recommended. 

4. Mitochondrial dysfunction after in utero exposure: Nucleosides and nucleoside analogs may have varying degrees of effects on mitochondrial function, with the most significant effects when used in combination with stavudine, didanosine and zidovudine. Mitochondrial dysfunction has been reported in HIV-negative infants exposed to nucleoside analogues in utero and/or postnatally, primarily in association with zidovudine-containing treatment regimens. The main adverse reactions reported were hematological disorders (anemia, neutropenia) and metabolic disorders (hyperlactemia, hyperlipidemia). These reactions are often short-lived. Some late-onset neurological disorders (hypertonia, convulsions, behavioral abnormalities) are rarely reported. It is unclear whether the neurological condition is temporary or permanent. These results should be considered in children exposed to nucleosides and nucleoside analogues in utero who have severe clinical symptoms of unknown etiology, especially neurological symptoms. These results do not affect current national guidelines for the use of antiretrovirals in pregnant women to prevent vertical transmission of HIV. 

5. Myocardial infarction: Observational studies have demonstrated an association between myocardial infarction and the use of abacavir. The patients participating in the study were mainly those who had received antiretroviral therapy. Clinical trial data show a limited number of myocardial infarctions and a small increase in risk cannot be ruled out. Overall, there are some inconsistencies between observational cohort data and randomized trial data, so a causal relationship between abacavir treatment and the risk of myocardial infarction cannot be confirmed or denied. To date, there is no precise biological mechanism to explain the possible increased risk. When using this product, steps should be taken to minimize all modifiable risk factors (such as smoking, hypertension, and hyperlipidemia). 

The above is the content of the precautions, I hope it can help you!