FDA label a2acaaef-d577-e770-e053-2995a90a713a

WARNING: LACTIC ACIDOSIS AND SEVERE HEPATOMEGALY, EXACERBATIONS OF HEPATITIS B, and DIFFERENT FORMULATIONS OF LAMIVUDINE. Lactic Acidosis and Severe Hepatomegaly with Steatosis Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogues and other antiretrovirals. Discontinue lamivudine tablets if clinical or laboratory findings suggestive of lactic acidosis or pronounced hepatotoxicity occur [see Warnings and Precautions (5.1) ] . Exacerbations of Hepatitis B Severe acute exacerbations of hepatitis B have been reported in patients who are co-infected with hepatitis B virus (HBV) and human immunodeficiency virus (HIV-1) and have discontinued lamivudine. Hepatic function should be monitored closely with both clinical and laboratory follow-up for at least several months in patients who discontinue lamivudine and are co-infected with HIV-1 and HBV. If appropriate, initiation of anti-hepatitis B therapy may be warranted [see Warnings and Precautions (5.2) ]. Important Differences Among Lamivudine-Containing Products Lamivudine tablets and oral solution (used to treat HIV-1 infection) contain a higher dose of the active ingredient (lamivudine) than EPIVIR-HBV ® tablets and oral solution (used to treat chronic HBV infection). Patients with HIV-1 infection should receive only dosage forms appropriate for treatment of HIV-1 [see Warnings and Precautions (5.2) ]. WARNING: LACTIC ACIDOSIS AND SEVERE HEPATOMEGALY, EXACERBATIONS OF HEPATITIS B, and DIFFERENT FORMULATIONS OF LAMIVUDINE See full prescribing information for complete boxed warning Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogues. ( 5.1 ) Severe acute exacerbations of hepatitis B have been reported in patients who are co-infected with hepatitis B virus (HBV) and human immunodeficiency virus (HIV-1) and have discontinued lamivudine. Monitor hepatic function closely in these patients and, if appropriate, initiate anti-hepatitis B treatment. ( 5.2 ) Patients with HIV-1 infection should receive only dosage forms of lamivudine appropriate for treatment of HIV-1. ( 5.2 )

5 WARNINGS AND PRECAUTIONS Co-infected HIV-1/HBV Patients: Emergence of lamivudine-resistant HBV variants associated with lamivudine-containing antiretroviral regimens has been reported. ( 5.2 ) Hepatic decompensation, some fatal, has occurred in HIV-1/HCV co-infected patients receiving interferon and ribavirin-based regimens. Monitor for treatment-associated toxicities. Discontinue lamivudine as medically appropriate and consider dose reduction or discontinuation of interferon alfa, ribavirin, or both. ( 5.3 ) Pancreatitis: Use with caution in pediatric patients with a history of pancreatitis or other significant risk factors for pancreatitis. Discontinue treatment as clinically appropriate. ( 5.4 ) Immune reconstitution syndrome and redistribution/accumulation of body fat have been reported in patients treated with combination antiretroviral therapy. ( 5.5 , 5.7 ) 5.1 Lactic Acidosis and Severe Hepatomegaly with Steatosis Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogues and other antiretrovirals. A majority of these cases have been in women. Obesity and prolonged nucleoside exposure may be risk factors. Caution should be exercised when administering lamivudine to any patient with known risk factors for liver disease; however, cases also have been reported in patients with no known risk factors. Treatment with lamivudine should be suspended in any patient who develops clinical or laboratory findings suggestive of lactic acidosis or pronounced hepatotoxicity (which may include hepatomegaly and steatosis even in the absence of marked transaminase elevations). 5.2 Patients with Hepatitis B Virus Co-infection Posttreatment Exacerbations of Hepatitis Clinical and laboratory evidence of exacerbations of hepatitis have occurred after discontinuation of lamivudine. These exacerbations have been detected primarily by serum ALT elevations in addition to re-emergence of HBV DNA. Although most events appear to have been self-limited, fatalities have been reported in some cases. Similar events have been reported from postmarketing experience after changes from lamivudine-containing HIV-1 treatment regimens to non-lamivudine-containing regimens in patients infected with both HIV-1 and HBV. The causal relationship to discontinuation of lamivudine treatment is unknown. Patients should be closely monitored with both clinical and laboratory follow-up for at least several months after stopping treatment. Important Differences Among Lamivudine-Containing Products Lamivudine tablets and oral solution contain a higher dose of the same active ingredient (lamivudine) than EPIVIR-HBV tablets and EPIVIR-HBV oral solution. EPIVIR-HBV was developed for patients with chronic hepatitis B. The formulation and dosage of lamivudine in EPIVIR-HBV are not appropriate for patients co-infected with HIV-1 and HBV. Safety and efficacy of lamivudine have not been established for treatment of chronic hepatitis B in patients co-infected with HIV-1 and HBV. If treatment with EPIVIR-HBV is prescribed for chronic hepatitis B for a patient with unrecognized or untreated HIV-1 infection, rapid emergence of HIV-1 resistance is likely to result because of the subtherapeutic dose and the inappropriateness of monotherapy HIV-1 treatment. If a decision is made to administer lamivudine to patients co-infected with HIV-1 and HBV, lamivudine tablets, lamivudine oral solution, or another product containing the higher dose of lamivudine should be used as part of an appropriate combination regimen. Emergence of Lamivudine-Resistant HBV Safety and efficacy of lamivudine have not been established for treatment of chronic hepatitis B in subjects dually infected with HIV-1 and HBV (see full prescribing information for EPIVIR-HBV). Emergence of hepatitis B virus variants associated with resistance to lamivudine has also been reported in HIV-1-infected subjects who have received lamivudine-containing antiretroviral regimens in the presence of concurrent infection with hepatitis B virus. 5.3 Use with Interferon- and Ribavirin-Based Regimens In vitro studies have shown ribavirin can reduce the phosphorylation of pyrimidine nucleoside analogues such as lamivudine. Although no evidence of a pharmacokinetic or pharmacodynamic interaction (e.g., loss of HIV-1/HCV virologic suppression) was seen when ribavirin was coadministered with lamivudine in HIV-1/HCV co-infected patients [see Clinical Pharmacology (12.3) ] , hepatic decompensation (some fatal) has occurred in HIV-1/HCV co-infected patients receiving combination antiretroviral therapy for HIV-1 and interferon alfa with or without ribavirin. Patients receiving interferon alfa with or without ribavirin and lamivudine should be closely monitored for treatment-associated toxicities, especially hepatic decompensation. Discontinuation of lamivudine should be considered as medically appropriate. Dose reduction or discontinuation of interferon alfa, ribavirin, or both should also be considered if worsening clinical toxicities are observed, including hepatic decompensation (e.g., Child-Pugh greater than 6). See the full prescribing information for interferon and ribavirin. 5.4 Pancreatitis In pediatric patients with a history of prior antiretroviral nucleoside exposure, a history of pancreatitis, or other significant risk factors for the development of pancreatitis, lamivudine should be used with caution. Treatment with lamivudine should be stopped immediately if clinical signs, symptoms, or laboratory abnormalities suggestive of pancreatitis occur [see Adverse Reactions (6.1) ]. 5.5 Immune Reconstitution Syndrome Immune reconstitution syndrome has been reported in patients treated with combination antiretroviral therapy, including lamivudine. During the initial phase of combination antiretroviral treatment, patients whose immune systems respond may develop an inflammatory response to indolent or residual opportunistic infections (such as Mycobacterium avium infection, cytomegalovirus, Pneumocystis jirovecii pneumonia [PCP], or tuberculosis), which may necessitate further evaluation and treatment. Autoimmune disorders (such as Graves’ disease, polymyositis, and Guillain-Barré syndrome) have also been reported to occur in the setting of immune reconstitution, however, the time to onset is more variable, and can occur many months after initiation of treatment. 5.6 Lower Virologic Suppression Rates and Increased Risk of Viral Resistance with Oral Solution Lamivudine scored tablet is the preferred formulation for HIV-1-infected pediatric patients who weigh at least 14 kg and for whom a solid dosage form is appropriate. 5.7 Fat Redistribution Redistribution/accumulation of body fat including central obesity, dorsocervical fat enlargement (buffalo hump), peripheral wasting, facial wasting, breast enlargement, and “cushingoid appearance” have been observed in patients receiving antiretroviral therapy. The mechanism and long-term consequences of these events are currently unknown. A causal relationship has not been established.

6 ADVERSE REACTIONS The following adverse reactions are discussed in other sections of the labeling: Lactic acidosis and severe hepatomegaly with steatosis [see Boxed Warning , Warnings and Precautions (5.1) ]. Exacerbations of hepatitis B [see Boxed Warning , Warnings and Precautions (5.2) ]. Hepatic decompensation in patients co-infected with HIV-1 and hepatitis C [see Warnings and Precautions (5.3) ]. Pancreatitis [see Warnings and Precautions (5.4) ]. Immune reconstitution syndrome [see Warnings and Precautions (5.5) ] . Fat redistribution [see Warnings and Precautions (5.7) ] . The most common reported adverse reactions (incidence greater than or equal to 15%) in adults were headache, nausea, malaise and fatigue, nasal signs and symptoms, diarrhea, and cough. ( 6.1 ) The most common reported adverse reactions (incidence greater than or equal to 15%) in pediatric subjects were fever and cough. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Mylan Pharmaceuticals Inc. at 1-877-446-3679 (1-877-4-INFO-RX) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Clinical Trials Experience in Adult Subjects Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. The safety profile of lamivudine in adults is primarily based on 3,568 HIV-1-infected subjects in 7 clinical trials. The most common adverse reactions are headache, nausea, malaise, fatigue, nasal signs and symptoms, diarrhea, and cough. Selected clinical adverse reactions in greater than or equal to 5% of subjects during therapy with lamivudine 150 mg twice daily plus RETROVIR ® 200 mg 3 times daily for up to 24 weeks are listed in Table 3. Table 3. Selected Clinical Adverse Reactions (Greater than or Equal to 5% Frequency) in Four Controlled Clinical Trials (NUCA3001, NUCA3002, NUCB3001, NUCB3002) Adverse Reaction Lamivudine 150 mg Twice Daily plus RETROVIR (n = 251) RETROVIR Either zidovudine monotherapy or zidovudine in combination with zalcitabine. (n = 230) Body as a Whole Headache 35% 27% Malaise & fatigue 27% 23% Fever or chills 10% 12% Digestive Nausea 33% 29% Diarrhea 18% 22% Nausea & vomiting 13% 12% Anorexia and/or decreased appetite 10% 7% Abdominal pain 9% 11% Abdominal cramps 6% 3% Dyspepsia 5% 5% Nervous System Neuropathy 12% 10% Insomnia & other sleep disorders 11% 7% Dizziness 10% 4% Depressive disorders 9% 4% Respiratory Nasal signs & symptoms 20% 11% Cough 18% 13% Skin Skin rashes 9% 6% Musculoskeletal Musculoskeletal pain 12% 10% Myalgia 8% 6% Arthralgia 5% 5% Pancreatitis Pancreatitis was observed in 9 out of 2,613 adult subjects (0.3%) who received lamivudine in controlled clinical trials EPV20001, NUCA3001, NUCB3001, NUCA3002, NUCB3002, and NUCB3007 [see Warnings and Precautions (5.4) ]. Lamivudine 300 mg Once Daily The types and frequencies of clinical adverse reactions reported in subjects receiving lamivudine 300 mg once daily or lamivudine 150 mg twice daily (in 3-drug combination regimens in EPV20001 and EPV40001) for 48 weeks were similar. Selected laboratory abnormalities observed during therapy are summarized in Table 4. Table 4. Frequencies of Selected Grade 3 to 4 Laboratory Abnormalities in Adults in Four 24-Week Surrogate Endpoint Trials (NUCA3001, NUCA3002, NUCB3001, NUCB3002) and a Clinical Endpoint Trial (NUCB3007) ULN = Upper limit of normal. ND = Not done. Test (Threshold Level) 24-Week Surrogate Endpoint Trials The median duration on study was 12 months. Clinical Endpoint Trial Lamivudine plus RETROVIR RETROVIR Either zidovudine monotherapy or zidovudine in combination with zalcitabine. Lamivudine plus Current Therapy Placebo plus Current Therapy Current therapy was either zidovudine, zidovudine plus didanosine, or zidovudine plus zalcitabine. Absolute neutrophil count (< 750/mm 3 ) 7.2% 5.4% 15% 13% Hemoglobin (< 8.0 g/dL) 2.9% 1.8% 2.2% 3.4% Platelets (< 50,000/mm 3 ) 0.4% 1.3% 2.8% 3.8% ALT (> 5.0 x ULN) 3.7% 3.6% 3.8% 1.9% AST (> 5.0 x ULN) 1.7% 1.8% 4.0% 2.1% Bilirubin (> 2.5 x ULN) 0.8% 0.4% ND ND Amylase (> 2.0 x ULN) 4.2% 1.5% 2.2% 1.1% The frequencies of selected laboratory abnormalities reported in subjects receiving lamivudine 300 mg once daily or lamivudine 150 mg twice daily (in 3-drug combination regimens in EPV20001 and EPV40001) were similar. Clinical Trials Experience in Pediatric Subjects Lamivudine oral solution has been studied in 638 pediatric subjects aged 3 months to 18 years in 3 clinical trials. Selected clinical adverse reactions and physical findings with a greater than or equal to 5% frequency during therapy with lamivudine 4 mg per kg twice daily plus RETROVIR 160 mg per m 2 3 times daily in therapy-naive (less than or equal to 56 days of antiretroviral therapy) pediatric subjects are listed in Table 5. Table 5. Selected Clinical Adverse Reactions and Physical Findings (Greater than or Equal to 5% Frequency) in Pediatric Subjects in Trial ACTG300 Adverse Reaction Lamivudine plus RETROVIR (n = 236) Didanosine (n = 235) Body as a Whole Fever 25% 32% Digestive Hepatomegaly 11% 11% Nausea & vomiting 8% 7% Diarrhea 8% 6% Stomatitis 6% 12% Splenomegaly 5% 8% Respiratory Cough 15% 18% Abnormal breath sounds/wheezing 7% 9% Ear, Nose, and Throat Signs or symptoms of ears Includes pain, discharge, erythema, or swelling of an ear. 7% 6% Nasal discharge or congestion 8% 11% Other Skin rashes 12% 14% Lymphadenopathy 9% 11% Pancreatitis Pancreatitis, which has been fatal in some cases, has been observed in antiretroviral nucleoside-experienced pediatric subjects receiving lamivudine alone or in combination with other antiretroviral agents. In an open-label dose-escalation trial (NUCA2002), 14 subjects (14%) developed pancreatitis while receiving monotherapy with lamivudine. Three of these subjects died of complications of pancreatitis. In a second open-label trial (NUCA2005), 12 subjects (18%) developed pancreatitis. In Trial ACTG300, pancreatitis was not observed in 236 subjects randomized to lamivudine plus RETROVIR. Pancreatitis was observed in 1 subject in this trial who received open-label lamivudine in combination with RETROVIR and ritonavir following discontinuation of didanosine monotherapy [see Warnings and Precautions (5.4) ]. Paresthesias and Peripheral Neuropathies Paresthesias and peripheral neuropathies were reported in 15 subjects (15%) in Trial NUCA2002, 6 subjects (9%) in Trial NUCA2005, and 2 subjects (less than 1%) in Trial ACTG300. Selected laboratory abnormalities experienced by therapy-naive (less than or equal to 56 days of antiretroviral therapy) pediatric subjects are listed in Table 6. Table 6. Frequencies of Selected Grade 3 to 4 Laboratory Abnormalities in Pediatric Subjects in Trial ACTG300 ULN = Upper limit of normal. Test (Threshold Level) Lamivudine plus RETROVIR Didanosine Absolute neutrophil count (< 400/mm 3 ) 8% 3% Hemoglobin (< 7.0 g/dL) 4% 2% Platelets (< 50,000/mm 3 ) 1% 3% ALT (> 10 x ULN) 1% 3% AST (> 10 x ULN) 2% 4% Lipase (> 2.5 x ULN) 3% 3% Total Amylase (> 2.5 x ULN) 3% 3% Additional pediatric use information for patients aged 3 months and above is approved for ViiV Healthcare Company’s EPIVIR ® (lamivudine) tablets and oral solution. However, due to ViiV Healthcare Company’s marketing exclusivity rights, this drug product is not labeled with that pediatric information. Neonates Limited short-term safety information is available from 2 small, uncontrolled trials in South Africa in neonates receiving lamivudine with or without zidovudine for the first week of life following maternal treatment starting at Week 38 or 36 of gestation [see Clinical Pharmacology (12.3) ] . Selected adverse reactions reported in these neonates included increased liver function tests, anemia, diarrhea, electrolyte disturbances, hypoglycemia, jaundice and hepatomegaly, rash, respiratory infections, and sepsis; 3 neonates died (1 from gastroenteritis with acidosis and convulsions, 1 from traumatic injury, and 1 from unknown causes). Two other nonfatal gastroenteritis or diarrhea cases were reported, including 1 with convulsions; 1 infant had transient renal insufficiency associated with dehydration. The absence of control groups limits assessments of causality, but it should be assumed that perinatally exposed infants may be at risk for adverse reactions comparable to those reported in pediatric and adult HIV-1-infected patients treated with lamivudine-containing combination regimens. Long-term effects of in utero and infant lamivudine exposure are not known. 6.2 Postmarketing Experience The following adverse reactions have been identified during post-approval use of lamivudine. Because these reactions are reported voluntarily from a population of unknown size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These reactions have been chosen for inclusion due to a combination of their seriousness, frequency of reporting, or potential causal connection to lamivudine. Body as a Whole: Redistribution/accumulation of body fat [see Warnings and Precautions (5.7) ]. Endocrine and Metabolic: Hyperglycemia. General: Weakness. Hemic and Lymphatic: Anemia (including pure red cell aplasia and severe anemias progressing on therapy). Hepatic and Pancreatic: Lactic acidosis and hepatic steatosis [see Warnings and Precautions (5.1) ] , posttreatment exacerbations of hepatitis B [see Warnings and Precautions (5.2) ]. Hypersensitivity: Anaphylaxis, urticaria. Musculoskeletal: Muscle weakness, CPK elevation, rhabdomyolysis. Skin: Alopecia, pruritus.

<table width="100%"> <caption>Table 3. Selected Clinical Adverse Reactions (Greater than or Equal to 5% Frequency) in Four Controlled Clinical Trials (NUCA3001, NUCA3002, NUCB3001, NUCB3002)</caption> <col width="46%"/> <col width="27%"/> <col width="28%"/> <tbody> <tr> <td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="bottom"> <paragraph> <content styleCode="bold">Adverse Reaction</content> </paragraph> </td> <td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="bottom"> <paragraph> <content styleCode="bold">Lamivudine 150 mg Twice Daily plus RETROVIR (n = 251) </content> </paragraph> </td> <td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="bottom"> <paragraph> <content styleCode="bold">RETROVIR</content> <footnote ID="_Ref420048371">Either zidovudine monotherapy or zidovudine in combination with zalcitabine.</footnote> <content styleCode="bold"> (n = 230) </content> </paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> <content styleCode="bold">Body as a Whole</content> </paragraph> </td> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Headache</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>35%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>27%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Malaise &amp; fatigue</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>27%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>23%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Fever or chills</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>10%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>12%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> <content styleCode="bold">Digestive</content> </paragraph> </td> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Nausea</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>33%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>29%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Diarrhea</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>18%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>22%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Nausea &amp; vomiting</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>13%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>12%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Anorexia and/or decreased appetite</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>10%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>7%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Abdominal pain</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>9%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>11%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Abdominal cramps</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>6%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>3%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Dyspepsia</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>5%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>5%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> <content styleCode="bold">Nervous System</content> </paragraph> </td> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Neuropathy</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>12%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>10%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Insomnia &amp; other sleep disorders</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>11%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>7%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Dizziness</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>10%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>4%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Depressive disorders</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>9%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>4%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> <content styleCode="bold">Respiratory</content> </paragraph> </td> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Nasal signs &amp; symptoms</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>20%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>11%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Cough</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>18%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>13%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> <content styleCode="bold">Skin</content> </paragraph> </td> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Skin rashes</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>9%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>6%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> <content styleCode="bold">Musculoskeletal</content> </paragraph> </td> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Musculoskeletal pain</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>12%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>10%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph> Myalgia</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>8%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>6%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Botrule Lrule Toprule " valign="top"> <paragraph> Arthralgia</paragraph> </td> <td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="bottom"> <paragraph>5%</paragraph> </td> <td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="bottom"> <paragraph>5%</paragraph> </td> </tr> </tbody> </table>

<table width="100%"> <caption>Table 4. Frequencies of Selected Grade 3 to 4 Laboratory Abnormalities in Adults in Four 24-Week Surrogate Endpoint Trials (NUCA3001, NUCA3002, NUCB3001, NUCB3002) and a Clinical Endpoint Trial (NUCB3007)</caption> <col width="26%"/> <col width="26%"/> <col width="16%"/> <col width="16%"/> <col width="16%"/> <tfoot> <tr> <td align="left" colspan="5" styleCode="Botrule" valign="top">ULN = Upper limit of normal. ND = Not done. </td> </tr> </tfoot> <tbody> <tr> <td align="center" rowspan="2" styleCode="Rrule Botrule Lrule Toprule " valign="bottom"> <paragraph> <content styleCode="bold">Test (Threshold Level) </content> </paragraph> </td> <td align="center" colspan="2" styleCode="Rrule Botrule Toprule " valign="bottom"> <paragraph> <content styleCode="bold">24-Week Surrogate Endpoint Trials </content> <footnote ID="_Ref462140483">The median duration on study was 12 months.</footnote> </paragraph> </td> <td align="center" colspan="2" styleCode="Rrule Botrule Toprule " valign="bottom"> <paragraph> <content styleCode="bold">Clinical Endpoint Trial </content> <footnoteRef IDREF="_Ref462140483"/> </paragraph> </td> </tr> <tr> <td align="center" styleCode="Rrule Lrule Botrule " valign="bottom"> <paragraph> <content styleCode="bold">Lamivudine plus RETROVIR </content> </paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="bottom"> <paragraph> <content styleCode="bold">RETROVIR</content> <footnote ID="_Ref462140491">Either zidovudine monotherapy or zidovudine in combination with zalcitabine.</footnote> </paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="bottom"> <paragraph> <content styleCode="bold">Lamivudine plus Current Therapy </content> </paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="bottom"> <paragraph> <content styleCode="bold">Placebo plus Current Therapy </content> <footnote ID="_Ref462140506">Current therapy was either zidovudine, zidovudine plus didanosine, or zidovudine plus zalcitabine.</footnote> </paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph>Absolute neutrophil count (&lt; 750/mm ³) </paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>7.2%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>5.4%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>15%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>13%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph>Hemoglobin (&lt; 8.0 g/dL) </paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>2.9%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>1.8%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>2.2%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>3.4%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph>Platelets (&lt; 50,000/mm ³) </paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>0.4%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>1.3%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>2.8%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>3.8%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph>ALT (&gt; 5.0 x ULN) </paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>3.7%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>3.6%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>3.8%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>1.9%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph>AST (&gt; 5.0 x ULN) </paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>1.7%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>1.8%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>4.0%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>2.1%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Botrule " valign="top"> <paragraph>Bilirubin (&gt; 2.5 x ULN) </paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>0.8%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>0.4%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>ND</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>ND</paragraph> </td> </tr> <tr> <td styleCode="Rrule Botrule Lrule " valign="top"> <paragraph>Amylase (&gt; 2.0 x ULN)</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>4.2%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>1.5%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>2.2%</paragraph> </td> <td align="center" styleCode="Rrule Botrule " valign="top"> <paragraph>1.1%</paragraph> </td> </tr> </tbody> </table>

<table width="100%"> <caption>Table 5. Selected Clinical Adverse Reactions and Physical Findings (Greater than or Equal to 5% Frequency) in Pediatric Subjects in Trial ACTG300</caption> <col width="41%"/> <col width="29%"/> <col width="29%"/> <tbody> <tr> <td styleCode="Rrule Botrule Lrule Toprule " valign="top"> <paragraph> <content styleCode="bold">Adverse Reaction</content> </paragraph> </td> <td align="center" styleCode="Rrule Botrule Toprule " valign="bottom"> <paragraph> <content styleCode="bold">Lamivudine plus RETROVIR (n = 236) </content> </paragraph> </td> <td align="center" styleCode="Rrule Botrule Toprule " valign="bottom"> <paragraph> <content styleCode="bold">Didanosine (n = 235) </content> </paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> <content styleCode="bold">Body as a Whole</content> </paragraph> </td> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> Fever</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>25%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>32%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> <content styleCode="bold">Digestive</content> </paragraph> </td> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> Hepatomegaly</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>11%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>11%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> Nausea &amp; vomiting</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>8%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>7%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> Diarrhea</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>8%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>6%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> Stomatitis</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>6%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>12%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> Splenomegaly</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>5%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>8%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> <content styleCode="bold">Respiratory</content> </paragraph> </td> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> Cough</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>15%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>18%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> Abnormal breath sounds/wheezing</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>7%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>9%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> <content styleCode="bold">Ear, Nose, and Throat</content> </paragraph> </td> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> Signs or symptoms of ears <footnote ID="_Ref462140516">Includes pain, discharge, erythema, or swelling of an ear.</footnote> </paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>7%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>6%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> Nasal discharge or congestion</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>8%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>11%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> <content styleCode="bold">Other</content> </paragraph> </td> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> <td styleCode="Rrule Lrule Toprule Botrule " valign="bottom"/> </tr> <tr> <td styleCode="Rrule Lrule Toprule Botrule " valign="top"> <paragraph> Skin rashes</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>12%</paragraph> </td> <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="bottom"> <paragraph>14%</paragraph> </td> </tr> <tr> <td styleCode="Rrule Botrule Lrule Toprule " valign="top"> <paragraph> Lymphadenopathy</paragraph> </td> <td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top"> <paragraph>9%</paragraph> </td> <td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top"> <paragraph>11%</paragraph> </td> </tr> </tbody> </table>