An older antiviral for chronic hepatitis B
Telbivudine
An older antiviral medicine for long-term hepatitis B, now seldom used because newer medicines work better.
What is Telbivudine?
Telbivudine is an older antiviral medicine used to treat long-term (chronic) hepatitis B, an infection of the liver. It works by stopping the virus from copying itself, which lowers the amount of virus and helps protect the liver. It is taken as a tablet by mouth. Two important problems are muscle problems (a condition called myopathy) and damage to the nerves in the hands and feet (peripheral neuropathy), and rarely a serious build-up of acid in the blood (lactic acidosis). The virus also tends to become resistant to it over time, so it is now rarely used.
Education and reference only. This is a plain-language guide to Telbivudine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Telbivudine is an antiviral medicine for chronic hepatitis B, a long-term infection that can gradually damage the liver. It belongs to a group of medicines that block the virus's ability to make copies of itself. It is taken by mouth as a tablet, usually over a long period under specialist care. It is an older treatment that has largely been replaced by newer antivirals that are more effective and less likely to lead to resistance, so it is now seldom started in the UK.
How it works
Hepatitis B multiplies inside liver cells using an enzyme that copies its genetic material. Telbivudine blocks this enzyme, so the virus makes far fewer copies and the amount of virus in the blood falls. Lowering the viral load reduces the ongoing inflammation and damage to the liver. However, because the medicine attacks the virus at a single point, the virus can change over time so that the medicine no longer works (resistance), which is one of the main reasons it has fallen out of favour.
Company & origin
Originated / developed by: Specialist manufacturer.
An older medicine used for long-term (chronic) hepatitis B infection, now rarely used in the UK as better antivirals are available.
Practical use
How to take Telbivudine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it by mouth as prescribed, at about the same time each day, with or without food.
- Do not stop it suddenly or without specialist advice, as hepatitis B can flare up badly when treatment is stopped.
- Report any unexplained, persistent muscle pain, tenderness or weakness to your team straight away.
- Tell your team about numbness, tingling or pain in the hands or feet, which can be a sign of nerve problems.
- Keep your blood test and review appointments, as resistance can develop and needs to be watched for.
Weighing it up
Advantages & disadvantages of Telbivudine
Advantages
- Can lower the amount of hepatitis B virus and help protect the liver.
- Taken as a simple tablet by mouth.
- A long-established medicine with known effects, used under specialist care.
Disadvantages
- Can cause muscle problems (myopathy) and nerve damage in the hands and feet (peripheral neuropathy).
- Rarely can cause a serious build-up of acid in the blood (lactic acidosis) and liver problems.
- The virus tends to become resistant over time, so it is now rarely used in favour of newer antivirals.
Practical use
Good to know
The most important things to know about telbivudine are its specific side effects. It can affect the muscles, causing aches, weakness or, more seriously, muscle breakdown (myopathy), so any unexplained, persistent muscle pain or weakness should be reported promptly. It can also damage the nerves in the hands and feet (peripheral neuropathy), causing numbness, tingling or pain, especially if combined with certain other medicines. Like several medicines of its kind, it can rarely cause a dangerous build-up of acid in the blood (lactic acidosis) and liver problems. Resistance develops fairly easily, so blood tests are used to check the virus is still being controlled, and treatment should not be stopped suddenly, as hepatitis B can flare badly afterwards. It is now rarely chosen, with newer antivirals preferred.
Who should not take it / use with caution
- People who have had a serious allergic reaction to telbivudine should not take it.
- It is used with great care, or avoided, alongside other medicines that can damage the nerves, such as certain HIV medicines.
- It should only be used under specialist liver or infection care, with monitoring.
Monitoring
- Regular blood tests to check the hepatitis B viral load and watch for resistance.
- Checking muscle-related blood tests and asking about muscle pain or weakness.
- Watching for nerve symptoms in the hands and feet and reviewing liver function.
Side effects
- Muscle aches, weakness or, more seriously, muscle breakdown (myopathy).
- Numbness, tingling or pain in the hands and feet (peripheral neuropathy).
- Tiredness, headache or stomach upset.
- Rarely but seriously, a dangerous build-up of acid in the blood (lactic acidosis) or worsening liver problems, which need urgent attention.
Key interactions
- Combining it with other medicines that can harm the nerves, such as some HIV treatments, raises the risk of neuropathy.
- Other medicines or conditions affecting the muscles may add to the risk of muscle problems.
- Always give your team a full list of your medicines so risks can be checked.
Available as: Tablets taken by mouth (an oral solution has also been available).
Answers
Telbivudine: frequently asked questions
What is telbivudine used for?
It is an older antiviral used to treat long-term (chronic) hepatitis B, lowering the amount of virus to help protect the liver, though it is now rarely used.
Why is it not used much any more?
Newer antivirals control hepatitis B more effectively and are less likely to lead to resistance, so telbivudine has largely been replaced.
What muscle and nerve problems can it cause?
It can cause muscle problems (myopathy), with pain or weakness, and damage to the nerves in the hands and feet (peripheral neuropathy); report these symptoms promptly.
Can I stop it if I feel well?
No. Stopping hepatitis B treatment suddenly can cause a serious flare-up, so only change it on specialist advice.
What is lactic acidosis?
It is a rare but serious build-up of acid in the blood that can occur with medicines of this kind; symptoms such as deep tiredness, breathlessness or stomach pain need urgent medical attention.
The wider class
About Antiviral (hepatitis B)
Telbivudine belongs to the antiviral (hepatitis b) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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