Entecavir and tenofovir disoproxil have also been approved locally for use in severe acute hepatitis B as an off-label indication when there is coagulopathy, a protracted course, or signs of acute liver failure. They should be initiated by a specialist in secondary care in an inpatient or outpatient setting following consultation with King's Hepatology Centre. A liver MDT meeting is held every week between King's and EKHUFT liver specialists. The usual duration of treatment will be 6 months, but may need to be extended to 12 months in some cases. Prescribing will be the sole responsibility of the gastroenterology/hepatology team in secondary care for the duration of treatment.
Doses for severe acute hepatitis B would be:
- Entecavir 0.5mg daily (preferred choice in renal dysfunction - reduce dose)
OR
- Tenofovir disoproxil 245mg daily
CG165 Hepatitis B (chronic): diagnosis and management October 2017 
