Telbivudine is a novel nucleoside drug recently approved for the treatment of patients with chronic hepatitis B. Its nonclinical safety was evaluated in a comprehensive program of studies, including safety pharmacology, acute and chronic toxicity, reproductive and developmental toxicity, genotoxicity, and carcinogenicity. There were no test article-related effects observed in an in vitro hERG assay or in a core battery of safety pharmacology studies (central nervous system, respiratory, and cardiovascular safety pharmacology studies). Telbivudine was well tolerated in rats and in monkeys following single oral doses up to 2,000 mg/kg/day. Except for equivocal axonopathic findings in monkeys and occasional incidences of emesis, soft feces, and minor changes in body weight and food consumption, there was no target organ toxicity observed in mice, rats, or monkeys following oral administration for up to 3, 6, or 9 months, respectively, at doses up to 3,000 mg/kg/day. Axonopathy in the sciatic nerves and in the spinal cords of monkeys dosed at 1,000 mg/kg/day observed in a 9-month study was considered equivocal, as the role of telbivudine in the injury could not be determined. Slightly higher incidences of abortion and premature delivery observed in rabbits dosed at 1,000 mg/kg/day were considered secondary to maternal toxicity. There was no evidence of genotoxicity or carcinogenicity. These results suggest that telbivudine has a favorable safety profile and support its use in patients with chronic compensated hepatitis B viral infection.Telbivudine (-L-2Ј-deoxythymidine) is the unmodified -L enantiomer of the naturally occurring nucleoside thymidine (Fig. 1).Its molecular formula is C 10 H 14 N 2 O 5 with a formula weight of 242 g/mol.Nucleoside/nucleotide analogs have been proven to be effective for the treatment of hepatitis B virus (HBV) and human immunodeficiency virus. To date, four nucleoside/nucleotide analogs, lamivudine, adefovir dipivoxil, entecavir, and telbivudine, have been approved by the United States Food and Drug Administration for the treatment of HBV (16,27). These agents vary with respect to antiviral and clinical efficacy, resistance profiles, and tolerability and safety (17). A major safety concern for this class of drugs is mitochondrial toxicity, which is manifested as hepatic failure, nephrotoxicity, pancreatitis, neuropathy, myopathy, and lactic acidosis (1,2,3,5,6,8,15,18,19,22,24,29). Furthermore, emergence of drug-resistant viruses in patients undergoing long-term maintenance therapy with these drugs can result in diminished drug efficacies (9, 30).Telbivudine shows potent, selective, and specific antiviral activity against HBV and other hepadnaviruses (4, 14). Telbivudine is phosphorylated by intracellular thymidine kinases to the active triphosphate form, which has an intracellular halflife of 14 h (12, 25). Telbivudine 5Ј-triphosphate inhibits HBV DNA polymerase (reverse transcriptase) by competing with the natural substrate, dTTP. Incorporation of telbivudine 5Ј-triphosphate into v...