What is Kivexa (Abacavir/Lamivudine)?
Kivexa is a fixed-dose combination oral preparation of the nucleoside analogue reverse transcriptase inhibitors (NRTIs) abacavir and lamivudine. Kivexa is used in the treatment of HIV-1 in combination with other antiretroviral drugs. Cross resistance between abacavir or lamivudine and antiretrovirals from other classes (protease inhibitors (PI) or non-nucleoside reverse transcriptase inhibitors (NNRTIs)), is unlikely.
Kivexa medicaiton should be used with caution in patients who are co-infected with HIV and Hepatitis B virus (HBV). Fatal cases have been reported. As such, co-infected patients should be monitored even after discontinuation of Kivexa. HIV-positive patients should be screened for Hepatitis B virus (HBV) at the time of diagnosis. Co-infection with HIV and HBV should be treated with antiretroviral therapy targeting both viruses, and should continue indefinitely to achieve optimal suppression of HIV and prevention of HBV exacerbation. Screening for Hepatitis C virus (HCV) and treatment of comorbid infections is also advised.
Kivexa dosage is one tablet (containing abacavir 600mg and lamivudine 300mg) by mouth once a day, for adults and children weighing 25kg or more. Safety and efficacy have not been established for children weighing less than 25kg. As well, clinical studies have not included sufficient patients aged 65 and older. Therefore, caution should be exercised. Kivexa can be given to patients with renal impairment (creatinine clearance < 50 mL/min) and patients with mild hepatic impairment.
Kivexa has not been studied in pregnant women. Therefore, Kivexa should not be used in pregnant women unless the potential benefits outweigh the potential risk to the fetus. To monitor maternal and fetal outcomes of pregnant women exposed to antiretroviral therapy, including Kivexa, an Antiretroviral Pregnancy Registry has been established. The purpose is to collect information about the patient’s health and the baby’s health. It is recommended that HIV infected women do not breastfeed their infants under any circumstances in order to avoid transmission of HIV from mother to child. Both of the active substances in Kivexa are likely to be found in breast milk.
Abacavir may cause serious, even fatal hypersensitivity reactions, including anaphylaxis. All patients should be tested for HLA-B*5701 prior to initiating treatment with abacavir to reduce the risk. Hypersensitivity to abacavir may also occur in patients who do not test positive for HLA-B*5701. Specific guidelines for this and other potential adverse reactions to Kivexa and drug-drug interactions are contained in the package insert, and prescribers should familiarize themselves with these.
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