What is Lamivudine/Zidovudine (Combivir)?
Lamivudine/Zidovudine is a combination of two Nucleoside and Nucleotide Reverse Transcriptase Inhibitor (NRTI) medications: lamivudine (150mg) and zidovudine (300mg). Lamivudine/Zidovudine is indicated for the treatment of HIV infection in combination with other antiretroviral agents. Lamivudine is also active against Hepatitis B virus (HBV).
Dosing & Administration
Lamivudine/Zidovudineis indicated for the treatment of HIV infection in adults and children weighing more than 30 kg, in combinations with other antiretroviral agents. The drug is also used off-label for post-exposure HIV prophylaxis, both occupational and non-occupational, in combination with other antiretroviral medications. Some formulations of lamivudine/zidovudine must be taken on an empty stomach while others are taken without regard to meals. The product monograph should be consulted for dosing and administration instructions.
This medciation is not recommended in patients with hepatic impairment because the zidovudine component may require a dose adjustment. Lamivudine/Zidovudine should not be used in renal impairment (creatinine clearance <= 50 mL/min) because both components may require dose adjustments.
Lamivudine/Zidovudine is contraindicated in patients with hypersensitivity to the drug, and in patients with low neutrophil or hemoglobin counts.
Lamivudine/Zidovudine Side Effects
The drug can cause the following side effects:
- immune reactivation syndrome,
- liver disease.
A complete list of potential adverse effects is provided in the product monograph.
Lamivudine/Zidovudine is not recommended in patients with hepatic impairment and should be used with caution in patients with risk factors for hepatic impairment, such as alcoholism. Severe, even fatal, cases of hepatotoxicity or lactic acidosis have been reported in patients using lamivudine/zidovudine, as with other NRTIs, especially in women. Clinicians should maintain a high clinical index of suspicion for hepatotoxicity or lactic acidosis, including hepatic steatosis or hepatomegaly with normal liver enzymes.
All patients who test positive for HIV infection should be screened for comorbid HBV and Hepatitis C virus (HCV) infection. Co-infected patients should be started on an antiretroviral regimen targeting co-infected viruses, regardless of CD4 counts or viral loads. Current HIV treatment guidelines outline drug regimens and prescribing considerations.
Lamivudine/zidovudine is associated with a large number of drug-drug interactions and contraindications. These are listed in the product monograph. Of note, the drug should not be used with emtricitabine or cladribine.
Pregnancy & Lactation
Highly active retroviral combination treatment should be used in all pregnant women, regardless of viral load and CD4 count. There are theoretical risks associated with lamivudine/zidovudine use in pregnancy, although data from the Antiretroviral Pregnancy Registry have not shown either drug to be associated with any increase in risk of major birth defects above baseline. Current guidelines should be consulted when treating women in pregnancy. Both components of lamivudine/zidovudine are secreted in the breast milk in high concentrations. The CDC recommends that all HIV positive women, treated or untreated, avoid breastfeeding to prevent vertical transmission of the virus.
Lamivudine/zidovudine overdose should be treated with standard supportive care. Lamivudine is dialyzable, but dialysis has limited effect on zidovudine.
Alternative Brand Names
Lamivudine/zidovudine 150/300mg is also available under the brand name Combivir.
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