What is Duovir-N?
Duovir-N is an antiretroviral formulation manufactured by Cipla Limited, an award-winning Indian pharmaceutical company. The medicine effectively manages human immunodeficiency virus (HIV) infections, with each tablet containing 150mg of lamivudine, 300mg of zidovudine, and 200mg of nevirapine. Both lamivudine and zidovudine are nucleoside analogue agents that stop the replication of the HIV virus by inhibiting the reverse transcriptase (RT). Nevirapine is a non-nucleoside reverse transcriptase inhibitor (NNRTI). By directly inhibiting the reverse transcriptase, the viral load in the blood is controlled. Each bottle of Duovir-N is supplied with 30 film-coated tablets that must be stored at a room temperature below 30℃.
The recommended dose of Duovir-N in adults (or children with a body weight of 25kg or more) is 1 tablet twice daily. The tablets can be taken without food. If a dose is accidentally missed, the patient should take it within 6 hours. Otherwise, they should continue with their usual schedule without taking a double dose to compensate for the missed dose.
Duovir-N is contraindicated in patients with clinically significant hypersensitivity to any of the components in this antiretroviral formulation. It is also contraindicated in patients with moderate or severe hepatic impairment, as classified by the Child-Pugh scoring system as category C or B. Additionally, patients who are initiating therapy with nevirapine cannot be prescribed Duovir-N. Most importantly, nevirapine should not be used as part of occupational or non-occupational post-exposure prophylaxis (PEP) regimens.
Duovir-N Side Effects
Some of documented side effects include:
- Stomach pain;
Rarer, less reported side effects may include:
This list of side effects is not exhaustive, therefore it is advised to refer to the medication package insert for all potential side effects.
Duovir-N must be with caution in patients with a history of pancreatitis, myopathy, bone marrow suppression, hematologic toxicity, and hepatic impairment.
As part of the initial consultation session, you must inform your health-care provider of your medical history to ensure your suitability to receive Duovir-N therapy.
The zidovudine component found in Duovir-N should not be used concomitantly with stavudine, doxorubicine or nucleoside analogues, such as ribavirin. This is due to an antagonistic relationship that has been demonstrated in vitro between these drugs. Besides this, co-administration of zidovudine with ganciclovir, interferon alfa, and other bone marrow suppressive or cytotoxic agents can result in harmful hematologic zidovudine toxicity. Some other medications that may interact undesirably with Duovir-N include:
- HIV antiviral agents (e.g. indinavir, atazanavir/ritonavir, fosamprenavir);
- Anti-arrhythmic agents (e.g. lidocaine, amiodarone, disopyramide);
- Antibiotics (e.g. rifampin, clarithromycin);
- Antifungal agents (e.g. ketoconazole, itraconazole);
- Antithrombotics (e.g. warfarin);
- Anticonvulsants (e.g. carbamazepine, clonazepam, ethosuximide);
- Calcium channel blockers (e.g. diltiazem, nifedipine, verapamil);
- Oral contraceptives (e.g. ethinyl estradiol, norethindrone).
Refer to the package insert for more information on drug interactions.
Pregnancy & Lactation
Clinical research has not been extensive, and this drug may not be suitable for use in pregnant patients. All components in the Duovir-N formulation are excreted in breast milk. It is not yet known if the quantity of drugs present in breast milk have a harmful or protective effect on the infants.
The symptoms of overdose relate to each individual drug in the formulation. For example, symptoms of an acute overdosage of zidovudine (up to 50g) like nausea and vomiting were observed in adult and pediatric patients. Patients who had overdosed on nevirapine, with doses ranging from 800–1,800mg/day for up to 15 days, experienced symptoms like edema, fatigue, fever, headache, and insomnia. There is only 1 known case of a patient ingesting a high dosage (6g) of lamivudine. Patients should seek medical attention if they suspect an overdose.
Alternative Brand Names
The alternative brand for Duovir-N is Zidovex LN.
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