ZIAGEN (abacavir) is a Nucleoside Reverse Transcriptase Inhibitor (NRTI) drug used for the treatment of HIV in combination with other antiretroviral drugs. ZIAGEN works by acting as a nucleoside substrate and chain terminator, thereby disrupting viral replication.
Dosing & Administration
ZIAGEN is indicated for the treatment of HIV infection in adults and children ages three months and up weighing at least 14 kg, as part of a combination drug regimen. It is also used off-label as part of a dug regimen for occupational HIV post-exposure prophylaxis. ZIAGEN oral tablets may be crushed, and it is available in an oral solution. ZIAGEN may be taken without regard to meals. Dosage and administration instructions are detailed in the product monograph.
ZIAGEN requires a dose reduction in patients with mild liver dysfunction, and is not recommended for use in patients with moderate or severe liver impairment. No dosage adjustments are required in patients with renal impairment, but ZIAGEN should not be used in the setting of end-stage renal disease. Details are given in the product monograph.
ZIAGEN is contraindicated in patients with hypersensitivity to abacavir.
Abacavir is associated with severe hypersensitivity reactions. A complete list of potential adverse effects is provided in the product monograph.
Abacavir may cause serious, even fatal hypersensitivity reactions, including anaphylaxis. Patients should be tested for HLA-B*5701 prior to initiating treatment. Hypersensitivity also occurs in patients who are not positive for HLA-B*5701.
ZIAGEN may increase the risk for myocardial infarction, so should not be used in patients with underlying cardiac risk.
ZIAGEN is associated with a risk of lactic acidosis or hepatotoxicity, including fatal cases, and should be used with caution or not at all in patients with liver impairment or risk factors for liver disease. Patients should be screened and monitored as described in the product monograph.
All patients who test positive for HIV infection should be screened for comorbid Hepatitis B virus (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.
ZIAGEN is associated with a large number of drug-drug interactions. A complete list is provided in the product monograph.
Pregnancy & Lactation
Highly active retroviral combination treatment should be used in all pregnant women, regardless of viral load and CD4 count. Data from the Antiretroviral Pregnancy Registry do not show that abacavir causes major birth defects above baseline. However, there are theoretical risks to the fetus and neonate, and pregnant women may be at increased risk of lactic acidosis and liver toxicity. Current guidelines should be consulted when treating women in pregnancy. Abacavir is excreted in breast milk. The CDC recommends that all HIV positive women, treated or untreated, avoid breastfeeding to prevent vertical transmission of the virus.
There is no known antidote for ZIAGEN overdose, so standard supportive treatment should be used. It is unknown if ZIAGEN can be hemodialyzed.
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