Simple FactSheet: Lamivudine/zidovudine (Combivir)

Lamivudine/zidovudine (Combivir)
a Simple FactSheet from the AIDS Treatment Data Network

||||| Combivir is a Nucleoside Reverse Transcriptase Inhibitor:

Combivir is a combination of two Nucleoside Reverse Transcriptase Inhibitors (NRTIs) in one pill. These two NRTIs are lamivudine (3TC, Epivir) and zidovudine (AZT, Retrovir). The body breaks down these drugs into chemicals that stop HIV from infecting uninfected cells in the body, but they do not help cells that have already been infected with the virus. As people with HIV lose CD4 cells cells - one of the immune systems main defenses - they become more likely to get infections and illnesses.

Ideally, Combivir should be used as part of a carefully chosen combination of anti-HIV treatments in order to get the most benefit. Many studies have now shown that using lamivudine in combination with zidovudine and at least one other anti-HIV drug from another class (Protease Inhibitors or Non-Nucleoside Reverse Transcriptase Inhibitors) can prevent the virus from getting resistant. This has helped people live longer and develop less opportunistic infections. Drug resistance tests (genotypic or phenotypic) have been shown to be useful in choosing the optimal anti-HIV treatment regimen specific to an individual. See the FactSheet "Understanding Drug Resistance" for a detailed discussion on theis subject.

New Public Health Service HIV treatment guidelines recommend combinations of three or four anti-HIV drugs as first treatment for HIV.
Lamivudine is also approved for the treatment of hepatitis B (Epivir HBV). Studies have shown that lamivudine can reduce the amount of hepatitis B virus to very low levels, although this effect does not always last. The treatment of Hepatitis B will likely require using combination therapy.

A study has also shown that pregnant women treated with zidovudine were only one-third as likely to pass HIV on to their babies as women who didn't take zidovudine. This has led to a recommendation that HIV-positive pregnant women be counseled about the potential benefits of zidovudine in preventing the transmission of HIV to their child.

Zidovudine is sometimes used to treat dementia. Symptoms of dementia can be forgetfulness and personality changes. Zidovudine is also used to treat a blood disorder called thrombocytopenia, which means low levels of the cells that allow blood to clot.

||||| Dosage:

The recommended dosage of Combivir is one tablet (containing 150 mg lamivudine and 300 mg zidovudine) twice a day. Combivir can be taken with or without food.

||||| Side effects:

Since Combivir contains two different drugs, the side effects associated with each drug also apply here.
Lamivudine has few side-effects, mainly nausea, vomiting, headaches, and rare cases of hair loss. Although not as commonly as with some other anti-HIV drugs, lamivudine can cause damage to the nerves in the hands and feet. This condition is called peripheral neuropathy. The symptoms of peripheral neuropathy are burning or numbing sensations in the hands and feet which can become very painful. If lamivudine causes this problem, it may be necessary to switch to another anti-HIV drug to prevent permanent nerve damage. See the FactSheet "Peripheral Neuropathy" for other treatment options which might be helpful.

Lamivudine can cause a side effect called pancreatitis, especially in children. Pancreatitis is a dangerous swelling of an organ in the body called the pancreas. People taking lamivudine should be carefully monitored for this side effect.

Long-term zidovudine use is associated with myopathy(loss of muscle). Other side effects can be anemia, white blood cell depression, lip, mouth and tongue sores, bone marrow damage, headaches, skin rash, itching, weakness, nervousness, dizziness, nausea, stomach pain, confusion, loss of speech or appetite, muscle aches, fever or sweating, sore throat or abnormal bruising or bleeding. In African-Americans, zidovudine can cause changes in nail color.

Studies indicate that possible blood cell damage may be prevented or treated by taking vitamin E, epoeitin alpha (EPO) or G-CSF with this drug. Nutritionists recommend taking manganese and B vitamins with this drug.

||||| Warnings:

A set of rare but serious side effects of nucleoside analog anti-HIV drugs is called lactic acidosis and severe hepatomegaly with steatosis (an enlarged fatty liver). Women, especially those who are oveweight, are particularly at risk. This set of side effects is probably the result of mitochondrial toxicity. Mitochondria are cell's power organs that supply the energy needed for normal cell growth. Anti-HIV nucleoside analogs impair the function of mitochondria. This can lead to increased acid levels in the blood, and an enlarged fatty liver. The symptoms are severe nausea, shortness of breath and vomiting that does not get better. If you are taking anti-HIV drugs and experience these symptoms, tell your provider immediately.

If you're going to use lamivudine, it's important to check for infection with hepatitis B. If you have active hepatitis B when you start lamivudine, you may feel sick for a month or two because liver cells infected with hepatitis B die off. Liver enzymes may also increase temporarily. These symptoms are a lot like some drug side effects, and knowing your hepatitis status can help tell the difference. There have also been several reports of hepatitis B flare-ups when lamivudine treatment is stopped. Symptoms of hepatitis B flare-ups are high liver enzymes, yellow skin (jaundice), nausea, vomiting, fatigue, abdominal and joint pain.

Call The Network at 212-260-8868 or 800-734-7104 for more information on Hepatitis and HIV co-infection.

GlaxoSmithKline, the maker of Combivir, has a patient assistance program for people having problems getting the drug. The number to call is (800) 722-9294.

The Simple Facts Project is a program of The Network. If you need help finding out whether or not a specific drug or therapy is covered by private or public insurance, contact The Network at (800) 734-7104. This information does not intend to promote or endorse any specific treatment for any health related condition.

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\|\|\|\|\| Combivir is a Nucleoside Reverse Transcriptase Inhibitor:
Combivir is a combination of two Nucleoside Reverse Transcriptase Inhibitors (NRTIs) in one pill. These two NRTIs are lamivudine (3TC, Epivir) and zidovudine (AZT, Retrovir). The body breaks down these drugs into chemicals that stop HIV from infecting uninfected cells in the body, but they do not help cells that have already been infected with the virus. As people with HIV lose CD4 cells cells - one of the immune systems main defenses - they become more likely to get infections and illnesses. Ideally, Combivir should be used as part of a carefully chosen combination of anti-HIV treatments in order to get the most benefit. Many studies have now shown that using lamivudine in combination with zidovudine and at least one other anti-HIV drug from another class (Protease Inhibitors or Non-Nucleoside Reverse Transcriptase Inhibitors) can prevent the virus from getting resistant. This has helped people live longer and develop less opportunistic infections. Drug resistance tests (genotypic or phenotypic) have been shown to be useful in choosing the optimal anti-HIV treatment regimen specific to an individual. See the FactSheet "Understanding Drug Resistance" for a detailed discussion on theis subject. New Public Health Service HIV treatment guidelines recommend combinations of three or four anti-HIV drugs as first treatment for HIV. Lamivudine is also approved for the treatment of hepatitis B (Epivir HBV). Studies have shown that lamivudine can reduce the amount of hepatitis B virus to very low levels, although this effect does not always last. The treatment of Hepatitis B will likely require using combination therapy. A study has also shown that pregnant women treated with zidovudine were only one-third as likely to pass HIV on to their babies as women who didn't take zidovudine. This has led to a recommendation that HIV-positive pregnant women be counseled about the potential benefits of zidovudine in preventing the transmission of HIV to their child. Zidovudine is sometimes used to treat dementia. Symptoms of dementia can be forgetfulness and personality changes. Zidovudine is also used to treat a blood disorder called thrombocytopenia, which means low levels of the cells that allow blood to clot.
\|\|\|\|\| Dosage:
The recommended dosage of Combivir is one tablet (containing 150 mg lamivudine and 300 mg zidovudine) twice a day. Combivir can be taken with or without food.
\|\|\|\|\| Side effects:
Since Combivir contains two different drugs, the side effects associated with each drug also apply here. Lamivudine has few side-effects, mainly nausea, vomiting, headaches, and rare cases of hair loss. Although not as commonly as with some other anti-HIV drugs, lamivudine can cause damage to the nerves in the hands and feet. This condition is called peripheral neuropathy. The symptoms of peripheral neuropathy are burning or numbing sensations in the hands and feet which can become very painful. If lamivudine causes this problem, it may be necessary to switch to another anti-HIV drug to prevent permanent nerve damage. See the FactSheet "Peripheral Neuropathy" for other treatment options which might be helpful. Lamivudine can cause a side effect called pancreatitis, especially in children. Pancreatitis is a dangerous swelling of an organ in the body called the pancreas. People taking lamivudine should be carefully monitored for this side effect. Long-term zidovudine use is associated with myopathy(loss of muscle). Other side effects can be anemia, white blood cell depression, lip, mouth and tongue sores, bone marrow damage, headaches, skin rash, itching, weakness, nervousness, dizziness, nausea, stomach pain, confusion, loss of speech or appetite, muscle aches, fever or sweating, sore throat or abnormal bruising or bleeding. In African-Americans, zidovudine can cause changes in nail color. Studies indicate that possible blood cell damage may be prevented or treated by taking vitamin E, epoeitin alpha (EPO) or G-CSF with this drug. Nutritionists recommend taking manganese and B vitamins with this drug.
\|\|\|\|\| Warnings:
A set of rare but serious side effects of nucleoside analog anti-HIV drugs is called lactic acidosis and severe hepatomegaly with steatosis (an enlarged fatty liver). Women, especially those who are oveweight, are particularly at risk. This set of side effects is probably the result of mitochondrial toxicity. Mitochondria are cell's power organs that supply the energy needed for normal cell growth. Anti-HIV nucleoside analogs impair the function of mitochondria. This can lead to increased acid levels in the blood, and an enlarged fatty liver. The symptoms are severe nausea, shortness of breath and vomiting that does not get better. If you are taking anti-HIV drugs and experience these symptoms, tell your provider immediately. If you're going to use lamivudine, it's important to check for infection with hepatitis B. If you have active hepatitis B when you start lamivudine, you may feel sick for a month or two because liver cells infected with hepatitis B die off. Liver enzymes may also increase temporarily. These symptoms are a lot like some drug side effects, and knowing your hepatitis status can help tell the difference. There have also been several reports of hepatitis B flare-ups when lamivudine treatment is stopped. Symptoms of hepatitis B flare-ups are high liver enzymes, yellow skin (jaundice), nausea, vomiting, fatigue, abdominal and joint pain. Call The Network at 212-260-8868 or 800-734-7104 for more information on Hepatitis and HIV co-infection. GlaxoSmithKline, the maker of Combivir, has a patient assistance program for people having problems getting the drug. The number to call is (800) 722-9294.