What is Epzicom?

Epzicom is an anti-HIV medication that combines Epivir (lamivudine) and Ziagen (abacavir). It belongs to the class of drugs called "nukes", or nucleoside reverse transcriptase inhibitors (NRTIs). Like other drugs of this class it works by preventing HIV from infecting new cells and taking them over. Epzicom also decreases the amount of HIV in the blood. The drug crosses the blood-brain barrier as well, meaning it may be helpful in fighting HIV in the brain. Epzicom should not be taken as part of a triple nuke combination to treat HIV, according to the makers of the drug, GlaxoSmithKline.

Epzicom combines 300mg of Epivir and 600mg of Ziagen. It is strongly recommended that Epzicom be taken with at least one other drug, such as a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor ("non-nuke"or NNRTI).

Before starting Epzicom

Tell your doctor is you have kidney or liver disease, or if you have ever taken Epzicom, Trizivir or Ziagen before. If you stopped taking any of these medications in the past because of problems, discuss this in detail with your doctor. Both your doctor and pharmacist should know about any prescription medications you are currently taking or have taken in the past. That includes over the counter remedies for headache or pain, heartburn or stomach upset, nutritional or vitamin supplements, and alternative therapies. Always be very careful of the amount of acetaminophen (such as Tylenol) that you are taking, or that is contained in any other prescription or over the counter remedies. Mixing acetaminophen with certain drugs, and especially with alcohol, can cause serious damage to your liver - possibly even a fatal overdose.

Because Epzicom contains both Ziagen and Epivir, a list of the most common warnings and precautions that you may need to take with either Epzicom or Ziagen is included on this fact sheet. Although Epzicom is a pill that is taken once a day, with or without food, your doctor still might decide that it is best to take the two drugs separately, or to take just one of the drugs in Epzicom. This might be done because of your resistance profile. If your resistance profile says that you are already resistant to Epivir, for example, your doctor may decide to prescribe Ziagen and two other drugs.

Potential Side Effects

If you have had a bad reaction called a "hypersensitivity reaction" to Epzicom, Ziagen or Trizivir (a drug combination that includes Ziagen), you should never taken Epzicom, Ziagen or Trizivir again. A potentially fatal reaction could occur. The possibility of a "hypersensitivity" reaction may make taking Epzicom for the first time scary, but most people don't have the reaction. About 5 to 8% of people do have it, however.It's a serious allergic reaction that requires that you stop taking the Ziagen containing drug and never take it again. You could still take the Epivir, or it's relative Emtriva (emtricitabine) however, once the hypersensitivity reaction is properly dealt with.

The reaction can occur during the first few days or during the second week after starting the drug. But it could take several more weeks to notice any symptoms. It is very important that you report any symptoms right away. The symptoms typically get worse over time. The common symptoms of a Ziagen hypersensitivity reaction are fever and rash. You may develop a different type of rash that is not as serious, but let your health care provider know. If your fever and rash are followed by, or occur at the same time as a sore throat, cough, shortness of breath, stomach upset, vomiting, nausea, headaches or feeling really sick or tired (flulike), it is crucial you contact your doctor, or get medical care immediately.

Why would you take a Ziagen containing drug?

The combination of Lexiva/r (fosamprenavir with ritonavir) and Epzicom was just named as first line therapy for people who have never taken HIV treatment before by the International AIDS Society (IAS). This is based on a study that showed that Lexiva/r and Epzicom worked just as well as the most widely prescribed anti-HIV drug, Kaletra. taken with Epzicom.

All drugs can cause bad reactions and side effects in some people. At least we know what to look out for with Epzicom. If you are not in the minority of people who have a bad reaction, the drug works just as well as other two drug combinations. It also often works against viruses that have a resistance mutation called M184V. This mutation may mean that other NRTIs no longer work.

The Ziagen hypersensitivity reaction seems to occur most in people with the HLA-B-5701 genotype. But anyone taking the drug needs to follow the same guidelines. If you are starting to feel unusual and have any of the symptoms of an allergic reaction, let someone know right away. Get clinical care.

Some other side effects

All of the NRTIs have warnings on them. As a class of drugs they can cause side effects that may be annoying, tolerable or possibly very dangerous. Fortunately, they don't happen with the majority of people who take these drugs. But they can occur. Lactic acidosis,a build up of lactic acid in the body, and severe liver problems have occurred in some of the people taking NRTIs. If you begin to develop symptoms such as nausea and vomiting, stomach pains or bloating, shortness of breath, weakness, fatigue, pain in the upper stomach area, really tired arms or legs or yellowing of the skin or eyes, contact your doctor immediately.

Another type of side effect that can occur with NRTIs has to do with body fat. This type of drug can cause blood fat (or lipids as they are also known as) to increase. Both cholesterol and triglycerides may increase. This condition is called hyperlipidemia.

Perhaps most disturbing, at least to some people, are changes in body shape such as increased fat around the stomach area, breasts or chest area, and the back of the neck. This is sometimes, but not always, combined with a loss of fat in the face (facial lipoatrophy), or in the arms, legs or butt (lipodystrophy). You could also develop diabetes. There are things that your doctor may suggest to lessen or possibly avoid these symptoms. For some people, these symptoms are severe and treating them may involve what is still unfortunately called "cosmetic" surgery. The effects these symptoms can have on how someone feels about themselves should be treated as important issues.

A special concern with Hepatitis B (HBV)

The Epivir in Epzicom is also a treatment for hepatitis B. If you suddenly stop taking Epivir or a drug that contains Epivir, such as Epzicom, it can cause a flare up of the hepatitis. This could cause your liver to flare-up and lead to liver damage. Make sure your doctor monitors you closely if you stop an Epivir containing drug. This is also true of Viread, a very widely used HIV medication. Make sure you have been tested for hepatitis, and that you have received the hepatitis A and B vaccinations. There are treatments for hepatitis.

What about Pregnant or Nursing Women?

Epzicom is a pregnancy category B drug according to the FDA. All anti-HIV drugs that get approval by the FDA are classified. Category B means that studies in animals suggest that taking the drug should not harm a fetus, but there have not been definitive studies done in pregnant women that clearly show there is no risk whatsoever. Category C means that animal drugs have actually shown that a drug had a bad effect in animals, but no studies in pregnant women say the fetus will be harmed.

Despite this risk, the benefits of using the drug may outweigh the possible harm. Women who are HIV-positive who become pregnant should discuss all the possible benefits and risks of any HIV med with their health care providers, especially since it is possible to keep the mother as healthy as possible while preventing the baby from having HIV. In most cases, it is recommended that an HIV-positive mom not breast feed her children. This is another very important issue to discuss with your health care providers.