Nevirapine Lamivudine

Acid-base balance A 42-year-old woman with advanced HIV disease who had taken stavudine, lamivudine, nevirapine, and prophylactic co-trimoxazole for 9 months developed a high anion gap metabolic acidosis with a pH of 7.15, due to lactic acidosis [114 ]. She was also discovered to have persistent glycosuria, phosphaturia, and aminoaciduria, in keeping with proximal renal tubular dysfunction. The lactic acidosis was attributed to the stavudine and the Fanconi syndrome to the combination of stavudine and lamivudine. 

Simultaneous didanosine, folic acid, ganciclovir, lamivudine, nevirapine, pyrazinamide, ranitidine, rifampin, stavudine, sulfamethoxazole, trimethoprim, zidovudine Noninterfering adefovir, amprenavir, delavirdine, efavirenz, fluconazole, indinavir, itraconazole, methadone, nelfinavir, oxazepam, pyrimethamine, rifampin, ritonavir, saquinavir, zalcitabine... 

Fan, B. Stewart, J.T. Determination of zidovudine/lamivudine/nevirapine in human plasma using ion-pair HPLC, J.Pharm.Biomed.Anal., 2002, 28, 903-908. [SPE LOQ 59 ng/mL for lamivudine]... 

Zidovudine Didanosine Stavudine Lamivudine Abacavir Tenofovir Emtricitabine Nevirapine Efavirenz TMC125 Saquinavir Indinavir Lopinavir Fosamprenavir Atazanavir Tipranavir Darunavir Raltegravir Elvitegravir Enluvirtide Maraviroc Vicriviroc Bevirimat... 

Tenofovir + Emtricitabine Zidovudine + Lamivudine Abacavir + Lamivudine Efavirenz or Nevirapine Lopinavir/r or Atazanavir/r or Eosamprenavir/r or Saquinavir/r... 

TC, lamivudine ABC, abacavir APV, amprenavir AST, aspartate aminotransferase ALT, alanine aminotransferase ATV, atazanavir CBC, complete blood cell count D/C, discontinue ddl, didano-sine d4T, stavudine EFV, efavirenz FTC, emtricitabine P1BV, hepatitis B virus F1CV, hepatitis C vims HIV, human immunodeficiency virus IDV, indinavir IV, intravenous LFT, liver function tests LPV/r, lopinavir + ritonavir NNRTI, nonnucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor NVP, nevirapine PI, protease inhibitor PT, prothrombin time T.bili, total bilirubin TDF, tenofovir disoproxiI fumarate TPV, tipranavir ULN, upper limit of normal ZDV, zidovudine. 

Drugs that may affect nelfinavir include anticonvulsants, azithromycin, azole antifungals, efavirenz, delavirdine, HMG-CoA reductase inhibitors, indinavir, interleukins, nevirapine, rifabutin, rifampin, ritonavir, saquinavir, St. John s wort. Drugs that may be affected by nelfinavir include amiodarone, antiarrhythmics (amiodarone, quinidine), azithromycin, benzodiazepines, efavirenz, ergot alkaloids, delavirdine, didanosine, fentanyl, indinavir, lamivudine methadone, nonsedating antihistamines, oral contraceptives, phenytoin, pimozide, quinidine, rifabutin, saquinavir, sildenafil, sirolimus, tacrolimus, zidovudine. 

Pharmacology Abacavir is a synthetic carbocyclic synthetic nucleoside analog with inhibitory activity against HIV. Abacavir has synergistic activity in combination with amprenavir, nevirapine, and zidovudine and additive activity in combination with didanosine, lamivudine, stavudine, and zalcitabine in vitro. 

TC Lamivudine ABC Abacavir d4T Stavudine ddC Zalcitabine ddl Didanosine TDF Tenofovir ZDV Zidovudine, also abbreviated as AZT FTC Emtricitabine NVP Nevirapine DLV Delavirdine EFV Efavirenz RTV, r Ritonavir Pl/r Ritonavir boosted protease inhibitor SQV Saquinavir IDV Indinavir LPV Lopinavir NEV Nelfinavir APV Amprenavir ATV Atazanavir DRV Darunavir... 

Alternative regimen Nevirapine Atazanavir Fosamprenavir Fosamprenavir + ritonavir Fopinavir/ ritonavir Abacavir/ lamivudine Didanosine/ lamivudine... 

At the present time, there are at least 14 compounds that have been formally approved for the treatment of human immunodeficiency virus (HIV) infections. There are six nucleoside reverse transcriptase inhibitors (NRTIs) that, after their intracellular conversion to the 5 -triphosphate form, are able to interfere as competitive inhibitors of the normal substrates (dNTPs). These are zidovudine (AZT), didanosine (ddl), zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), and abacavir (ABC). There are three nonnucleoside reverse transcriptase inhibitors (NNRTIs) — nevirapine, delavirdine, and efavirenz — that, as such, directly interact with the reverse transcriptase at a nonsubstrate binding, allosteric site. There are five HIV protease inhibitors (Pis saquinavir, ritonavir, indinavir, nelfinavir, and amprenavir) that block the cleavage of precursor to mature HIV proteins, thus impairing the infectivity of the virus particles produced in the presence of these inhibitors. 

Nevirapine = Viramune] (dipyridodiazepinone) [NRTIs in clinical use Abacavir (ABC) Adefovir dipivoxil (9-[2-Phosphonomethoxy)ethyl] -adenine PMEA) AZT Didanosine (= 2, 3 -Dideoxyinosine) Lamivudine Stavudine Zalcitabine (2, 3 -Dideoxycytidine]... 

An active transport mechanism has long been suspected to account for the placental barrier that causes maternal and fetal concentrations for many drugs to differ (96 97). Studies of maternal-fetal transport of medications used during pregnancy in HIV-positive women have shown variable penetration into the fetus (98 99). Whereas the maternal-fetal drug ratios for zidovudine lamivudine/ and nevirapine (approximately 0.85 1.0/ and 0.9/ respectively) demonstrate good fetal penetration/ most protease inhibitors/ nelhnavir/ ritonavh/ saquinivir/ and lopinavir/ are known P-gp substrates and do not cross the placenta in detectable levels (98). 

A 48-year-old HIV-positive man taking indinavir, zidovudine, and lamivudine developed Herpes zoster infection, which was treated with famciclovir. Postherpetic neuralgia was treated with carbamazepine, and his plasma indinavir concentration fell substantially. The carbamazepine was withdrawn after 2.5 months and 2 weeks later HIV-RNA was detectable in his plasma (6 X 10 /ml). His circulating virus was resistant to lamivudine. With a further increase in viral load, his therapy was changed to nevirapine, didanosine, and stavudine. 

System affected by the adverse event Stavudine + nevirapine -t ritonavir (n = 41) Stavudine + nevirapine -t nelfinavir (n = 44) Stavudine + lamivudine -t nevirapine -t nelfinavir (n = 44) Stavudine + lamivudine + nelfinavir (n = 52)... 

A 23-year-old woman who took stavudine, lamivudine, and nevirapine had nausea and diarrhea during the first few days and within 2 weeks developed sudden bilateral hearing loss, dizziness, and tinnitus (16). The hearing defect was sensorineural. CT and MRI scans were normal. Prednisolone was ineffective. 

Rey D, L Heritier A, Lang JM. Severe ototoxicity in a health care worker who received postexposure prophylaxis with stavudine, lamivudine, and nevirapine after occupational exposure to HIV. CUn Infect Dis 2002 34(3) 418-19. 

GR is a 55-year-old HIV positive man currently receiving ritonavir/lopinavir, nevirapine, and lamivudine. You would like to start simvastatin to decrease his triglycerides. Which of his ARVs will interact with simvastatin ... 

E Simvastatin is metabolized by CYP3A4. Nevirapine is an inducer of CYP3A4, whereas lopinavir and ritonavir are inhibitors of CYP3A4. Thus, the effect of these two drugs on simvastatin levels is unpredictable. Lamivudine is not metabolized by the CYP450 system and will not affect simvastatin levels. 

The NRU and nNRTl form two additional classes of antiviral compounds applied against HIV. Examples of NRTl are zidovudine (AZT), lamivudine (3TC), di nosine (ddl), and stavudine (d4T). Examples of nNRTl are efavirenz and nevirapine. 

There are currently a variety of nucleoside analogs (i.e., AZT [zidovudine] [3], DDC [zalcitabine] [4], DDI [didanosine] [4], D4T [stavudine] [5], and 3TC [lamivudine] [6] [also designated NRTIs or nucleoside RT inhibitors]) and two nonnucleoside RT inhibitors (i.e., nevirapine [viramune] and BHAP [delavirdine] [also designated NNRTIs] [7,8]) officially approved for treatment of HIV-infected individuals. It should be noted that the NNRTIs are uniquely active against HIV-1, but not HIV-2 RT, whereas the NRTIs inhibit both HIV-1 and HIV-2 RTs. In addition, several other structural classes of... 

Moura MD +, J Contemp Dent Pract 9(1), 84 (with nevirapine and lamivudine)... 

Successful treatment of human immunodeficiency virus (HIV-1) infection has been achieved through successful implementation of highly active antiretroviral therapy, frequently referred to as HAART. This involves simultaneous administration of both nucleoside and nonnucleoside reverse transcriptase inhibitors and one or more protease inliibitors. The common nucleoside reverse transcriptase inhibitors are the thymidine analogs didanosine (ddl), lamivudine (3TC), and zalcitabine (ddC) and the non-thymidine analogs abacavir (Ziazen), stavudine (d4T), and zidovudine (AZT). The nonnucleoside reverse transcriptase inhibitors include delavirdine, efavirenz, and nevirapine. The protease inhibitors include indinavir, nelfinavir, ritonavir, and saquinavir. Response to therapy is monitored by quantification of HIV-RNA copies (viral load) and CD-4+ T-lymphocyte count. Successful therapy is indicated when viral load is reduced to <50 copies/mL and CD-4+ count >500 per mL. 

Lamivudine -I- Stavudine Lamivudine -I- Zidovudine Lamivudine + Stavudine + Efavirenz Lamivudine -I- Stavudine + Nevirapine Lamivudine -I- Zidovudine + Efavirenz Lamivudine -I- Zidovudine + Nevirapine Lamivudine -I- Zidovudine + Abacavir Tenofovir -I- Emtricitabine... 

Lamivudine + Stavudine + Nevirapine Lamivudine + Zidovudine + Nevirapine Lamivudine + Zidovudine + Abacavir... 

Nevirapine plus (lamivudine or emtricitabine) plus zidovudine (or stavudine or didanosine)... 

Inhibit viral reverse transcriptase Zidovudine, didanosine, zalcitabine, lamivudine, stavudine, nevirapine... 

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