Lamivudine-zidovudine

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

Tipranavir (Aptivus) Zidovudine (Retrovir) Zidovudine Lamivudine (Combivir)... 

Mark C. is taking a regimen consisting of zidovudine, lamivudine, and efavirenz for the treatment of HIV infection. To help him fall asleep at night, he took a normal dose of diazepam (10 mg before bed), which he got from a friend. He then had symptoms of diazepam overdose, including grogginess and... 

Zidovudine, lamivudine Didanosine, emtricitabine, stavudine, abacavir... 

Preferred regimen Efivarenz Atazanavir + ritonavir Fosamprenavir + ritonavir Lopinavir/ ritonavir Tenofovir/ emtricitabine Zidovudine/ lamivudine... 

Gallant JE, DeJesus E, Arribas JR, Pozniak AL, et al. 2006. Tenofovir DF, Emtricitabine and Efavireuz vs. Zidovudine, Lamivudine and Efavirenz for HIV. NEJM. 354 251-260. 

The effects of the protease inhibitor indinavir and the NNRTI efavirenz on lipid concentrations have been compared in a large comparative randomized study (154). Each of the two comparison drugs were used in one arm (with a zidovudine + lamivudine backbone) and the combination of the two drugs in a third arm. Zidovudine and lamivudine did not play a role in the lipid changes. However, both of the comparison drugs significantly increased cholesterol concentrations. 

Support for the hypothesis of a casual relation between stavudine and lipodystrophy comes from another randomized study in which stavudine-containing HAART regimens were switched to a combination of zidovudine, lamivudine, and abacavir (157). Eight patients were randomized to continue stavudine and 14 patients switched to the triple combination. Imbalance in the treatment arms resulted from exclusion of patients who maintained treatment for a minimum of 6 months of follow up. Over 48 weeks after randomization, the average leg and arm fat mass fell in the continuation arm but increased in the switch arm. One patient in the switch arm, who had previously taken zidovudine and lamivudine, had a therapeutic failure. 

Zidovudine/lamivudine plus either Ritonavir 600 mg twice daily Didanosine/stavudine Saquinavir soft gel 1,200 mg three times daily... 

A 36-year-old HIV-positive man taking zidovudine, lamivudine, and indinavir was noticed to have a mild asymptomatic anemia (hemoglobin 10.2 g/1, white cell count 10.4 x 109/1 with a normal differential count, and platelets 237 x 109/1). The blood film suggested hemolysis. He had taken ecstasy 2 weeks earlier for the first time. The anemia was reportedly secondary to oxidative stress, probably due to drug toxicity. Three weeks later his hemoglobin returned to normal. 

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). 

Lamivudine (3TC) is a reverse transcriptase inhibitor with a relatively long intracellular half-life (14 h plasma t 6 h). In combination with zidovudine, lamivudine appears to reduce viral load effectively and to be well tolerated, although bone marrow suppression may be produced. Rarely, pancreatitis may occur. Lamivudine has also been used for treatment of chronic hepatitis B infection, but resistant strains of virus have been reported. 

In a multicenter trial, 128 children were randomly assigned to zidovudine + lamivudine (n — 36), to zidovudine + abacavir n — 45), or to lamivudine + abacavir n — 47) (18). One child had an allergic reaction to abacavir and stopped taking it, as did three with possible reactions. 

A 38-year-old man, who had taken amiodarone 200 mg/day for more than 6 months, was given postexposure prophylaxis for HIV infection after a needle injury this included zidovudine, lamivudine, and indinavir (256). During the 4 weeks of therapy his serum amiodarone concentration rose from 0.9 to 1.3 mg/1, with only a small rise in the serum concentration of desethylamiodarone from 0.4 to 0.5 mg/1. After withdrawal of the prophylactic therapy the plasma amiodarone concentration gradually fell to the pretreatment value, and there was no further change in the concentration of desethylamiodarone. 

Kost RG, Hurley A, Zhang L, Vesanen M, Talal A, Furlan S, Caldwell P, Johnson J, Smiley L, Ho D, Markowitz M. Open-label phase II trial of amprenavir, abacavir, and fixed-dose zidovudine/lamivudine in newly and chronically HIV-l-infected patients. J Acquir Immune Defic Syndr 2001 26(4) 332-9. 

Efavirenz is a non-nucleoside reverse transcriptase inhibitor with excellent inhibitory activity against HTV-l. Its most frequent adverse effects involve the central nervous system and the skin (1). At the start of therapy, dizziness, insomnia, or fatigue is observed in most patients, and headache and even psychotic reactions have also been observed. A maculopapular rash is seen in about 10%. These adverse effects usually vanish within the first 2-4 weeks of therapy (2). About 1-2% of individuals stop taking efavirenz because of neurological or dermatological adverse events. Administration of efavirenz at bedtime reduces the incidence of severe adverse effects, and the rash can be managed by short-term antihistamines or topical corticosteroids (1). Nausea and vomiting are less often observed than in patients treated with zidovudine, lamivudine, or indinavir. 

Because efavirenz is metabolized by cytochrome P450, several clinically significant interactions have been described. Efavirenz induces CYP3A4 (5) there was 55% mean induction at a dose of 400 mg/day and 33% at 200 mg/day. However, no significant interaction was noted with co-administration of nelfinavir, zidovudine, lamivudine, fluconazole, or azithromycin (2). 

A 51-year-old woman taking zidovudine, lamivudine, indinavir, and simvastatin started to take ritonavir and after 1 week developed diffuse muscle weakness and body aches. Creatine kinase (total and the MB isozyme), lactate dehydrogenase, and transaminases were all raised. There were crystals and hemoglobin in the urine. 

In a multicenter trial, 128 chUdren were randomly assigned to one of three regimens zidovudine + lamivudine (n — 36), zidovudine + abacavir (n = 45), or lamivudine + abacavir (n — 47) (12). The children who were free of symptoms (n — 55) were also randomized to nelfinavir or placebo, while those with more advanced disease received open-label nelfinavir (n — 73). All 13 episodes of diarrhea occurred in those taking nelfinavir. Nelfinavir did not affect serum cholesterol or triglyceride concentrations and there were no cases of lipodystrophy. There were 24 serious adverse events six were in the symptom-free children (all taking nelfinavir), but all were attributed to the NRTIs. 

A variable-dose plasma concentration-controlled approach to combination antiretroviral therapy (zidovudine, lamivudine, and indinavir) has been compared with conventional fixed-dose therapy in 40 patients in a randomized, 52-week, open trial (6). Significantly more concentration-controlled recipients achieved the desired concentrations for aU three drugs there was a good response in 15 of 16 concentration-controlled recipients compared with nine of 17 conventional regimen recipients. However, there was no difference in the occurrence... 

A 28-year-old female medical resident was given zidovudine, lamivudine, and indinavir after a needle-stick... 

Lipemia retinalis and pancreatitis have been reported in a 39-year-old man with HIV infection associated with protease inhibitor therapy (13). He developed lipemia retinahs after switching to an antiretroviral regimen including ritonavir and saquinavir (together with zalci-tabine and delavirdine). He had previously been taking zidovudine, lamivudine, and indinavir. 

BCRP Anthracyclines, epipoxophyllotoxins, camptothecins or their active metabolites, mitoxantrone, bisantrene, methotrexate, flavopiri-dol, zidovudine, lamivudine FTC, GF120918, Ko-134... 

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... 

SLC28A1 CNTl Pyrimidine nucleosides. Zidovudine, lamivudine, zalcitabine, cytarabine Liver, kidney, small intestine Gray et al., 2004 Kong... 

Parameter Zidovudine Lamivudine Stavudine Didanosine Abacavir Zalcitabine Tenofovir Emtricitabine... 

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