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Lamivudine / zidovudine

HOW SUPPLIED

Tablets: 150 mg larnivudine and 300 mg zidovudine
ACTION

Inhibit reverse transcriptase via DNA chain termination. Both drugs are also weak inhibitors of DNA polymerase. Together, they have synergistic antiretroviral activity. Combination therapy with larnivudine and zidovudine is targeted at suppressing or delaying the emergence of resistant strains that can occur with retroviral monotherapy because dual resistance requires multiple mutations.

INDICATIONS & DOSAGE

HIV infection-

Adults and children ages 12 and older weighing over 50 kg (110 lb): one tablet P.O. b.i.d.
ADVERSE REACTIONS

CNS: headache, malaise,jatigue, insomnia, dizziness, neuropathy, depression.

EENT: nasal signs and symptoms.

GI: nausea, diarrhea, vomiting, anorexia, abdominal pain, abdominal cramps, dyspepsia.

Hematologic: neutropenia, anemia.

Hepatic: increased ALT, AST, amylase.

Musculoskeletal: musculoskeletal pain, myalgia, arthralgia.

Respiratory: cough.

Skin: rash.

Other: fever, chills.
INTERACTIONS

Drug-drug. Ganciclovir, interferonalpha, other bone marrow suppressive or cytotoxic agents: may increase zidovudine's hematologic toxicity. Monitor patient.
EFFECTS ON DIAGNOSTIC TESTS

None reported.
CONTRAINDICATIONS

Contraindicated in patients with known hypersensitivity to drug's components and in those requiring dosage adjustments, such as children under age 12, those weighing under 50 kg, and those with creatinine clearance below 50 ml/minute. Also contraindicated in patients experiencing dose-limiting adverse effects.
SPECIAL CONSIDERATIONS
Use combination cautiously in patients with bone marrow suppression as evidenced by granulocyte count below 1,000 cells/mm3 or hemoglobin level below 9.5 g/dl.
Lactic acidosis and severe hepatomegaly with steatosis have been reported in patients receiving lamivudine and zidovudine alone and in combination. The health care provider is notified if signs of lactic acidosis or hepatotoxicity develop (abdominal pain, jaundice).
Bone marrow toxicity must be monitored by frequent blood counts, particularly in patients with advanced HIV infection. Patients should be monitored for signs and symptoms oflactic acidosis and hepatotoxicity.
A patient's fine motor skills and peripheral sensation should be assessed for evidence of peripheral neuropathies.
An Antiretroviral Pregnancy Registry has been established to monitor maternalfetal outcomes of pregnant women exposed to Combivir. To register a pregnant patient, health care provider can call 1-800-258-4263.

Patient teaching
The lamivudinelzidovudine combination drug therapy is not a cure for HTV infection; illness, including opportunistic infections, may continue to occur.
HIV transmission can still occur with drug therapy.
Use protection when engaging in sexual activities to prevent disease transmission.
Signs and symptoms of neutropenia and anemia include fever, chills, infection, fatigue; report such occurrences.
Blood counts should be followed closely while on drug, especially ifthere is advanced disease.
Consult health care provider or a pharmacist before taking other drugs.
Report abdominal pain immediately.
Report signs and symptoms of myopathy or myositis (muscle inflammation, pain, weaknessArticle Submission, decrease in muscle size).
Take combination drug therapy exactly as prescribed to reduce the development of resistance.
Combination may be taken with or without food.
Breast-feeding is contraindicated in my infection and during drug therapy

Article Tags: Health Care Provider, Abdominal Pain, Bone Marrow, Health Care, Care Provider, Drug Therapy

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