One 300 mg tablet once daily |
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Brand name: Epivir
Common name: lamivudine, 3TC
Class: nucleoside analog (also called nucleoside reverse transcriptase inhibitor, NRTI, or nuke)
Standard dose: One 300 mg tablet once-a-day (or one 150 mg tablet twice daily), with no food restrictions (may be taken with or without food). Dose is lower for people with kidney impairment and in children and people who weigh less than 110 pounds (50 kg), to 2 mg/kg (a kilogram equals 2.2 pounds). A strawberry/banana flavored liquid is also available. Take missed dose as soon as possible, but do not double up on your next dose.
AWP: $331.53 / month for 300 mg
Manufacturer contact: GlaxoSmithKline, www.treathiv.com, 1 (800) 722–9294
AIDS Treatment Information Service: 1 (800) HIV–0440 (448–0440) |
| Potential side effects and toxicity: This remains one of the most easily tolerated HIV medications. Potential side effects/toxicities include headache, nausea, diarrhea, fatigue, hair loss, insomnia, malaise (general ill feeling), nasal symptoms, cough, peripheral neuropathy, low white blood cells and anemia.
Rare but potentially fatal toxicity with all NRTIs is pancreatitis (inflammation of the pancreas), hepatomegaly with steatosis (enlarged, fatty liver) and lactic acidosis (accumulation of lactate in the blood and abnormal acid-base balance). Lactic acidosis has been seen in patients taking NRTIs but is more common and more severe in women, people who are obese and people who have been taking nukes for a long time; and more common in people with liver disease, but can occur in people without a history of liver damage. People with lactic acidosis may experience persistent fatigue, abdominal pain or distension, nausea/vomiting, and difficulty breathing or shortness of breath; and enlarged, fatty liver. Pancreatitis can be life-threatening and may cause pain in the stomach and back, along with nausea, vomiting and blood in the urine. Your physician will check for pancreatitis by checking for increased levels of amylase and lipase in the blood. Risks for pancreatitis include: higher than recommended doses of NRTIs, advanced HIV, and alcohol use. Children should be monitored carefully for pancreatitis.
Potential drug interactions: No significant drug interactions.
Tips: Exciting news: drug resistance that the virus develops against Epivir—the M184V mutation—makes the virus less fit to replicate and has even been shown to keep T-cells from dropping as much as they would have otherwise. It is also approved for treatment of hepatitis B virus (HBV), under the brand name Epivir HBV. So if you have hepatitis B and HIV, this drug works for both diseases, but make sure you are taking Epivir at HIV doses—always ask your doctor or pharmacist. Worsening of hepatitis B (HBV) in people co-infected with HIV/HBV has occurred when Epivir was discontinued. Epivir is also available combined with Retrovir (Combivir, one tablet twice-a-day), in a new once-a-day formula with Ziagen (Epzicom, one tablet daily) and in a triple combination with both Retrovir and Ziagen (Trizivir, one tablet twice-a-day). |
Doctor
Epivir is a potent NRTI usually used in combination with Retrovir, Zerit, Videx, Ziagen or Viread to form the so-called nucleoside backbone of anti-retroviral therapy. Its low toxicity and ease of administration (it can now be dosed once daily) make it an ideal medication for the treatment of HIV/AIDS; but its hallmark resistance mutation, M184, occurs rapidly if a patient is not compliant with his or her regimen. Viruses with the M184 mutation are considered “less fit” than the natural, nonresistant, form of the virus, which means that disease progression is slower if the person continues on Epivir even when resistant to it. —Ross Slotten, MD |
Activist
In the pageant of ARVs, 3TC would win “Most Popular”. It was the fifth, and friendliest, ARV approved. Potent, easy to take, minimal side effects—it has lovely features, you might say. The only thing to harsh on your mellow is that resistance to 3TC develops really easily. However, 3TC-resistant virus has less punch and this resistance can make HIV more susceptible to other ARV drugs. No wonder, then, it turns up in countless first-line regimens and is often kept on board even after resistance to it develops. You’ll also find a daily dose of it in Trizivir, Combivir and Epzicom. For people with HIV and hepatitis B, 3TC is a twofer—it is approved for HBV treatment, though it should be taken at the HIV dose if you have both viruses, and care must be taken if it is stopped suddenly because HBV can rebound and damage the liver. —Heidi M. Nass |
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