Abacavir/Lamivudine

Dosing

원내

HIV infection 1 tab PO q24h

If BW <40 kg Avoid

Kivexa (TN) or Epizicom (TN) 1 tab = Abacavir 600 mg + Lamivudine 300 mg

원내

Safety and efficacy in pediatric patients <18y of age have not been established

Hepatic impairment Avoid

CrCl ≥50CrCl <50No dose adjustmentAvoid

General Information

Treatment of HIV infection.

Black Box Warning: Perform HLA-B5701 testing prior to initiation or reinitiation of abacavir and lamivudine to reduce risk of hypersensitivity reaction. Discontinue abacavir and lamivudine combination if a hypersensitivity reaction is suspected, regardless of HLA-B5701 status and even when other diagnoses are possible. Severe acute exacerbations of hepatitis B have been reported in patients who are co-infected with hepatitis B virus (HBV) and human immunodeficiency virus (HIV-1) and have discontinued lamivudine.

Test HLA-B*5701 before use to reduce risk of hypersensitivity reaction.

Monitor viral load prior to initiation or modification of treatment.

Monitor CD4 cell counts prior to initiation or with modification of ARV treatment and every 3-6 months; thereafter during at least the first 2 years of treatment.

Monitor hepatitis B screening at baseline and with modification of ARV treatment.

Monitor ALT, AST, and total bilirubin at baseline and with modification of ARV treatment.

Common

  • Headache

  • Dizziness

  • Insomnia

  • Depression

Serious

  • Stevens-Johnson syndrome

  • Toxic epidermal necrolysis

  • Lactic acidosis

  • Myocardial infarction

  • Pancreatitis

  • Anemia

  • Thrombocytopenia

  • Hepatomegaly

  • Hepatotoxicity

  • Steatosis

  • Hypersensitivity

  • Inhibition by protease inhibition of CYP3A4 mediated alosetron metabolism

  • Horsetail - reduced lamivudine efficacy; increased HIV RNA viral loads

  • Methadone - increased plasma clearance

  • Orlistat - inhibited absorption of antiretroviral agent

  • Ribavirin- fatal or nonfatal lactic acidosis

  • Tipranavir - decreased abacavir levels

Antimicrobial class: Antiretroviral agent, Nucleoside reverse transcriptase inhibitor

Pregnancy category: C

Average serum half life: 1.45 hours (Abacavir), 5-7 hours (Lamivudine)

Precautions: Use not recommended in patients with impaired renal function (i.e. CrCl <50 mL/min).

Consider underlying risk of coronary heart disease and minimize modifiable risks (eg, hypertension, hyperlipidemia, diabetes mellitus, smoking).

Interrupt therapy if lactic acidosis or pronounced hepatotoxicity, which may include hepatomegaly and steatosis even in the absences of marked transaminase elevations, is suspected.

Emergence of lamivudine-resistant hepatitis B virus has been reported in HIV-1 infected patients coinfected with hepatitis B virus after treatment with lamivudine-containing antiretroviral regimens.

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