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Common Name:
zidovudine (AZT) and lamivudine (3TC)
Brand Name:
Combivir |
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Class: fixed dose combination—nucleoside analogs (also called nucleoside reverse transcriptase inhibitors, NRTIs or nukes)
Standard dose: One tablet (150 mg Epivir/3TC/lamivudine, 300 mg zidovudine/AZT/Retrovir), twice-a-day (12 hours apart), with no food restrictions (may be taken with or without food). Take missed dose as soon as possible, but do not double up on your next dose.
AWP: $838.94 / month
Manufacturer contact: GlaxoSmithKline,
www.combivir.com, 1 (888) 825–5249
AIDSInfo:
1 (800) HIV–0440 (448–0440), www.aidsinfo.nih.gov
Potential side effects and toxicity: May be taken with food to decrease potential nausea associated with AZT. See drug pages for lamivudine, 3TC (Epivir) and zidovudine, AZT (Retrovir) for more details.
Potential drug interactions: See the drugs contained in Combivir: lamivudine, 3TC (Epivir) and zidovudine, AZT (Retrovir). Do not take zidovudine (Retrovir), Epivir, Epzicom, Trizivir, Emtriva, Truvada, or Atripla while taking Combivir, since all or part of these medications are already in Combivir or have equivalent medications.
Tips: See also the drugs contained in Combivir: lamivudine, 3TC (Epivir) and zidovudine, AZT (Retrovir). Combivir has been shown in multiple clinical trials to be a potent regimen with either a protease inhibitor or an NNRTI. It is the combination of lamivudine, 3TC (Epivir) and zidovudine, AZT (Retrovir) into one pill; see the pages of those individual drugs for more information. The AZT in Combivir can cause fatigue and anemia—it isn’t pretty in those at risk for developing anemias (see zidovudine). One head-to-head study against Truvada found greater toxicity with Combivir, due to anemia. New Procrit or Epogen warning: if hemoglobin target is above manufacturer’s recommendation (12 g/dL), risk for serious and life-threatening cardiovascular complications significantly increases. For AZT patients, measure hemoglobin once a week after starting the anemia drugs until hemoglobin has stabilized. Notify healthcare provider if experiencing pain and/or swelling in the legs, worsening in shortness of breath, increase in blood pressure, dizziness or loss of consciousness, extreme tiredness, or blood clots in hemodialysis vascular access ports. Combivir brings with it one of the “T” drugs, or thymidine analogs (AZT and Zerit)—some clinicians are avoiding those when possible because of implication in lipoatrophy. The wasting of “AZT butt” could be irreversible or take a long time to rebuild. If you are on it though, don’t worry—Combivir is still an effective combination. Please see package insert for more complete potential side effects and interactions.
I don’t use Combivir anymore, mostly for the reasons I’ve discussed elsewhere (see “Retrovir”). When I do use AZT, it’s almost always to take advantage of certain NRTI resistance mutations in someone who is also taking tenofovir. However, rather than use Combivir plus Viread, it’s cheaper to give Truvada plus generic AZT. It also means that two of the three nukes (tenofovir and FTC) are being given once a day instead of just one (the Viread in Combivir plus Viread)—a potential advantage in case of a missed dose.—Joel Gallant, M.D.
Combivir was the first effort to simplify therapy by combining two drugs in a single pill, thus reducing the number of pills needed each day. This approach eventually became known as a “fixed dose combination,” or FDC, and several other FDCs followed in later years. Combivir instantly became popular, mostly because it allowed a person to take two of the drugs in a typical three drug combination in the form of just one pill twice daily. Combivir combines AZT (Retrovir) and 3TC (Epivir) and this is both its greatest strength and its greatest weakness. The strength is that it is a well proven combination that doctors and patients are very familiar with. The weakness is that AZT, the oldest and first HIV drug, has a well-known and fairly predictable side effect profile, as does 3TC, and if you want the convenience of two drugs in one pill, this is one of the very few choices available, side effects and all. With so many newer drugs available today, many people are understandably reluctant to use the old standards. Surely, after 20 years, people expect something better than the oldest drug on the shelf. Consequently, though Combivir initially was widely used, over time its share of the market has been dropping. One advantage that the manufacturer, GlaxoSmithKline, achieved by combining two of its drugs has been to overcome some of the deserved or undeserved bad reputation of AZT. Many people who are prescribed Combivir don’t even realize that they are taking AZT. They simply assume they are using a different drug called Combivir. Many people readily take Combivir who swear they would never take AZT. This has helped extend the use of AZT for many additional years.—Martin Delaney
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