View source for Abacavir/lamivudine

==Administration==
*Type: [[Antiviral]]
*Dosage Forms: TAB 600mg, 300mg
*Routes of Administration: Oral
*Common Trade Names: Epzicom, APO, Auro, Kivexa, MYLAN, PMS, TEVA
*Administered W/WO food.

==Adult Dosing==
===[[HIV]] infection===
*1 tab PO daily (abacavir 600 mg and lamivudine 300 mg)

==Pediatric Dosing==
===[[HIV]] infection===
*>25kg: 1 tab PO daily

==Special Populations==
===[[Drug pregnancy categories|Pregnancy Rating]]===
*Abacavir: Benefits outweigh risks during pregnancy
*Lamivudine: Benefits outweigh risks during pregnancy

===Lactation risk===
*Avoid breastfeeding

===Renal Dosing===
*Adult:
**CrCl <50: Avoid use
*Pediatric:
**CrCl <50: Avoid use

===Hepatic Dosing===
*Adult:
**Child-Pugh Class A: Avoid use
**Child-Pugh Class B or C: Contraindicated
*Pediatric:
**Child-Pugh Class A: Avoid use
**Child-Pugh Class B or C: Contraindicated

==Contraindications==
*Allergy to class/drug
*HLA-B*5701 Positive pts
*Hepatic impairment

==Adverse Reactions==
===Serious===
*Hypersensitivity reaction
*[[Anaphylaxis]]
*[[Stevens-Johnson syndrome]]
*[[Toxic epidermal necrolysis]]
*[[Erythema multiforme]]
*MI
*[[Lactic acidosis]]
*Hepatomegaly w/ steatosis
*[[Pancreatitis]]
*HBV exacerbation, post-treatment
*[[Peripheral neuropathy]]
*[[Anemia]], severe
*[[Rhabdomyolysis]]
*Immune reconstitution syndrome
*Autoimmune disorders

===Common===
*Insomnia, depression, [[fatigue]], abnormal dreams
*[[Headache]], [[dizziness]]
*[[Nausea]], [[diarrhea]], abdominal pain, 
*[[Rash]]
*[[Fever]]
*Anxiety
*Hyperamylasemia

===Disease-related concerns===
*Coronary heart disease: Use associated with increased risk of MI in some cohort studies (Elion 2018; HHS 2017)
*Chronic hepatitis B: Severe acute exacerbations of hepatitis B have been reported in patients who are co-infected with hepatitis B virus (HBV) and HIV-1 and have discontinued lamivudine, which is one component of abacavir/lamivudine.

==Pharmacology==
*Half-life: 
**Abacavir: 1.5h
**Lamivudine: 5-7h
*Metabolism: 
**Abacavir: Liver
**Lamivudine: Intracellular; active metabolite
*Excretion: 
**Abacavir: Urine 82.2% (1.2% unchanged), feces 16%
**Lamivudine: Urine (primarily unchanged)

==Mechanism of Action==
Both drugs inhibit reverse transcriptase and incorporates into viral DNA, resulting in chain termination

==Comments==


==See Also==

*Elion RA, Althoff KN, Zhang J, et al; American AIDS Cohort Collaboration on Research and Design of IeDEA. Recent abacavir use increases risk of type 1 and type 2 myocardial infarctions among adults with HIV. J Acquir Immune Defic Syndr. 2018;78(1):62-72. doi: 10.1097/QAI.0000000000001642. [PubMed 29419568]
*Epzicom (abacavir and lamivudine) [prescribing information]. Research Triangle Park, NC: GlaxoSmithKline; April 2018.
*HHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Updated October 17, 2017. Accessed October 18, 2017.
*Kivexa (abacavir and lamivudine) [product monograph]. Laval, Quebec, Canada: ViiV Healthcare ULC; December 2018.

==References==
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[[Category:Pharmacology]] [[Category:ID]]