Abacavir + Lamivudine + Zidovudine (Abacavirum + Lamivudinum + Zidovudinum)

Pharmacodynamics Pharmacokinetics Indications Carefully Contraindications Dosing and Administration Side effects
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Clinical and pharmacological group: & nbsp

Means for the treatment of HIV infection

Included in the formulation
  • Akimasol
    pills inwards 
    FARMASINTEZ, JSC (Irkutsk)     Russia
  • Trizivir®
    pills inwards 
    VeeV Helsker United Kingdom Limited     United Kingdom
    • Included in the list (Order of the Government of the Russian Federation No. 2782-r of 30.12.2014):

    VED

    АТХ:

    J.05.A.R.04   Abacavir + Lamivudine + Zidovudine

    Pharmacodynamics:

    Lamivudine, zidovudine and abacavir are subsequently metabolized by intracellular kinases to 5'-triphosphates. Lamivudine triphosphate, zidovudine triphosphate and abacavir triphosphate are substrates and competitive inhibitors of HIV reverse transcriptase. The main mechanism of their antiviral activity is the introduction of triphosphate forms of these drugs into a chain of viral DNA with its subsequent breakage. Lamivudine, zidovudine and abacavir have a significantly lower affinity for DNA polymerases of host cells.

    Lamivudine and zidovudine have a high synergism of action and inhibit HIV replication in cell culture. Abacavir in vitro also showed synergy with zidovudine and an additional effect in combination with lamivudine.

    Pharmacokinetics:

    After oral administration lamivudine, abacavir and zidovudine It is quickly and well absorbed from GIT, the absolute bioavailability in adults is about 80-85%, 83% and 60-70%, respectively. Eating food reduces absorption of the drug (Cmax decreases by an average of 18-32%) and increases Tmax (approximately 1 hour), but does not affect the amount of absorption. The average volume of distribution for lamivudine, abacavir and zidovudine is 1.3; 0.8; 1.6 l / kg, respectively. Lamivudine has a linear pharmacokinetics in the entire range of therapeutic doses and a low ability to bind to plasma albumin (less than 36% in vitro). Binding to plasma proteins zidovudine ranges from 34 to 38%, and abacavir - approximately 49%. This indicates that for the drug the probability of interaction with drugs by displacing them from binding sites with proteins is not high. Lamivudine, abacavir and zidovudine go through blood-brain barrier and are found in cerebrospinal fluid. The average value of the ratio of concentration of lamivudine and zidovudine 2-4 hours after oral administration in cerebrospinal fluid and serum was 0.12 and 0.5, respectively. The ratio of abacavir concentration in cerebrospinal fluid and plasma (AUC) is 30-44%. The mean concentration of abacavir in cerebrospinal fluid 1.5 hours after taking the dose of 300 mg was 0.14 μg / ml, after taking a dose of 600 mg in 0.5-1 hour, it was 0.13 μg / ml and after 3-4 hours it increased to 0.74 μg / ml.

    Lamivudine is excreted from the body by the kidneys in unchanged form. Drug interactions of lamivudine are unlikely due to a small hepatic metabolism (5-10%) and weak binding to plasma proteins. 50-80% of the accepted dose of zidovudine is excreted by the kidneys in the form of 5'-glucuronide. Abacavir primary metabolized in the liver with the participation of alcohol dehydrogenase and through glucuronization formed its metabolites - 5'-carbolic acid and 5'-glucuronic acid, constituting 66% of the dose of the drug that is excreted in the urine, less than 2% of abacavir is excreted unchanged in the urine.

    Half-life lamivudine - 5-7 hours. The prevalence of renal clearance (more than 70%), elimination is carried out using the transport system of organic cations, and the average system clearance is approximately 0.32 l / h / kg. Elimination of lamivudine is impaired in renal failure, so when ground clearance creatinine ≤ 50 mL / min, a dose reduction is necessary.

    When intravenous introduction of zidovudine half-life, systemic and renal clearance was 1.1 h; 1.6 and 0.34 l / h / kg, respectively. The concentration of zidovudine in plasma increases with severe renal failure.

    Average half-life Abacavir is approximately 1.5 hours. With repeated intake of 300 mg twice a day, significant cumulation of abacavir is not observed. Abacavir metabolized in the liver, the subsequent elimination of metabolites is carried out by the kidneys. Abacavir and its metabolites make up about 83% of the dose received in the urine, the rest is excreted with feces.

    Patients with impaired liver function. In patients with cirrhosis of the liver, cumulation of zidovudine may be observed due to a decrease in glucuronization. The pharmacokinetics of lamivudine is not significantly impaired with moderate and severe hepatic insufficiency. Abacavir Primarily metabolized in the liver. With mild hepatic insufficiency, there is an average increase AUC in 1.89 times, and half-life - in 1,58 times. The rate of formation and excretion of its metabolites is reduced. Thus, with mild hepatic insufficiency, a reduction in the dose of abacavir is recommended, with moderate to severe - the use of abacavir is contraindicated.

    Patients with impaired renal function. With renal failure, a decrease in renal clearance of lamivudine is observed and its elimination is disturbed. When ground clearance creatinine <50 ml / min is recommended to reduce the dose of the drug. The concentration of zidovudine in plasma increases with severe renal failure. Abacavir metabolized in the liver and less than 2% of the drug is excreted unchanged in the urine. The pharmacokinetics of abacavir are the same in the final stage of renal failure and with preserved kidney function. When adjustment of the dose of lamivudine and zidovudine is required (clearance creatinine <50 ml / min), it is preferable to prescribe lamivudine, zidovudine and abacavir apart.

    Indications:HIV infection in adults and children over 12 years of age as antiretroviral therapy.
    ICD-10

    I.B20-B24.B24   Disease caused by human immunodeficiency virus [HIV], unspecified

    Contraindications:

    - hypersensitivity, liver failure;

    - neutropenia (less than 0.75 × 109/ l), a decrease in the concentration of hemoglobin (less than 75 g / l or 4.65 mmol / l);

    - Children's age (up to 12 years);

    - body weight less than 40 kg;

    - lactation.

    Carefully:

    Inhibition of bone marrow hematopoiesis, deficiency of cyanocobalamin or folic acid, hepatic insufficiency, overweight,long-term administration of nucleoside analogues; renal failure, pancreatitis (including in history), peripheral neuropathy (including in the anamnesis); pregnancy.

    Pregnancy and lactation:

    FDA Action Category - C.

    The effects of abacavir, lamivudine and zidovudine on fertility in women have not been studied to date. With respect to zidovudine, it is shown that its use in men does not affect the number, morphology and motility of spermatozoa.

    There are data from experimental studies on the effects of abacavir, lamivudine and zidovudine on fetal development in animals. Therefore, during pregnancy, the drug is prescribed only if the intended benefit to the mother exceeds the potential risk to the fetus.

    There is evidence of a slight transient increase in serum lactic acid concentrations, possibly due to mitochondrial disorders, in newborns and infants whose mothers during pregnancy and in the perinatal period received nucleoside reverse transcriptase inhibitors. The clinical significance of this is not currently established.

    In addition, there are some reports of developmental delay, convulsive seizures and other neurological disorders. However, the causal relationship of these disorders to the effect of nucleoside reverse transcriptase inhibitors during the intrauterine and postpartum periods has not been established. These data do not abolish existing recommendations for antiretroviral treatment during pregnancy to prevent vertical transmission of HIV.

    Experts recommend that HIV-infected women, when possible, avoid breastfeeding to prevent their infection with HIV. The concentration of lamivudine and zidovudine in breast milk is comparable to their concentration in serum. It is assumed, although it is not proved that abacavir also excreted in breast milk. Women who take the medicine are not recommended to breastfeed.

    Dosing and Administration:

    If it is necessary to cancel or reduce the dose of one of the active components of the drug, they are prescribed as separate preparations of abacavir, lamivudine and zidovudine.

    The recommended dose of the drug for adults and children over 12 years - 1 tablet 2 times a day, regardless of food intake.

    If the body weight of a teenager or adult is below 40 kg, the drug is not prescribed, since the dose of each active substance in the pill is fixed, that is, a reduction in the dose for each active substance alone is not possible.

    Side effects:

    From the cardiovascular system: cardiomyopathy.

    Hematologic side reactions caused by zidovudine. Anemia (which requires blood transfusion), neutropenia, leukopenia and aplastic anemia develop with high doses of zidovudine (1200-1500 mg in day) and in patients with a developed clinical picture HIV-infection, especially with a CD4 cell count of less than 100 /mm3. The frequency of occurrence of neutropenia increases in cases when the amount of neutrophils, hemoglobin and vitamin B content are reduced before the initiation of zidovudine12.

    From the gastrointestinal tract: nausea, vomiting, diarrhea, pain in the upper abdomen, anorexia, pigmentation of the oral mucosa, flatulence.

    From the side of the blood: anemia, aplasia of the erythrocyte sprout of the bone marrow, neutropenia, thrombocytopenia, leukopenia, pancytopenia.

    From the liver / pancreas: transient increase in the activity of hepatic enzymes, serum amylase, bilirubinemia, pancreatitis, severe hepatomegaly with steatosis.

    From the side of metabolism and endocrine system: lactic acidosis.

    From the musculoskeletal system: muscle damage, rarely - rhabdomyolysis, myalgia, myopathy, arthralgia.

    From the nervous system / mental: headache, insomnia, peripheral neuropathy, paresthesia, dizziness, drowsiness, convulsions, anxiety, depression, decreased thinking speed.

    From the respiratory system: cough, shortness of breath.

    From the skin: rash without systemic symptoms, alopecia, pigmentation of nails and skin, urticaria, pruritus, sweating, very rarely erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome).

    Other: fever, lethargy, fatigue, malaise, anorexia, frequent urination, taste perversion, pain syndrome, chills, chest pain, flu-like syndrome, gynecomastia, asthenia.

    Overdose:

    FROMno overdose was noted.Symptoms of acute poisoning with zidovudine and lamivudine, other than unwanted reactions for these drugs, are unknown. There were no cases of a lethal outcome with an overdose of zidovudine and lamivudine. Clinical studies of abacavir, when administered in single doses not exceeding 1200 mg, and in daily doses not exceeding 1800 mg, did not reveal unexpected undesirable reactions. The effects of abacavir in higher doses have not been studied to date.

    Treatment: in case of an overdose, patients are observed to detect symptoms of poisoning and, if necessary, to carry out standard maintenance therapy. Because the lamivudine is derived by dialysis, with overdose it is possible to resort to prolonged hemodialysis, although its effectiveness in this situation has not been studied. Although hemodialysis and peritoneal dialysis are ineffective for the excretion of zidovudine, they accelerate the elimination of its metabolite - glucuronide. How effective are hemodialysis and peritoneal dialysis for the removal of abacavir, is still unknown.
    Interaction:

    Clinically significant interactions between abacavir, zidovudine and lamivudine were not observed.Since the composition of the drug includes 3 substances, the drug interactions that occur in each of them are retained in the combined preparation.

    Drug interactions due to the presence of abacavir

    Ethanol: the metabolism of abacavir is disturbed by simultaneous administration with ethanol, which leads to an increase in AAC of abacavir by approximately 41%. Given the safety profile of abacavir, these data are not considered clinically relevant. Abacavir does not affect the metabolism of ethanol.

    Methadone: in the study of pharmacokinetics of drugs with concomitant administration of abacavir (600 mg twice daily) and methadone, there was a decrease in Cmax abacavir by 35% and a decrease in the time to reach Cmax for 1 h, however AUC remained unchanged. Changes in the pharmacokinetics of abacavir have not been clinically significant. In this study abacavir increased the average total methadone clearance by 22%. This change was not clinically significant in most patients, but there may sometimes be a need for a methadone dose adjustment.

    Drug interactions due to the presence of lamivudine

    Trimethoprim: taking trimethoprim / sulfamethoxazole 160 mg / 800 mg (co-trimoxazole) causes an increase in lamivudine exposure by 40%, which is due to the presence of trimethoprim. However, except for patients with renal failure, a dose adjustment of lamivudine is not required. Lamivudine does not affect the pharmacokinetics of trimethoprim and sulfamethoxazole. Joint use of lamivudine with higher doses of co-trimoxazole used to treat pneumonia (caused by Pneumocystis carinii) and toxoplasmosis, has not been studied.

    Zalcitabine: lamivudine can inhibit intracellular phosphorylation of zalcitabine with simultaneous administration of these drugs. In this regard, it is not recommended to take the drug in combination with zalcitabine.

    Drug interactions due to the presence of zidovudine

    With lamivudine: The combined use of zidovudine and lamivudine leads to an increase in exposure to zidovudine by 13% and an increase Cmax in plasma by 28%, but the total exposure (AUC) is not significantly disturbed. An increase in these indicators does not require a dose adjustment. Zidovudine does not affect the pharmacokinetics of lamivudine.

    With phenytoin: concentration of phenytoin in the blood of patients receiving zidovudine, is usually low, but in some cases it may increase, so when phenytoin is combined with a combination drug, it is necessary to control the level of phenytoin.

    With drugs that block tubular secretion: these medicines increase the average half-life and AUC zidovudine by reducing glucuronization, while renal excretion of glucuronide (and, possibly, zidovudine itself) decreases.

    With ribavirin: since the nucleoside analogue ribavirin is an antagonist of zidovudine, this combination of drugs should be avoided.

    With rifampicin: when combined zidovudine and rifampicin AUC zidovudine decreased by 48 ± 34% (the clinical significance of this change is unknown).

    With stavudine: zidovudine can suppress intracellular phosphorylation of stavudine when administered concomitantly, therefore stavudine not recommended to combine with the drug.

    The combination of a combination drug with potentially nephrotoxic and myelosuppressive drugs (such as pentamidine, dapsone, pyrimethamine, co-trimoxazole, amphotericin B, flucytosine, ganciclovir, interferon, vincristine, vinblastine, doxorubicin) increases the risk of adverse reactions to zidovudine. In cases where such therapy is necessary, increased attention should be paid to monitoring kidney function and blood counts, if necessary, the dosage of drugs should be reduced.

    With extreme caution, the drug should be used in combination with acetylsalicylic acid, codeine, morphine, methadone, indomethacin, ketoprofen, naproxen, oxazepam, lorazepam, cimetidine, clofibrate, dapsone, inosine pranobex because they disrupt its metabolism through competitive inhibition of glucuronidation or direct suppression of microsomal oxidation in the liver.

    Special instructions:

    According to clinical studies, about 5% of patients taking abacavir, hypersensitivity to the drug develops, in rare cases with a fatal outcome.

    Risk factors

    In clinical studies, carriage of the HLA-B * 5701 allele has been shown to significantly increase the risk of a hypersensitivity reaction to abacavir.In the prospective clinical trial CNA106030 (PREDICT-1), patients with the presence of the HLA-B * 5701 allele were not given abacavir preparations, which significantly reduced the incidence of clinically suspected hypersensitivity reactions from 7.8% (66 patients out of 847) to 3.4% (27 patients out of 803), as well as the incidence of hypersensitivity reactions confirmed by the skin-application test from 2.7% (23 patients out of 842) to 0.0% (0 patients from 802). Thus, based on the results of this study, it was shown that hypersensitivity reactions to abacavir develop in patients carrying the HLA-B * 5701 allele at a frequency of 48-61% compared to patients who do not have this allele (frequency of hypersensitivity reactions 0 -4 %).

    Clinicians are advised to screen for carriage of the HLA-B * 5701 allele in HIV-infected patients who have not previously been prescribed drugs containing abacavir.

    Screening for the carriage of the HLA-B * 5701 allele is recommended before reassignment of the abacavir-containing drug in patients with an unknown HLA-B * 5701-status who previously had a good abacavir-containing drug.

    The use of abacavir drugs is not recommended in such patients and should be considered only in exceptional cases with careful medical supervision when the potential benefit exceeds the risk of using the drug.

    The clinical diagnosis of suspected hypersensitivity reactions should remain the basis for deciding the use of drugs containing abacavir, in all patients. Even in the absence of the HLA-B * 5701 allele abacavir it is necessary to cancel and not to resume its reception in all cases when the hypersensitivity reaction can not be ruled out, guided by clinical data, because of the potential risk of serious adverse effects or even death.

    Clinical picture

    The reaction of hypersensitivity is characterized by the appearance of symptoms of multiple organ failure. Most patients have fever and / or rash.

    Other possible symptoms of hypersensitivity include weakness, malaise, symptoms of gastrointestinal tract damage (such as nausea, vomiting, diarrhea, abdominal pain), respiratory symptoms (such as shortness of breath,sore throat, cough), as well as radiographic signs of lesions of the chest (mainly, limited infiltrates). Symptoms of hypersensitivity reactions in the treatment of abacavir can be observed at any time, however, usually appear within the first six weeks of taking the drug. With the continuation of treatment, the severity of the symptoms increases, and they can take a life-threatening character. In most cases, these symptoms disappear when discontinuing abacavir.

    Some patients with hypersensitivity initially believed that they suffer from respiratory (pneumonia, bronchitis, pharyngitis) or flu-like diseases, gastroenteritis or reactions to other medications. In this regard, the hypersensitivity reaction was not diagnosed immediately, and patients continued (or resumed) the drug. This entailed the development of a more severe hypersensitivity reaction (up to a lethal outcome). Taking this into account, it is necessary to take into account the possibility of developing such a reaction and to exclude it in patients who have symptoms of these diseases.If it is impossible to exclude the presence of a hypersensitivity reaction, resume taking the drug or any other drug containing abacavir, do not do it.

    Symptoms caused by hypersensitivity reactions increased with continued treatment and usually disappeared after discontinuation of abacavir.

    The resumption of abacavir after a hypersensitivity reaction for several hours leads to a rapid return of symptoms. Recurrence of hypersensitivity reactions may be more severe, compared with the first reaction, and accompanied by life-threatening lowering of blood pressure (up to a lethal outcome). Patients who have experienced this hypersensitivity reaction should stop and never resume taking the drug, as well as any other medications containing abacavir.

    There are isolated reports of the development of a hypersensitivity reaction after resuming admission of abacavir, which was canceled when certain key symptoms of hypersensitivity appear (rash, fever, weakness / malaise, gastrointestinal disorders or respiratory symptoms).In very rare cases, the development of a hypersensitivity reaction has been reported after resumption of treatment with patients who have not previously experienced hypersensitivity symptoms.

    Treatment

    Patients, regardless of HLA-B * 5701-status, who have signs and symptoms of hypersensitivity, MUST immediately contact their doctor for advice. When making a diagnosis of hypersensitivity, SHOULD immediately stop taking the drug. NEVER SHOULD RESUME TREATMENT OF THE MEDICINE AND OTHER MEDICINES CONTAINING abacavir (such as Ziagen, Trizivir), after the occurrence of a hypersensitivity reaction. This is due to the threat of appearance within a few hours after the resumption of taking the drug of severe symptoms (including life-threatening hypotension), which can lead to death.

    Lactic acidosis, hepatomegaly and fatty liver disease

    There are reports of the development of lactic acidosis, hepatomegaly and fatty liver disease, including fatal outcomes, due to antiretroviral therapy with nucleoside analogues in the form of individual drugs, including abacavir, lamivudine and zidovudine or combinations thereof. In most cases, these complications occur in women.

    Symptoms that indicate lactic acidosis include general weakness, decreased appetite, rapid weight loss of unclear etiology, impaired gastrointestinal tract and respiratory system disorders (dyspnea and tachypnea).

    The use of the drug in any patient requires caution, especially if there are risk factors for liver damage. When clinical or laboratory signs of lactic acidosis or hepatotoxic effects appear (hepatomegaly and fatty liver dystrophy, even in the absence of a marked increase in aminotransferase activity) treatment should be stopped.

    Redistribution of subcutaneous fat

    Treatment with combined antiretroviral drugs may be accompanied by one or more of the following symptoms: obesity, redistribution of subcutaneous fat with fat deposits on the face, trunk, neck (buffalo buffalo), atrophy of peripheral muscles and facial muscles, gynecomastia, increased serum lipid concentration and the level of glucose in the blood.

    All these symptoms are related to lipodystrophy. One or more of these symptoms may occur when treated with any HIV protease inhibitors and nucleoside reverse transcriptase inhibitors. However, the risk of these unwanted reactions in the treatment with different drugs of these two groups is not the same.

    Lipodystrophy has a complex etiology and can develop under the influence of various factors that can act synergistically. For example, an important role in its development is played by HIV infection itself, the elderly patient's age and the duration of antiretroviral treatment.

    The long-term consequences of these undesirable phenomena are still unknown.

    At physical examination it is necessary to pay attention to the redistribution of subcutaneous fat. A laboratory test should include the determination of serum lipid concentrations and blood glucose levels. If the lipid metabolism is disturbed, an appropriate treatment is prescribed.

    Hematologic adverse reactions

    Treatment with zidovudine may lead to the development of anemia, neutropenia and leukopenia (usually secondary due to neutropenia).These complications are more common in the treatment of high doses of zidovudine (1200-1500 mg per day), as well as in cases when the patient is experiencing oppression of hematopoiesis, in particular, in the late stages of HIV infection. In this regard, in patients taking the drug, it is necessary to carefully assess the hematological parameters

    Hematologic disorders usually occur no earlier than 4-6 weeks after initiation of treatment. In the late stages of HIV infection during the first three months of treatment, a blood test is recommended at least every 2 weeks, then at least monthly. For therapy initiated in the early stage of HIV infection, hematologic side effects are atypical. Depending on the general condition of the patients, a blood test can be performed less often, for example, every 1-3 months.

    With the development of severe anemia and severe myelosuppression under the action of the drug, as well as in the presence of hematologic disorders prior to treatment, for example, with a hemoglobin level below 9 g / dL (5.59 mmol / L) or neutrophil count below 1.0×109/ l, a dose adjustment of zidovudine may be required. Since the dose of zidovudine can not be changed in the composition of the drug, such patients are prescribed certain preparations of zidovudine, abacavir and lamivudine.

    Pancreatitis

    On a background of treatment with abacavir, lamivudine and zidovudine, pancreatitis is rare in rare cases, although it is still unclear whether it is caused by the action of these drugs or is a consequence of HIV infection. When clinical or laboratory signs of pancreatitis appear, treatment is immediately stopped.

    Patients with concomitant viral hepatitis B

    Clinical studies and post-marketing data on the use of lamivudine suggest that some patients with concomitant viral hepatitis B may develop clinical or laboratory signs of hepatitis relapse after stopping lamivudine. Discontinuation of lamivudine may have more severe consequences in patients with decompensated liver damage. Therefore, in patients with concomitant viral hepatitis B, when the drug is withdrawn, it is necessary to monitor the performance of functional liver samples and regularly determine the level of replication of the hepatitis B virus.

    Concomitant Hepatitis C

    The causes of worsening anemia with ribavirin with concomitant antiretroviral therapy with zidovudine are not well understood, therefore it is not recommended to combine preparations containing zidovudine with ribavirin; if zidovudine already included in combined antiretroviral therapy, this regimen should be reviewed, especially for patients who have an anemia in the history of zidovudine.

    Immunodeficiency Syndrome

    If HIV-infected patients with severe immunodeficiency are asymptomatic or asymptomatic opportunistic infections at the time of initiation of antiretroviral therapy, such therapy may lead to an increase in the symptoms of opportunistic infections or other severe consequences. Usually, these reactions occur within the first weeks or months after the onset antiretroviral therapy. Typical examples are cytomegalovirus retinitis, generalized or focal infection caused by mycobacteria, and pneumonia caused by Pneumocystis jiroveci (P. carinii). The appearance of any symptoms of inflammation requires immediate examination and, if necessary, treatment.

    Opportunistic infections

    The use of a drug or other antiretroviral drugs does not exclude the possibility of developing opportunistic infections or other complications of HIV infection, so patients should remain under the supervision of a doctor who has experience in the treatment of these diseases.

    Transmission of HIV infection

    Patients need to be explained that carrying out antiretroviral therapy, including with the use of the drug, does not reduce the risk of transmission of HIV to others through sexual and parenteral routes, and therefore does not negate the need for appropriate precautions.

    Myocardial infarction

    As a result of a prospective, observational, epidemiological study in order to study the incidence of myocardial infarction in patients receiving combined antiretroviral therapy, a previous connection, within 6 months, of abacavir with an increased risk of myocardial infarction was found. According to the generalized analysis of clinical studies, there was no increase in the risk of myocardial infarction associated with abacavir. Biological mechanisms that explain a potentially increased risk are unknown. In general, the available data from observing cohorts and controlled clinical studies do not allow one to unequivocally determine the relationship between abacavir therapy and the risk of myocardial infarction.

    However, care should be taken to prescribe antiretroviral therapy, including drugs containing abacavir, patients with a possible risk of coronary heart disease. It is necessary to take all measures to minimize risk factors (such as arterial hypertension, dyslipidemia, diabetes and smoking).

    Concomitant treatment

    Patients should be cautioned against self-medication with any form of medication.

    Selection of doses

    If you need individual selection of doses appoint individual drugs abacavir, lamivudine and zidovudine. However, in this case, the physician should become familiar with the information on each of these drugs.

    Data on the pharmacokinetics of the drug y persons over 65 years of age are absent. In connection with the possibility of age-related changes, including a decrease in kidney function and hematological disorders, the prescription of the drug to persons of this age group requires special care.

    Impaired renal function may require a reduction in the dose of lamivudine or zidovudine. Concerning, patients with impaired renal function (creatinine clearance less than 50 ml / min) is recommended abacavir, lamivudine and zidovudine in the form of separate preparations.

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