Adverse reactions have been described in the treatment of patients with HIV with lamivudine and zidovudine in the form of monotherapy or as a combination of these drugs.
For many adverse reactions, it is not known whether they are caused by lamivudine, zidovudine, or a wide range of other drugs used to treat HIV infection, or are a consequence of the underlying disease.
The composition of the drug Zidovudine + Lamivudine includes lamivudine and zidovudine, and therefore, the side reactions described below, by the type and severity of each of these components, may be expected. At present, there is no evidence that the combination of lamivudine and zidovudine has additive toxicity.
Cases of lactic acidosis, sometimes fatal, associated, as a rule, with severe hepatomegaly and steatosis of the liver, were recorded with the use of nucleoside analogues.
Combined Apt can cause redistribution / accumulation of fatty tissue (lipodystrophy), in particular, central obesity, the accumulation of fat in the dorsocervical (buffalo hump) and chest areas, thinning of fat in the limbs or face area.
Application of combined Apt was associated with metabolic disorders such as hypertriglyceridemia, hypercholesterolemia, insulin resistance, hyperglycemia and hyperlactatemia.
In HIV-infected patients with severe immunodeficiency during the onset of combined Apt possibly exacerbation of the inflammatory process against a background of asymptomatic or residual opportunistic infection.
There have also been cases of autoimmune diseases (for example, Graves' disease) developing against the background of restoration of immunity, but the time of primary manifestations varied and the disease could occur many months after initiation of therapy.
Osteonecrosis cases have been reported, especially in patients with typical risk factors, late stage of HIV infection, or long-term use of combined Apt. The frequency of occurrence of this phenomenon is unknown.
Frequency of occurrence is defined as follows: Often (≥ 1/10), often (≥ 1/100 and <1/10), infrequently (≥1 / 1,000 and <1/100), rarely (≥ 1/10 000 and <1/1 000), rarely (<1/10 000, including individual cases). Frequency categories were formed on the basis of clinical studies of the drug and post-registration surveillance.
Lamivudine
Violations of the blood and lymphatic system:
infrequently - neutropenia, anemia, thrombocytopenia;
rarely - true erythrocytic aplasia.
Disturbances from the nervous system:
often - headache, insomnia;
rarely - peripheral neuropathy (paresthesia).
Disturbances from the respiratory system, organs of the chest and mediastinum:
often - cough, nasal symptoms.
Disorders from the gastrointestinal tract:
often - nausea, vomiting, abdominal pain or colic, diarrhea;
rarely - pancreatitis, whose association with lamivudine treatment has not been established. Increase of activity of amylase in blood serum.
Disturbances from the liver and bile ducts:
infrequently - transient increase in the activity of hepatic enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (ACT));
rarely - Hepatitis.
Disturbances from the skin and subcutaneous tissues:
often rash, alopecia;
rarely - angioedema.
Disturbances from musculoskeletal and connective tissue:
often - Arthralgia, muscle disorders;
rarely - rhabdomyolysis.
General disorders and disorders at the site of administration:
often - fatigue, general malaise, fever.
Zidovudine
Violations of the blood and lymphatic system:
often - Anemia (blood transfusion may be required), neutropenia and leukopenia.
These adverse reactions often occur with high doses of zidovudine (1200-1500 mg per day), in patients with advanced HIV infection (especially when reduced bone marrow reserve before the start of treatment) and, in particular, in patients with a CD4 cell count of less than 100 in 1 mm3. In some patients it is necessary to reduce the dose of zidovudine up to cancellation. Neutropenia occurs more often in those patients in whom the number of neutrophils, hemoglobin and vitamin concentrations AT12 in the blood serum reduced at the time of starting treatment with zidovudine;
infrequently - thrombocytopenia and pancytopenia (with bone marrow hypoplasia);
rarely - true erythrocytic aplasia;
rarely aplastic anemia.
Disorders from the metabolism and nutrition:
often - hyperlactatemia;
rarely - lactic acidosis, anorexia.
Disorders of the psyche:
rarely - anxiety and depression.
Disturbances from the nervous system:
Often - headache;
often - dizziness;
rarely - Insomnia, paresthesia, drowsiness, decreased mental activity, convulsions.
Heart Disease:
rarely - cardiomyopathy.
Disturbances from the respiratory system, organs of the chest and mediastinum:
infrequently - Shortness of breath;
rarely - cough.
Disorders from the gastrointestinal tract:
Often - nausea;
often - vomiting, abdominal pain and diarrhea;
infrequently - Flatulence;
rarely - pigmentation of the oral mucosa, taste distortion, dyspepsia, pancreatitis.
Disturbances from the liver and bile ducts:
often - increase in the blood activity of liver enzymes and bilirubin concentrations;
rarely - Liver damage, such as severe hepatomegaly with steatosis.
Disturbances from the skin and subcutaneous tissues:
infrequently rash, itching;
rarely - pigmentation of nails and skin, hives and sweating.
Disturbances from musculoskeletal and connective tissue:
often - myalgia;
infrequently - Myopathy.
Disorders from the kidneys and urinary tract:
rarely - Frequent urination.
Violations of the genitals and mammary gland:
rarely - gynecomastia.
General disorders and disorders at the site of administration:
often general malaise;
infrequently - fever, generalized pain syndrome and asthenia;
rarely - chills, chest pain and flu-like syndrome.