lamivudine / zidovudine
Combivir is a combination medication containing two HIV antiretrovirals (ARVs), lamivudine (Epivir) and zidovudine (Retrovir). It's used with other HIV ARVs for the treatment of HIV.
What is Combivir?
What is Combivir used for?
- HIV treatment
How Combivir works
Combivir contains two nucleoside reverse transcriptase inhibitors (NRTIs). They insert themselves into the virus's DNA and stop the DNA-making process. When this happens, the HIV virus can't make copies of itself.
Drug facts
Side effects of Combivir
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Headache (35%)
- Nausea (33%)
- Fatigue/tiredness (27%)
- Runny nose and congestion (20%)
- Cough (18%)
- Diarrhea (18%)
- Nausea and vomiting (13%)
- Muscle and nerve pain (12%)
- Insomnia/difficulty sleeping (11%)
Less Common Side Effects
- Fever or chills
- Dizziness
- Anorexia or low appetite
- Stomach pain and cramps
- Change in mood
- Skin rash
- Joint pain
The following Combivir side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Burning, tingling, numbness, or pain in the hands, arms, feet, or legs
muscle tenderness and weakness
severe stomach pain
skin rash
vomiting
yellow eyes or skin
Incidence not known
Blistering, peeling, or loosening of the skin
chest discomfort or pain
chills
convulsions
dark urine
decreased appetite
difficulty with breathing
difficulty with swallowing
dizziness
faintness
fast, irregular, or pounding heartbeat
fast, shallow breathing
feeling of fullness
general feeling of discomfort
general tiredness and weakness
itching, puffiness, or swelling of the eyelids or around the eyes, face, lips, or tongue
jerking of all extremities
joint or muscle pain
light-colored stools
loss of bladder control
muscle pain, spasms, stiffness, or cramping
red skin lesions often with a purple center
red, irritated eyes
redness, soreness, or itching skin
sensation of pins and needles
sleepiness
sores, ulcers, or white spots in the mouth or on the lips or tongue
sores, welting or blisters
stabbing pain
sudden loss of consciousness
swelling of the feet or lower legs
tingling, burning, numbness, or pain in the hands, arms, feet, or legs
tightness in the chest
troubled with breathing
unsteadiness or awkwardness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Headache
Incidence not known
Blurred vision
body fat redistribution or accumulation
darkening of the skin and mucous membranes
flushed, dry skin
fruit-like breath odor
increased hunger
increased thirst
increased urination
sweating
swelling of the breasts or breast soreness in both females and males
swollen, painful, or tender lymph glands in the neck, armpit, or groin
thinning of the hair
troubled breathing, unexplained
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Combivir
Pros
- Two HIV ARVs in one tablet so you don't have to take as many pills
- Contains lamivudine, which also works against hepatitis B
- Can be taken with or without food
- Available as a generic, which can be more affordable
- The recommended dose is the same for everyone who weighs at least 30 kg
Cons
- Needs to be taken twice daily
- Contains zidovudine, which can cause serious blood and muscle problems
- Not a good option if you have kidney or liver problems since the dose can't be adjusted
- Some people experience fat loss in their face, limbs, and buttocks
- Not a good HIV ARV option if you are going to be treated with ribavirin for hepatitis C
Pharmacist tips for Combivir
- Take 1 tablet twice daily with or without food. Try to space the medication times 12 hours apart and keep it consistent day to day.
- Make sure you're also taking at least one other HIV ARV. Combivir is not a full regimen on its own.
- Don't stop taking Combivir without talking to your healthcare provider first, especially if you have hepatitis B.
- Tell your healthcare providers about all the medications that you take. Combivir doesn't interact with too many medications, but some of the potential interactions can have serious results.
- Have your labs drawn when your provider orders them. They will use your lab results to check if the medication is working and to see if you are having side effects.
Common questions about Combivir
Combivir is very effective against HIV when taken every day with other HIV ARVs. All of the medications work together to lower the amount of virus in your body and prevent the virus from becoming resistant to the medications.
One tablet of Combivir should be taken every 12 hours with or without food. Most people find it helpful to take all of their HIV ARVs together. Pay attention to the food requirements of your other HIV ARV(s); this can help you plan out your schedule.
If you forget your dose of Combivir, take it as soon as you remember unless it's almost time for your next dose. Never double up on doses.
ViiV Healthcare is the original maker of Combivir and still makes the brand name product. It's now available as generic and made by a number of manufacturers.
Yes, Combivir is still used by many people throughout the world. It's not a first-choice option for people starting HIV ARV therapy, but many people have chosen to stay on Combivir since it works well for them and a generic version is available.
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Risks and warnings for Combivir
Combivir can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
BLOOD AND BONE MARROW PROBLEMS
- Risk factors: Advanced HIV | Anemia | Neutropenia
Combivir can cause bone marrow problems, which can lead to anemia and affect your immune system. These effects are more serious when people already have some type of low blood count or advanced HIV. Your provider will draw blood tests regularly to check your blood count. If your numbers become too low, they may lower your dose or recommend switching to a different HIV ARV.
MUSCLE PAIN AND WEAKNESS
- Risk factors: Extended use of Combivir
Taking Combivir for a long time can lead to muscle pain or weakness. Talk to your provider right away if you have unexplained fatigue and muscle pain or weakness all over your body.
LIVER PROBLEMS
- Risk factors: Liver disease | Women | Obesity
Although rare, NRTIs including Combivir can cause a life-threatening liver problem called lactic acidosis with hepatic steatosis. Most of the cases have been in women. Symptoms include appetite loss, stomach pain, muscle pain, fast and shallow breathing, extreme tiredness, and sudden weakness. Stop taking Combivir and go to the emergency room right away if this happens.
WORSENING OF HEPATITIS B
- Risk factors: Hepatitis B virus (HBV) | Stopping Combivir
People who have stopped taking Combivir have had severe worsening of their hepatitis B. Don't stop taking Combivir unless instructed by your healthcare provider. If you are instructed to stop the medication, or switch to a different antiviral medication, make sure you get your labs drawn regularly. This is how your provider will monitor your liver and HBV.
PANCREATITIS
- Risk factors: History of other NRTI use | History of pancreatitis | High risk of pancreatitis
Some children taking Combivir have experienced a condition called pancreatitis. This is when your pancreas becomes inflamed. It's more common in children who have used other NRTIs in the past, had pancreatitis in the past, or have a high risk of getting pancreatitis. Pancreatitis is treatable, but treatment usually requires hospitalization. Talk to your healthcare provider if your child suddenly has severe abdominal pain, nausea, and vomiting.
IMMUNE RECONSTITUTION SYNDROME
- Risk factors: Weakened immune system | Current untreated infection
HIV attacks your immune system. Over time, if the virus isn't treated your body may become defenseless against bacterial and fungal infection. Your HIV medications are very good at killing the virus, and when the number of viruses goes down, your immune system gets started making more cells. Once your immune system gets better, it will start to fight off any infections you might have, which can lead to a lot of inflammation. Even though it's a good thing that your immune system is getting better, too much inflammation can be bad. Your healthcare provider might check for underlying infections (sometimes called opportunistic infections) before starting Combivir especially if it is your first time taking HIV medications. Call your provider if you experience fever, difficulty breathing, or sudden changes to your health after starting Combivir.
FAT REDISTRIBUTION
- Risk factors: Taking HIV ARVs
Some people taking HIV ARVs, including Combivir have noticed changes to the way fat is located in the body. This might be more fat in the abdomen and upper back, and less fat in the face, arms, legs, and buttocks. Scientists and health care providers don't really know why this happens. Switching to a different HIV ARV can help, even if the change isn't 100% reversible.
Combivir dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 150mg/300mg | 60 tablets | $43.02 | $0.72 |
Typical dosage for Combivir
The recommended dose is 1 tablet twice a day. Each tablet contains 150 mg of lamivudine and 300 mg of zidovudine.
Interactions between Combivir and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Cabotegravir
- Clarithromycin
- Dapsone
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Flucytosine
- Horsetail
- Orlistat
- Pexidartinib
- Pyrazinamide
- Pyrimethamine
- Ribavirin
- Sorbitol
- Stavudine
- Vinblastine
- Vincristine
- Vincristine Sulfate Liposome
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acetaminophen
- Fluconazole
- Interferon Beta-1a
- Methadone
- Nelfinavir
- Probenecid
- Rifabutin
- Rifampin
- Rifapentine
- Tipranavir
- Valproic Acid
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