Abacavir/lamivudine

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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

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

Common

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