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Brand Name: Combivir

Common Name: zidovudine (AZT) and lamivudine (3TC)

Class:fixed dose combination—nucleoside analogs (also called nucleoside reverse transcriptase inhibitors, NRTIs or nukes)

Standard Dose:One tablet (150 mg Epivir/3TC/lamivudine, 300 mg Retrovir/AZT/zidovudine), twice-a-day (12 hours apart), with no food restrictions (may be taken with or without food). Take missed dose as soon as possible, but do not double up on your next dose.

AWP: $761.83 / month

Manufacturer contact: GlaxoSmithKline,
www.combivir.com, 1 (888) 825–5249

AIDSInfo:1 (800) HIV–0440 (448–0440), www.aidsinfo.nih.gov

Potential side effects and toxicity:

May be taken with food to decrease potential nausea associated with AZT. See drug pages for lamivudine, 3TC (Epivir) and zidovudine, AZT (Retrovir) for more details.
Potential drug interactions:
See lamivudine, 3TC (Epivir) and zidovudine, AZT (Retrovir). Do not take Retrovir or Epivir while taking Combivir since these medications are already in Combivir.
Tips:
Combivir has been shown in multiple clinical trials to be a potent regimen with either a protease inhibitor or NNRTI. It is the combination of lamivudine, 3TC (Epivir) and zidovudine, AZT (Retrovir) into one pill; see the pages of those individual drugs for more information. The AZT in Combivir can cause fatigue and anemia—it isn’t pretty in those at risk for developing anemias (see Retrovir). One head-to-head study against Truvada found greater toxicity with Combivir, due to anemia. But Combivir is still the most proven dual-nuke combo and every doctor out there should be comfortable with managing its side effects. Combivir brings with it one of the “T” drugs, or thymidine analogs (AZT and Zerit)—some clinicians are avoiding those when possible because of implication in lipoatrophy. The wasting of “AZT butt” could be irreversible or take a long time to rebuild. If you are on it though, don’t worry—Combivir is still an effective combination.
Doctor
Until recently, the combination of AZT plus 3TC was the nucleoside backbone of first choice. Advantages included a long history of use with reasonable safety and efficacy. Results of studies such as Gilead Study 934 have reported superior results with tenofovir plus emtricitabine (see Truvada), generally due to a more favorable toxicity profile and tolerability. Advantages of the two other available combined RTI formulations (Truvada or Epzicom) include once-a-day dosing and less effect on mitochondria with a generally more favorable metabolic/fat profile. Only 3TC is active against hepatitis B, which is germane to co-infected patients where hepatitis B monotherapy is often avoided. —Keith Henry, MD
Activist
Combivir was the very first combination antiretroviral drug. Widely hailed in its launch as the beginning of treatment simplification, Combivir has since paved the way for several fixed dose combinations…and we hope that more are yet to come! Easy to take (one pill twice a day), and the same side effect profile as its two component drugs (AZT and 3TC), Combivir remains almost as popular today as it was when it was launched. There are, however, several newer players on the field, and there appears to be some “turf-war” tension going on out there among the companies for share of the market. This has resulted in some not so subtle jabs at the competitors. Note to companies: “As the community we urge you to stop behaving like children. When your drugs are good, they will speak for themselves. Please stick to selling your own drugs rather than trying to trash the competitors. It really does look silly. Now pick up your dollies and play nice.” —Cathy Olufs
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