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Nombre de Marca: Trizivir
Common Name: abacavir, AZT, and lamivudine
Class:fixed dose combination—nucleoside analogs (also called nucleoside reverse transcriptase inhibitors, NRTIs or nukes)
Standard Dose: One tablet (300 mg Ziagen/abacavir, 150 mg Epivir/3TC/lamivudine, and 300 mg Retrovir/AZT/zidovudine), twice-a-day, 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: $1,164.35 / month
Manufacturer contact: GlaxoSmithKline,
www.treathiv.com, 1 (888) 825–5249
AIDSInfo:1 (800) HIV–0440 (448–0440), www.aidsinfo.nih.gov
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| Potential side effects and toxicity: |
The most common side effects of Trizivir are the same as Epivir, Retrovir, and Ziagen. See those pages for more information. Side effects associated with Trizivir include headache, nausea, upset stomach, and fatigue. May be taken with food to decrease potential nausea associated with AZT. The hypersensitivity reaction (HSR, an allergic-like reaction) warning on abacavir (Ziagen) bears repeating here. Approximately 8% of people taking abacavir experienced hypersensitivity during clinical trials. People who think they are experiencing hypersensitivity must be evaluated by an experienced HIV provider as soon as possible before they stop taking abacavir. If treatment is stopped because of this serious reaction, they can never take abacavir or Trizivir or Epzicom again (called “re-challenging”) because of life-threatening and in a few instances fatal reaction. (This does not apply to missed doses, when there’s no HSR, but watch for symptoms if you’ve stopped the drug for at least a few days). This hypersensitivity usually occurs during the second week of treatment, but may take as long as six weeks to appear, gets progressively worse and resolves quickly (24–48 hours) after permanent discontinuation. Symptoms usually, but not always, include some combination of sudden fever, muscle ache, severe nausea, vomiting or abdominal pain, severe tiredness, respiratory symptoms (cough, difficulty breathing and sore throat) and possibly mild rash. These symptoms are listed on the patient information sheet and warning card that you receive each time you fill your prescription. You should always keep the warning card with you. Hypersensitivity might be confused with flu during flu season, but remember that HSR worsens with every dose. See Epzicom tips. Check with your doctor if you have any side effects after taking this medicine—don’t just stop!
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| Potential drug interactions: |
| See also Epivir, Retrovir and Ziagen for more information. Do not take Retrovir, Epivir or Ziagen while taking Trizivir since these medications are already in Trizivir. If you are taking one of the following medications, consult your doctor or pharmacist before starting Trizivir: Zerit, ribavirin, interferon, rifabutin, rifampin, probenecid, methadone, ganciclovir, clarithromycin, pyramethamine, flucytosine, amphotericin B, doxorubicin and hydroxyurea. |
| Tips: |
Trizivir is the only combination NRTI that has been studied in a randomized, controlled study, but this has shown it to be inferior to the standard treatment of two NRTI plus a PI or NNRTI. U.S. treatment guidelines recommend that Trizivir should only be used if other options are not possible, when there are concerns of certain toxicities or drug interactions.
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| Doctor |
| Trizivir (AZT plus 3TC plus abacavir) is a triple NRTI combination that has generally had modestly less efficacy than Sustiva-based regimens, so that its use as a first line ART regimen is considered acceptable but not recommended by the DHHS Guidelines. Recent three-year results from ACTG 5095 found no advantage to the use of Trivivir plus Sustiva (quad therapy) versus Combivir plus Sustiva (classic triple therapy), highlighting uncertainty of when to use Trizivir during early stages of ART. A number of patients are still doing well on Trizivir as their initial therapy and they frequently continue on that therapy alone. Advantages of Trizivir include relative lack of interaction with TB and many other medications, and little renal toxicity, while disadvantages include the need for twice-a-day dosing and the additive adverse reactions of the individual drugs. 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 |
| This is the first of the “triple combo” pills (it contains three drugs all from the same class of nucleosides). Apart from the potential side effects of its component drugs (see AZT, 3TC, Ziagen), Trizivir is a potent option if you are looking to reduce your pill burden and have not developed previous resistance to any of its ingredients. It was briefly used by itself as a stand-alone therapy, but studies showed that resistance developed quickly for some people. Now it is more commonly prescribed with at least one drug from another class, such as a PI.—Cathy Olufs |
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