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Brand Name: Trizivir
Common Name: abacavir, AZT, and lamivudine
Class: nucleoside analog (also called nucleoside reverse transcriptase inhibitor, NRTI or nuke)
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
AIDS Treatment Information Service: 1 (800) HIV–0440 (448–0440)
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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 5% of people (1 in 20) 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.) 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!
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, Hivid, ribavirin, interferon, rifabutin, rifampin, probenecid, methadone, ganciclovir, clarithromycin, pyramethamine, flucytosine, amphotericin B and hydroxyurea.
Tips: Good for Trizivir: when combined with Viread, it was the sole successful nuke-only combination seen so far (see AZT page for more information). A study found that at 48 weeks (a significant amount of time), results were the same as in people taking the well-documented successful combination of Sustiva/Combivir. 39/40 people on Trizivir/Viread had less than 50 viral load at 48 weeks, compared to 40/40 people on Sustiva/Combivir. Taking into account all the people who actually started on therapy (before dropping out or moving away or whatever), the results were still an excellent 70% below 50 viral load. More importantly, only one person experienced virologic failure (not staying below undetectable viral load) on Trizivir/Viread. Both groups also had similar T-cell increases of 165 on Trizivir/Viread vs. 120 for Sustiva/Combivir. The participants were taking HIV medications for the first time, so they can be expected to do better. Still, the study shows that this nucleoside-only drug combination can be taken. The number of people is small, but then, they also started out with high viral load—more than 100,000. That’s impressive. The drug resistance pattern of the AZT in Trizivir is what was found to save the day for the nuke-only combination containing the potent Ziagen and Viread. Still, a nuke-only regimen should only be tried by people with low viral loads (below 50,000)—see treatment guidelines at aidsinfo.nih.gov for a full discussion.
Doctor
Trizivir is the fixed-dose combination of AZT, 3TC, and abacavir. It is dosed twice daily. When initially marketed, it was hoped this three-drug combination could be used as a convenient alternative to the traditional two-class cocktail, potentially allowing providers to spare the use of non-nucleosides and protease inhibitors for later use. Unfortunately, in some studies a significant portion of patients given this triple-agent alone without an agent from another class showed evidence of earlier than expected virologic failures. While there are many patients who have been maintained on this agent alone with no evidence of failure, most providers will only use this drug in combination with another class of antiretroviral medication.—Chad J. Zawitz, MD
Activist
The first and only three drugs in one pill, it’s a triple combo of Ziagen, AZT, and Epivir. Studies showed lack of efficacy in patients, so doctors are not prescribing it alone anymore, although I meet many people who are still taking it by itself and doing fine.—Nelson Vergel
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