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Test Positive Aware Network
Trizivir (Zidovudine/Lamivudine/Abacavir, AZT/3TC/ABC)
January/February 2008
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Brand Name: 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/zidovudine/AZT), 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: $1,358.87/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 those of the drugs it contains: 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 zidovudine. Of note is the hypersensitivity reaction (HSR, an allergic-like reaction) warning on abacavir (Ziagen). See Ziagen. If treatment is stopped because of this serious reaction, 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). 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. A blood test for HLA-B*5701 can identify people at high risk for this reaction. 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 the drugs contained in Trizivir: Epivir, Retrovir and Ziagen for more information. Do not take zidovudine (Retrovir), Epivir, Ziagen, Epzicom, Emtriva, Truvada, or Atripla while taking Trizivir, since all or part of these medications are already in Trizivir or have equivalent medications. If you are taking one of the following medications, consult your doctor or pharmacist before starting Trizivir: Zerit, ribavirin, interferon, Mycobutin (rifabutin), rifampin, probenecid, methadone, Cytovene (ganciclovir), Valcyte (valganciclovir), Biaxin (clarithromycin), Daraprim (pyramethamine), flucytosine, Fungizone (amphotericin B), doxorubicin, and hydroxyurea. |
| Tips: |
See the drugs contained in Trizivir: Epivir, zidovudine (Retrovir), and Ziagen. Trizivir is the only triple 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 NRTIs plus an 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. New Procrit or Epogen warning: if hemoglobin target is above manufacturer’s recommendation (12 g/dL), the risk for serious and life-threatening cardiovascular complications significantly increases. For patients on zidovudine (Retrovir), which is one of the drugs in Trizivir, measure hemoglobin once a week after starting the anemia drugs until hemoglobin has stabilized. Notify healthcare provider if experiencing pain and/or swelling in the legs, worsening in shortness of breath, increases in blood pressure, dizziness or loss of consciousness, extreme tiredness, or blood clots in hemodialysis vascular access ports. Please see package insert for more complete potential side effects and interactions.
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| Doctor |
| Retrovir, more commonly called AZT, was the first drug approved for the treatment of HIV infection, and it prolonged many lives back in the late ’80’s and early ’90’s. It got a new life in the form of Combivir after 3TC became available, experienced another resurrection as part of Trizivir, a once popular “triple-nuke” combination, and has been a cornerstone of therapy in the HAART era. However, AZT’s time has finally passed. Compared to the nukes we’re using now (namely tenofovir and abacavir), it’s weaker, is dosed twice a day, is harder on the stomach, is more prone to resistance, and causes anemia and mitochondrial toxicity, including lipoatrophy. I still have a few patients still taking AZT because of resistance to other drugs (it becomes stronger if you have mutations that cause resistance to 3TC, FTC, abacavir, or tenofovir), but that may change as newer, safer agents become available. So long, AZT, and congratulations on a good, long run! -- Joel Gallant, M.D. |
| Activist |
| Retrovir/AZT was the first drug developed for the treatment of HIV. In subsequent years, activists fought many battles to speed up the drug development process, but the history of AZT demonstrates that the mechanisms and ability to quickly test and approve drugs were present all along. What was lacking, except in the case of AZT, was the will to do it. AZT certainly has served a useful place in the history of treatment for HIV, but it has always come at a price. There is almost a cultural memory of the early and often severe side effects, but people don’t always remember that this was primarily the result of overdosing. When dosed properly, AZT can still have side effects but they are seldom severe. Still, many people today believe it is time to reconsider the whole class of drugs that AZT comes from. Most of them have potentially significant side effects that derive from the very nature of what they are doing. It is difficult to conceive of a drug of this type that would be completely free of side effects. With so many new and relatively non-toxic drugs becoming available in recent years, it may be time to ask whether we can build fully effective regimens that don’t rely on the old paradigm of “two nukes and a protease inhibitor” or “two nukes and a non-nuke.” When this paradigm first became standard in 1996, it wasn’t chosen because this was inherently the right or best way to treat HIV. Rather, it was simply the only kind of combination available at the time. -- Martin Delaney |
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This article was provided by Test Positive Aware Network. It is a part of the publication Positively Aware.
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