Epzicom/Kivexa (Abacavir + Lamivudine)

Table of Contents

What Is Epzicom?

Epzicom is a pill that contains two drugs used to fight HIV: abacavir (Ziagen) and Epivir (lamivudine, 3TC). Epzicom is manufactured by ViiV Healthcare. In Europe, it is called Kivexa. Generic versions have been tentatively approved under PEPFAR (see Fact Sheet 925).

The drugs in Epzicom are called nucleoside analog reverse transcriptase inhibitors, or nukes. These drugs block the reverse transcriptase enzyme. This enzyme changes HIV's genetic material (RNA) into the form of DNA. This has to occur before HIV's genetic code gets inserted into an infected cell's own genetic codes.

Who Should Take Epzicom?

Epzicom was approved in 2004 for people with HIV infection. Epzicom has not been carefully studied in children.

There are no absolute rules about when to start antiretroviral therapy (ART). You and your health care provider should consider your CD4 cell count, your viral load, any symptoms you are having, and your attitude about taking ART. Fact Sheet 404 has more information about guidelines for the use of ART.

Epzicom should not be used by people under 13 years old or people with a damaged liver.

If you take Epzicom with other antiretroviral drugs (ARVs), you can reduce your viral load to extremely low levels, and increase your CD4 cell counts. This should mean staying healthier longer.

Epzicom provides two drugs in one pill. It can be more convenient to use Epzicom than some other combinations of drugs. This could mean fewer missed doses and better control of HIV.

Although lamivudine can be used to treat hepatitis B, a lower dose is used than for HIV. People with HIV infection should use the higher (HIV) dose. Some people had a flare-up of hepatitis B after stopping lamivudine treatment. People with hepatitis B should not stop taking lamivudine (or Epzicom) without careful monitoring by their health care provider.

What About Drug Resistance?

Many new copies of HIV are mutations. They are slightly different from the original virus. Some mutations can keep multiplying even when you are taking an ARV. When this happens, the drug will stop working. This is called "developing resistance" to the drug. See Fact Sheet 126 for more information on resistance.

Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called "cross-resistance."

Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses.

How Is Epzicom Taken?

Epzicom is taken by mouth as a tablet. The normal adult dose is one tablet, once a day. Each tablet includes 600 milligrams (mg) of abacavir (Ziagen) and 300 mg of lamivudine (Epivir, 3TC).

Epzicom can be taken with food, or between meals.

The dosage of 3TC should be reduced for people who weigh less than 50 kilograms (110 pounds). People who weigh less than 110 pounds should normally not take Epzicom.

What Are the Side Effects?

When you start any ART, you may have temporary side effects such as headaches, high blood pressure, or a general sense of feeling ill. These side effects usually get better or disappear over time.

The most common side effects of Epzicom are the same as with abacavir (Ziagen) and Epivir (3TC). They include nausea, vomiting, fatigue, and headaches. See Fact Sheet 551 for more information on fatigue.

The most serious side effect of abacavir is a hypersensitivity reaction. The FDA recommends a genetic test before using abacavir. This blood test identifies people at high risk of developing the hypersensitivity reaction. People who have this reaction have to stop taking abacavir and cannot take it again. If they do, they will have a serious and possibly fatal reaction. See Fact Sheet 416 for more information on the abacavir hypersensitivity reaction.

The reaction usually starts within two weeks of starting abacavir. Patients had the following symptoms: fever, rash, headache, feeling bad, no energy, nausea, vomiting, diarrhea, stomach pain, cough, shortness of breath, and sore throat. If you develop any of these symptoms while taking Epzicom, call your health care provider immediately.

Levels of lactic acid in the blood (lactic acidosis, see Fact Sheet 556) increase in some people taking nucleoside analog drugs. Liver problems including "fatty liver" may also occur.

How Does Epzicom React With Other Drugs?

Epzicom can interact with other drugs or supplements you are taking. These interactions can change the amount of each drug in your bloodstream and cause an under- or overdose. New interactions are constantly being identified. Make sure that your health care provider knows about ALL drugs and supplements you are taking.

Epzicom should not be taken with d4T (stavudine, Zerit) or emtricitabine (Emtriva, FTC). However, since these are other nucleoside analog drugs, there is very little chance that a health care provider would prescribe them along with Epzicom.

Blood levels of 3TC may be increased by bactrim or septra. See Fact Sheet 535 for more information on these drugs.