Combivir: Advanced Dual-Therapy for Effective HIV Management
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Combivir represents a significant advancement in antiretroviral therapy, combining two potent nucleoside reverse transcriptase inhibitors (NRTIs) into a single fixed-dose tablet. This formulation streamlines treatment regimens for HIV-1 infection, offering enhanced adherence potential while maintaining therapeutic efficacy. Developed through rigorous clinical research, Combivir has established itself as a cornerstone in combination antiretroviral therapy, providing physicians with a reliable option for both treatment-naïve and experienced patients. Its dual-mechanism approach targets viral replication at critical stages, contributing to sustained viral suppression and immunologic recovery.
Features
- Fixed-dose combination of lamivudine 150mg and zidovudine 300mg
- Film-coated tablet formulation for improved tolerability
- Twice-daily dosing schedule
- Manufactured under current Good Manufacturing Practices (cGMP)
- Stability maintained at room temperature (15-30°C)
- Bioequivalent to individual component administration
Benefits
- Simplified Regimen Management: Reduces pill burden from multiple medications to a single tablet taken twice daily
- Enhanced Treatment Adherence: Streamlined dosing schedule supports consistent medication intake, crucial for maintaining viral suppression
- Proven Virologic Efficacy: Demonstrated effectiveness in reducing viral load and increasing CD4 cell counts in clinical trials
- Established Safety Profile: Extensive post-marketing surveillance and clinical experience support well-characterized risk-benefit ratio
- Flexible Treatment Integration: Compatible with various third agents including protease inhibitors and non-nucleoside reverse transcriptase inhibitors
- Long-term Treatment Sustainability: Maintains efficacy while minimizing development of resistance through dual NRTI mechanism
Common use
Combivir is indicated for the treatment of HIV-1 infection in adults and pediatric patients weighing at least 30 kg, in combination with other antiretroviral agents. It is commonly prescribed as part of initial combination therapy for treatment-naïve patients and may be used in treatment-experienced patients where the components remain active against the patient’s viral strain. The medication is particularly valuable in scenarios where regimen simplification is desired to improve adherence, or when managing patients with complex medication schedules. Clinical decisions regarding its use should consider baseline viral load, CD4 count, potential drug interactions, and patient-specific factors including comorbidities and concomitant medications.
Dosage and direction
The recommended adult dosage is one tablet (containing 150mg lamivudine and 300mg zidovudine) taken orally twice daily. Administration should occur with or without food, though consistent timing relative to meals may help minimize gastrointestinal discomfort. For pediatric patients weighing 30 kg or more, the same adult dosage applies. Dosage adjustment is required in patients with renal impairment (creatinine clearance <50 mL/min) - consult prescribing information for specific guidance. Tablets should be swallowed whole with water and not chewed, crushed, or divided. Treatment should be initiated by physicians experienced in the management of HIV infection.
Precautions
- Hematologic Monitoring: Regular blood counts are recommended due to potential for anemia, neutropenia, and leukopenia
- Lactic Acidosis Risk: Monitor for symptoms of lactic acidosis, particularly in patients with risk factors for hepatic impairment
- Hepatic Function: Assess liver function periodically, especially in patients co-infected with hepatitis B or C
- Pancreatitis Monitoring: Observe for signs of pancreatitis, particularly in pediatric patients with history of pancreatitis
- Lipodystrophy Changes: Long-term use may be associated with fat redistribution
- Immune Reconstitution Syndrome: Inflammatory response may occur during initial treatment phase
- Osteonecrosis: Monitor for joint pain and mobility issues, particularly in patients with risk factors
Contraindications
Combivir is contraindicated in patients with known hypersensitivity to lamivudine, zidovudine, or any component of the formulation. It should not be administered to patients with significantly reduced bone marrow function evidenced by hemoglobin <7.5 g/dL or neutrophil count <0.75 × 10⁹/L. Concomitant use with stavudine is contraindicated due to antagonistic effects. The medication is contraindicated in patients with end-stage renal disease not receiving hemodialysis. Use in patients with hepatic decompensation should be avoided unless no alternative exists.
Possible side effect
Common (≥10%): Headache, nausea, malaise, fatigue, insomnia, nasal signs and symptoms, diarrhea, cough, musculoskeletal pain, neuropathy Less common (1-10%): Anorexia, dizziness, fever, chills, rash, abdominal pain, vomiting, myalgia, arthralgia Rare (<1%): Lactic acidosis, severe hepatomegaly with steatosis, pancreatitis, myelosuppression, hepatic failure, Stevens-Johnson syndrome Laboratory abnormalities: Anemia, neutropenia, thrombocytopenia, elevated liver enzymes, hyperbilirubinemia, elevated amylase
Drug interaction
- Ganciclovir/Valganciclovir: Increased risk of hematologic toxicity
- Ribavirin: Antagonistic effect with zidovudine; avoid concomitant use
- Stavudine: Pharmacologic antagonism; contraindicated
- Doxorubicin: Enhanced hematologic toxicity potential
- Nephrotoxic agents: May affect lamivudine clearance
- Probenecid: May increase zidovudine exposure
- Trimethoprim/Sulfamethoxazole: Increases lamivudine exposure approximately 40%
Missed dose
If a dose is missed, patients should take it as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed dose. Consistent adherence is critical for maintaining viral suppression and preventing resistance development. Healthcare providers should be informed of pattern missed doses to assess adherence support needs.
Overdose
Symptoms of overdose may include fatigue, headache, nausea, vomiting, and hematologic changes including anemia and neutropenia. Cases of neurological symptoms such as dizziness and insomnia have been reported. Management should include supportive care with monitoring of hematologic parameters. Hemodialysis removes lamivudine (approximately 70% over 4 hours) and has been shown to remove zidovudine, though efficacy may vary. There is no specific antidote; treatment should focus on symptomatic support and monitoring for complications.
Storage
Store at controlled room temperature between 15-30°C (59-86°F). Keep container tightly closed and protect from moisture. Do not remove desiccant from bottle. Keep out of reach of children and pets. Do not use if seal is broken or missing. Avoid storage in bathrooms or other areas with high humidity. Discard any unused medication after expiration date printed on packaging.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions must be made by qualified healthcare professionals based on individual patient circumstances. The prescribing physician should be consulted for complete prescribing information. Patients should not alter or discontinue medication without medical supervision. While every effort has been made to ensure accuracy, medical knowledge evolves and the most current prescribing information should always be consulted.
Reviews
Clinical studies demonstrate Combivir’s efficacy in maintaining viral suppression with 72-85% of patients achieving undetectable viral loads (<50 copies/mL) at 48 weeks when combined with a third agent. Patient-reported outcomes indicate high satisfaction with regimen simplicity, though some note gastrointestinal effects during initiation phase. Long-term follow-up studies show sustained virologic response and immunologic improvement over 5-year periods. Healthcare providers report improved adherence rates compared to multi-tablet regimens, particularly in patients with complex treatment histories. Real-world evidence supports its position as a valuable component of modern antiretroviral strategies.