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 into a single fixed-dose tablet. This formulation simplifies treatment regimens while maintaining therapeutic efficacy for HIV-1 infection management. Developed through extensive clinical research, Combivir offers healthcare providers a reliable option for combination therapy in both treatment-naïve and experienced patients. The medication’s balanced pharmacokinetic profile ensures consistent viral suppression while potentially improving adherence through reduced pill burden.
Features
- Fixed-dose combination containing 300 mg lamivudine and 150 mg zidovudine
- Film-coated tablet formulation for improved tolerability
- Bioequivalent to individual component administration
- Manufactured under strict quality control standards
- Stable at room temperature with appropriate storage
- Available in blister packs of 60 tablets
Benefits
- Enhanced Treatment Adherence: Dual therapy in a single tablet reduces daily pill count, supporting consistent medication intake
- Proven Viral Suppression: Demonstrated efficacy in reducing HIV RNA levels across multiple clinical trials
- Simplified Regimen Management: Streamlines complex treatment protocols for both patients and healthcare providers
- Established Safety Profile: Extensive post-marketing surveillance confirms well-characterized risk-benefit ratio
- Flexible Dosing Options: Compatible with various third-agent antiretrovirals in combination regimens
- Cost-Effective Therapy: Potentially reduces overall treatment costs compared to separate component administration
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 therapy regimens and may be used in treatment-experienced patients where the components remain appropriate. The medication is particularly valuable in settings where regimen simplification is desired to support long-term adherence. Healthcare providers often consider Combivir when constructing regimens that balance efficacy, tolerability, and practical administration requirements.
Dosage and direction
The recommended adult dosage is one tablet (containing 300 mg lamivudine and 150 mg zidovudine) taken orally twice daily. Administration should occur with or without food, though consistent timing relative to meals may help maintain steady pharmacokinetics. For pediatric patients weighing at least 30 kg, the same adult dosage applies. Dosage adjustment is required in patients with impaired renal function (creatinine clearance <50 mL/min), typically involving extended dosing intervals rather than tablet splitting. Treatment should be initiated by physicians experienced in HIV management, with regular monitoring of therapeutic response and potential adverse effects.
Precautions
- Hematological Monitoring: Regular complete blood counts are essential due to potential zidovudine-associated bone marrow suppression
- Hepatic Function Assessment: Monitor liver enzymes, particularly in patients with pre-existing hepatitis B or C coinfection
- Lactic Acidosis Vigilance: Watch for symptoms suggestive of lactic acidosis, especially in obese patients or those with prolonged nucleoside exposure
- Lipodystrophy Monitoring: Assess for body fat redistribution over long-term therapy
- Renal Function Evaluation: Regular assessment of creatinine clearance is necessary for appropriate dosing
- Immune Reconstitution: Monitor for inflammatory responses following initiation of therapy
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 (neutrophil count <750 cells/mm³ or hemoglobin <7.5 g/dL). The medication is contraindicated in combination with stavudine due to antagonistic antiviral effects. Use is prohibited in patients with end-stage renal disease not receiving dialysis, and caution is required when co-administering with other medications that may cause similar adverse effects.
Possible side effects
- Common Effects: Headache (approximately 35%), nausea (33%), malaise/fatigue (27%), nasal signs and symptoms (20%)
- Hematological Effects: Anemia (1.9%), neutropenia (5.4%), thrombocytopenia (0.4%)
- Gastrointestinal: Vomiting (15%), diarrhea (18%), abdominal pain (11%)
- Neurological: Insomnia (16%), dizziness (12%), peripheral neuropathy (12%)
- Metabolic: Hyperamylasemia (8%), elevated liver enzymes (3-8%)
- Dermatological: Rash (6%), pruritus (5%)
- Musculoskeletal: Myalgia (8%), arthralgia (5%)
Drug interaction
Combivir exhibits several clinically significant interactions requiring careful management. Concurrent administration with ganciclovir, valganciclovir, or other bone marrow suppressive agents may exacerbate hematological toxicity. Drugs that compete for renal tubular secretion (such as trimethoprim) may increase lamivudine concentrations. Zidovudine metabolism may be affected by drugs that undergo glucuronidation, including probenecid and certain NSAIDs. Combination with other nucleoside analogues requires careful evaluation of potential additive toxicities. Rifampicin may decrease zidovudine levels by approximately 48%, potentially necessitating dosage adjustment.
Missed dose
If a dose is missed within 4 hours of the scheduled time, the patient should take the missed dose immediately. If more than 4 hours have passed, the patient should skip the missed dose and resume the regular dosing schedule. Patients should never double the dose to make up for a missed administration. Consistent timing is important for maintaining therapeutic drug levels, so patients should be counseled to establish routine administration times. Healthcare providers should discuss specific strategies for managing missed doses based on individual patient circumstances and treatment goals.
Overdose
Limited experience exists with Combivir overdose, though symptoms would be expected to reflect component toxicities. Lamivudine overdose may cause minimal symptoms due to wide therapeutic index, while zidovudine overdose could manifest as hematological toxicity, nausea, vomiting, and lethargy. Management should include symptomatic and supportive care, with particular attention to hematological parameters. Hemodialysis removes approximately 70% of lamivudine and 14% of zidovudine, making it potentially beneficial in significant overdoses. Activated charcoal may be considered if administered shortly after ingestion. Patients should be monitored for at least 24 hours with complete blood count assessment.
Storage
Store at controlled room temperature between 15-30°C (59-86°F). Keep in the original container with the lid tightly closed to protect from moisture. Do not store in bathroom areas where humidity fluctuations may occur. Keep away from direct sunlight and heat sources. Do not freeze the medication. Keep out of reach of children and pets. Discard any medication that appears discolored, shows signs of moisture damage, or is past the expiration date printed on the 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 specific dosage recommendations and treatment guidance. Patients should not alter their medication regimen without professional medical consultation. While every effort has been made to ensure accuracy, medical knowledge evolves rapidly, and healthcare providers should consult current prescribing information and clinical guidelines.
Reviews
Clinical studies demonstrate Combivir’s efficacy in maintaining viral suppression with approximately 60-70% of patients achieving HIV RNA <50 copies/mL at 48 weeks when combined with a third agent. Physician surveys indicate high satisfaction with the convenience of fixed-dose combination therapy, particularly noting improved adherence rates compared to separate component administration. Patient-reported outcomes suggest preference for reduced pill burden, though some report persistent gastrointestinal effects during initial treatment phases. Long-term follow-up data confirm maintained efficacy with appropriate monitoring and management of potential adverse effects.