Epivir® (Lamivudine, 3TC)
Who should take this?
Epivir has been approved by the FDA to treat HIV infection in adults and in children three months old or older. Epivir is sometimes used to prevent HIV infection in healthcare workers and others who have been accidentally exposed to HIV at work. The FDA has not approved the drug for this use, however.
Lamivudine should not be taken by women who are pregnant. The drug can cause birth defects when it is given in very high doses. Lamivudine can also be passed to a baby through breast milk. Women taking lamivudine should bottlefeed their babies.
Lamivudine is strong medicine. It can have serious side effects, especially in children. Children taking Epivir should be seen often by their doctors.
How is it taken? / Dosage
Epivir is taken by mouth as a tablet or in liquid form. It should be taken with a full glass of water, either with or without food. Epivir is usually taken twice a day in combination with other anti-HIV drugs.
Epivir is often paired with zidovudine (AZT). The two drugs are given in a single tablet of Combivir®. It can also be paired with abacavir sulfate in a tablet called Epizicom® or combined with AZT and abacavir sulfate in a tablet called Trizivir®.
Lamivudine comes in lower dose forms to treat hepatitis B virus. This form is called Epivir-HBV. This lower dose form should not be used by people who have both HIV and hepatitis B.
To make Epivir as effective as possible and to prevent the possibility of drug resistance, Epivir should be taken exactly as directed by the doctor.It is important not to miss a dose. If a dose is missed, it should be taken right away. If it is close to the time of the next dose, skip the missed dose and go back to the regular schedule.
Side Effects
While Epivir has many benefits in fighting HIV, it has some effects that are problems. Epivir can increase the risk of:
- Allergic reactions. Signs of this include difficulty breathing, closing of the throat, swelling of the face and lips and hives. Get emergency medical attention if these signs occur.
- Lactic acidosis, a condition that can be fatal. Symptoms such as nausea, vomiting, unusual stomach pains, weakness, shortness of breath, yellowing of the skin or eyes should be reported to a doctor right away.
- Pancreatitis or inflammation of the pancreas
- Redistribution of the fat on the body. This usually means getting more fat in the neck, between the shoulders (buffalo hump), the breasts and trunk and losing fat from the arms, legs and face.
- Nerve damage
- Kidney disease
- Liver disease, especially if the person is also overweight
Other side effects may include:
- Discharge or swelling of the ear
- Feeling of not being well
- Loss of appetite
- Canker sores
- Depression
- Dizziness
- Fever and chills
- Headache
- Muscle and joint pain
- Nausea, vomiting or diarrhea
- Painful, swollen spots on the neck, armpit or groin
- Problems sleeping
- Skin rash
- Stomach aches
- Tingling, burning, numbness or pain in the hands, arms, feet or legs
- Tiredness
- Unsteadiness or awkward movements
- White spots on the lips, tongue or inside the mouth
Some side effects go away as the body adjusts to the Epivir. If the side effects are troubling or don’t go away, a doctor should be consulted.
Drug Interactions
Sometimes when two drugs are used together they have a bad effect. Sometimes, two drugs used together change how each works. It is important that a person taking Epivir make sure that his or her doctors and pharmacist know all the medications being taken.
A person taking Epivir should avoid also taking:
- Anti-HIV drugs such as Atripla®, an anti-HIV tablet containing efavirenz, emtricitabine and tenofovir; Emtriva® (emtricitabine); Truvada® (emtricitabine and tenofovir combined) and Hivid® (zalcitabine)
- Bactrim® (trimethoprim and sulfamethoxazole) given to treat urinary tract infections
- Interferon alfa 2b/ribavirin, given to treat tumors
- Virazole® (ribavirin), given to treat hepatitis C
Resistance
Prolonged use of Epivir can cause certain changes in HIV structure to occur. Some mutations will prevent Epivir from working against HIV. The key mutation that causes resistance to Epivir can cause the virus to be at least partially resistant to other nucleoside reverse transcriptase inhibitors (NRTIs), including Ziagen® (abacavir) and Hivid® (ddC) and will likely prevent the NRTI Emtriva® (FTC) from working at all against the virus. However, Epivir resistance might make the virus even more sensitive to other NRTIs, most notably Retrovir® and Viread®.
