Combivir - Zidovudine and lamivudine

Combivir is a fixed-dose combination of two antiretroviral agents that contain Zidovudine and lamivudine. It is used in combination with another antiretroviral agent orally for the treatment of HIV-1 infection.

Combivir dose in Adults

Combivir dose in the treatment of HIV-1 infection in adults:

  • One tablet orally two times a day.

Combivir dose in Childrens

 Note: It should be used with at least one other antiretroviral agent (triple therapy).

Combivir dose in the treatment of HIV-1 infection in children:

  • Children and Adolescents weighing less than 30 kg:

    • The safety and efficacy of this fixed drug combination have not been established for use in children weighing less than 30 kgs.
  • Children and Adolescents weighing 30 kg or more:

    • One tablet orally two times a day.

Combivir Pregnancy Risk Factor: B

  • Combivir (lamivudine in combination with zidovudine) is considered as an alternative to NRTI treatment in pregnancy.
  • Patients who have been prescribed antiretroviral treatment in the past but were not successful, patients with a poor response or intolerant to the current regimen, as well as patients trying to conceive who aren't yet pregnant, but are trying to conceive.
  • Combivir is preferred in pregnancy, but it requires twice daily dosing and can cause hematologic toxicities.

Use of lamivudine or zidovudine during breastfeeding

  • Both zidovudine (lamivudine) and zidovudine (zidovudine) are excreted in breastmilk.
  • For safety in breastmilk, consult individual agents.

Dose in renal disease:

  • CrCl of 50 mL/minute or more:

    • Adjustment in the dose is not necessary.
  • CrCl of less than 50 mL/minute:

    • Avoid using it in patients with a CrCl of less than 50 ml/min.

Dose in patients with liver disease:

Avoid using it in patients with liver disease.


 See individual agents for detailed side effects.

Common Side Effects of Zidovudine Include:

  • Central Nervous System:

    • Headache
    • Malaise
  • Dermatologic:

    • Skin Rash
  • Gastrointestinal:

    • Nausea
    • Anorexia
    • Vomiting
  • Hematologic & Oncologic:

    • Macrocytosis
    • Anemia
  • Hepatic:

    • Hepatomegaly
  • Respiratory:

    • Cough
  • Miscellaneous:

    • Fever

Less Common Side Effects of Zidovudine Include:

  • Cardiovascular:

    • Cardiac Failure
    • ECG Abnormality
    • Edema
    • Left Ventricular Dilation
  • Central Nervous System:

    • Hyporeflexia
    • Irritability
    • Nervousness
    • Chills
    • Fatigue
    • Insomnia
    • Neuropathy
  • Endocrine & Metabolic:

    • Weight Loss
    • Increased Amylase
  • Gastrointestinal:

    • Diarrhea
    • Constipation
    • Stomatitis
    • Abdominal Cramps
    • Abdominal Pain
    • Dyspepsia
    • Increased Serum Lipase
  • Genitourinary:

    • Hematuria
  • Hematologic & Oncologic:

    • Lymphadenopathy
    • Neutropenia
    • Splenomegaly
    • Thrombocytopenia
  • Hepatic:

    • Increased Serum Aspartate Aminotransferase
    • Increased Serum Alanine Aminotransferase,
  • Neuromuscular & Skeletal:

    • Asthenia
    • Arthralgia
    • Musculoskeletal Pain
    • Myalgia
  • Otic:

    • Ear Sign Or Symptom
  • Respiratory:

    • Nasal Congestion
    • Rhinorrhea
    • Abnormal Breath Sounds
    • Wheezing

Side effects (Frequency not defined):

  • Local:

    • Injection site reaction (IV)
    • Irritation at the injection site (IV)
    • Pain at the injection site (IV)

Contraindication to Combivir (Zidovudine and lamivudine) Include:

  • Allergy reactions to zidovudine or lamivudine, or any other component of the formulation.
  • A hemoglobin of less than 7.75 g/dL or a neutrophil count below 750/mm3 is considered to be a low-risk condition (4.65 mg/L).

Warnings and precautions

  • Hematologic toxicities: [US Boxed Warning]

    • It is possible to get hemologic toxicity, including severe anemia or neutropenia, as a result of its treatment.
    • Zidovudine should be used with caution in patients with anemia and neutropenia before initiating therapy.
  • Immune reconstitution syndrome:

    • After antiretroviral treatment, immunorestitution syndrome is common.
    • Patients may develop an immune response to tuberculosis and other indolent infections.
  • Lactic acidosis/hepatomegaly: [US Boxed Warning]:

    • It is well-known that antiretrovirals and nucleoside analogs can cause lactic acidosis.
    • In rare cases, severe hepatomegaly and lactic acidosis can be fatal.
    • Females of all ages and obese people are at greatest risk for lactic acidosis.
    • Patients with hepatotoxicity or clinical evidence of lactic acidosis should be stopped from receiving treatment.
  • Lipoatrophy

    • Lipoatrophy refers to the loss of subcutaneous fats. It can occur after Zidovudine treatment, especially in the face and limbs.
    • The treatment's duration and dose are correlated and may not be reversed if you switch to another drug. In some cases, it may take several months or even years.
    • When starting treatment with combination zidovudine drugs, patients should be closely monitored for signs of lipoatrophy.
  • Myopathy: [US Boxed Warning]

    • Zidovudine may cause symptoms such as myopathy.
  • Chronic Hepatitis B: [US-Boxed Warning]

    • Patients co-infected by HBV or HIV-1 may experience severe acute exacerbations if treatment is stopped.
    • You should monitor the patient for signs of clinical deterioration and perform laboratory tests to rule out acute exacerbations.
    • After treatment is stopped, follow-up monitoring should continue for several weeks.
    • Lamivudine-resistant Hepatitis B infection has been reported in patients treated for HIV-1 with a lamivudine-containing regimen.
  • Hepatic impairment

    • Patients suffering from liver disease should be cautious when taking the drug.
  • Pancreatitis

    • Patients who have had pancreatitis in the past or are at risk for developing it should not use this drug.
    • If you notice any signs or symptoms that suggest pancreatitis, the drug should be stopped immediately.
  • Renal impairment

    • Patients with a CrCl lower than 50 ml/minute should avoid it.

Zidovudine and lamivudine: Drug Interaction

Risk Factor C (Monitor therapy)

Acemetacin

May enhance the adverse/toxic effect of Zidovudine. Specifically, the risk for hematologic toxicity may be increased.

Acyclovir-Valacyclovir

May enhance the CNS depressant effect of Zidovudine.

Cabozantinib

MRP2 Inhibitors may increase the serum concentration of Cabozantinib.

Chloramphenicol (Ophthalmic)

May enhance the adverse/toxic effect of Myelosuppressive Agents.

CloZAPine

Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased.

Dexketoprofen

May enhance the adverse/toxic effect of Zidovudine.

Fluconazole

May decrease the metabolism of Zidovudine.

Ganciclovir-Valganciclovir

May enhance the adverse/toxic effect of Zidovudine. Specifically, hematologic toxicity may be enhanced.

Interferons

May enhance the adverse/toxic effect of Zidovudine. Interferons may decrease the metabolism of Zidovudine.

Levomethadone

May increase the serum concentration of Zidovudine.

Mesalamine

May enhance the myelosuppressive effect of Myelosuppressive Agents.

Methadone

May increase the serum concentration of Zidovudine.

Nitisinone

May increase the serum concentration of OAT3 Substrates.

Orlistat

May decrease the serum concentration of Antiretroviral Agents.

Probenecid

May decrease the metabolism of Zidovudine.

Promazine

May enhance the myelosuppressive effect of Myelosuppressive Agents.

Protease Inhibitors

May decrease the serum concentration of Zidovudine.

Raltegravir

May enhance the myopathic (rhabdomyolysis) effect of Zidovudine.

Rifamycin Derivatives

May decrease the serum concentration of Zidovudine. Exceptions: Rifabutin.

Tenoxicam

May enhance the adverse/toxic effect of Zidovudine.

Teriflunomide

May increase the serum concentration of OAT3 Substrates.

Trimethoprim

May increase the serum concentration of LamiVUDine.

Valproate Products

May increase the serum concentration of Zidovudine.

Risk Factor D (Consider therapy modification)

Clarithromycin

May enhance the myelosuppressive effect of Zidovudine. Clarithromycin may decrease the serum concentration of Zidovudine. Management: Monitor response to zidovudine closely when used with clarithromycin, and consider staggering zidovudine and clarithromycin doses when possible in order to minimize the potential for interaction.

DOXOrubicin (Conventional)

May enhance the adverse/toxic effect of Zidovudine. DOXOrubicin (Conventional) may diminish the therapeutic effect of Zidovudine.

DOXOrubicin (Liposomal)

May enhance the adverse/toxic effect of Zidovudine. DOXOrubicin (Liposomal) may diminish the therapeutic effect of Zidovudine.

Ribavirin (Oral Inhalation)

Zidovudine may enhance the adverse/toxic effect of Ribavirin (Oral Inhalation). Specifically, the risk/severity of anemia may be increased. Management: Due to significantly increased risk of anemia, consider even closer monitoring for anemia than routinely recommended. Alternative therapies should be considered when clinically possible, particularly for patients with other risk factors.

Ribavirin (Systemic)

Zidovudine may enhance the adverse/toxic effect of Ribavirin (Systemic). Specifically, the risk/severity of anemia may be increased. Management: Due to significantly increased risk of anemia, consider even closer monitoring for anemia than routinely recommended for ribavirin. Alternative therapies should be considered when clinically possible, particularly for patients with other risk factors.

Sorbitol

May decrease the serum concentration of LamiVUDine. Management: When possible, avoid chronic coadministration of sorbitol-containing solutions with lamivudine, but if this combination cannot be avoided, monitor patients more closely for possible therapeutic failure associated with decreased lamivudine exposure.

Tolvaptan

May increase the serum concentration of OAT3 Substrates.

Risk Factor X (Avoid combination)

Amodiaquine

Zidovudine may enhance the neutropenic effect of Amodiaquine.

BCG (Intravesical)

Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical).

Cladribine

May enhance the myelosuppressive effect of Myelosuppressive Agents.

Cladribine

Agents that Undergo Intracellular Phosphorylation may diminish the therapeutic effect of Cladribine.

Deferiprone

Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone.

Dipyrone

May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased

Emtricitabine

LamiVUDine may enhance the adverse/toxic effect of Emtricitabine.

Stavudine

Zidovudine may diminish the therapeutic effect of Stavudine.

Monitor:

  • Amylase
  • Bilirubin
  • Clinical features of pancreatitis
  • CBC with MCV and differential and platelet count should be monitored at least every 2 weeks.
  • Observe for hepatomegaly and monitor liver function tests
  • Serum creatinine kinase
  • Viral load, and CD4 count
  • Observe the patient for opportunistic infections
  • Monitor the patient for myopathy
  • Monitor blood lactate levels and signs of acidosis.

How to administer Combivir (Zidovudine and lamivudine)?

  • It may be administered without regard to meals.

Mechanism of action of C0mbivir (Zidovudine and lamivudine):

  • The drugs work together to block reverse transcriptase. 
  • It delays the development of drug resistance. Under each drug, you will find details about MOA and Pharmacology.  

Zidovudine and lamivudine Brand Nmaes (International):

  • Avocomb
  • Avudin
  • Biovir
  • Cipladuovir
  • Combine
  • Combivir
  • Combivir f.c.
  • Diavix
  • Duovir
  • Duovir-D
  • Ganvirel Duo
  • Lamister
  • Lamizidine
  • Lamozid
  • Lamuzid
  • Varivar
  • Virdual
  • Zetavudin
  • Zidolam
  • Zidomax
  • Zidovir Plus
  • Zilarvir
  • Zovilam
  • APO-Lamivudine-Zidovudine
  • Auro-Lamivudine/Zidovudine
  • Combivir
  • TEVA-Lamivudine/Zidovudine

Combivir Bands in Pakistan:

Zidovudine [Tabs 300 mg]

Lamizid Bosch Pharmaceuticals (Pvt) Ltd.

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