Lamivudine + Stavudine + Nevirapine

Indications

Lamivudine + Stavudine + Nevirapine is used for: HIV infection

Adult Dose

Oral HIV infection Adult <60kg: 1 tab twice daily

Child Dose

Renal Dose

Administration

May be taken with or without food.

Contra Indications

Hypersensitivity. Lactation. Severe hepatic impairment.

Precautions

Patient w/ hepatomegaly, hepatitis or other risk factors for hepatic disease; childn w/ history or risk factors for pancreatitis. Pregnancy. Monitoring Parameters Monitor amylase, bilirubin, liver enzymes 3 mthly during therapy; haematologic parameters, HIV viral load, CD4 count; signs and symptoms of pancreatitis or hepatonecroinflammation; hepatitis B virus (HBV) DNA regularly during therapy. Monitor hepatic function for several mth following discontinuation of therapy. Perform HIV testing prior to and periodically during treatment.

Pregnancy-Lactation

Interactions

Antiviral effect inhibited by zidovudine, doxorubicin and ribavirin. Avoid concurrent admin with drugs that cause pancreatitis (e.g. IV pentamidine) or peripheral neuropathy (e.g. metronidazole, isoniazid and vincristine). Increased risk of adverse effects such as hepatoxicity, peripheral neuropathy and pancreatitis if used with hydroxycarbamide and didanosine. May antagonise the antiviral action of zalcitabine. May enhance the adverse effect of emtricitabine.

Side Effects

Side effects of Lamivudine + Stavudine + Nevirapine : Abdominal pain, nausea, vomiting, diarrhoea, headache, fever, rash, alopecia, malaise, insomnia, cough, nasal symptoms, arthralgia, musculoskeletal pain, pancreatitis, anaemia, neutropenia, thrombocytopenia, immune reconstitution syndrome, lipodystrophy, metabolic abnormalities (e.g. hypertriglyceridaemia, hypercholesterolaemia, insulin resistance, hyperglycaemia, hyperlactataemia), osteonecrosis; increased creatine phosphokinase, liver enzymes and serum amylase. Rarely, rhabdomyolysis. Potentially Fatal: Lactic acidosis, hepatomegaly w/ steatosis. Severe and life-threatening hepatotoxic and skin reactions.

Mode of Action

Lamivudine, a synthetic nucleoside analogue, is phosphorylated into the body to the active 5'-triphosphate metabolite. It inhibits RNA- and DNA-dependent polymerase activities of reverse transcriptase via DNA chain termination. Stavudine is converted intracellularly to the active metabolite stavudine 5'-triphosphate which is then incorporated into the viral DNA by reverse transcriptase resulting in premature ending of the DNA chain elongation. Nevirapine is a non-nucleoside reverse transcriptase inhibitor that acts against HIV-1. It binds directly to reverse transcriptase and thereby blocks the RNA-dependent and DNA-dependent DNA polymerase activities by disrupting the enzyme's catalytic site.