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Indications & Uses
A fixed dose combination of Lamivudine, Zidovudine and Nevirapine is recommended for people with HIV-1 infection who can tolerate maintenance therapy with Nevirapine 200 mg twice daily. All three medicines are taken twice daily, and each tablet holds half of the daily dose of every component. Because the three drugs come together in a single tablet taken twice a day, it's easier for patients to manage, and more of them are likely to keep taking it as prescribed.
Pharmacology
Lamivudine, Zidovudine and Nevirapine work together to reduce viral resistance, and they inhibit reverse transcriptase through DNA chain termination.
Lamivudine: Intracellularly, Lamivudine is phosphorylated to its active 5'-triphosphate metabolite, Lamivudine triphosphate (L-TP). L-TP mainly works by inhibiting reverse transcription (RT). Once the nucleoside analogue is incorporated, the DNA chain is terminated. After an oral dose, Lamivudine is absorbed quickly and distributed widely. Binding to plasma protein is low.
Zidovudine: Intracellularly, Zidovudine is phosphorylated to its active 5'-triphosphate metabolite, Zidovudine triphosphate (ZDV-TP). ZDV-TP mainly works by inhibiting RT through DNA chain termination, which happens after the nucleoside analogue is incorporated. After an oral dose, Zidovudine is absorbed quickly and distributed widely. Binding to plasma protein is low. Zidovudine is eliminated mainly by hepatic metabolism.
Nevirapine: Nevirapine binds directly to reverse transcriptase (RT). It blocks the RNA-dependent and DNA-dependent DNA polymerase activities by disrupting the catalytic site of the enzyme. Its activity does not compete with template or nucleoside triphosphates.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
The adult dose of Lamivudine + Zidovudine + Nevirapine is one tablet twice daily. This fixed dose combination is not recommended for patients who have not first taken the lower dose of Nevirapine, 200 mg once daily, for 2 weeks, and/or who have not tolerated that dose. After two weeks of successful therapy on the low dose, patients can be switched to 200 mg twice daily, provided they showed no hypersensitivity reaction (rash, abnormal liver function tests) during their first exposure to Nevirapine. Liver function tests and similar checks are desirable before Nevirapine is started, and they should be repeated at frequent intervals while the patient continues on the fixed dose combination.
Dosage adjustment
Lamivudine: for patients with low body weight (<50 kg), where a dose adjustment may be needed, it is preferable not to use this fixed dose combination.
Zidovudine: this is a fixed dose combination, so it should not be prescribed for patients who need a dose adjustment. That includes patients with reduced renal function (creatinine clearance 50 ml/min) and those who have dose limiting adverse events.
Nevirapine: some patients get a severe rash, or a rash with constitutional complaints, during the first 14 days on Nevirapine 200 mg once daily. In these patients the dose should not be raised to twice daily, and they should not receive the triple fixed dose combination, until the rash has resolved. In the same way, if liver function tests are abnormal, Nevirapine should be stopped until liver function returns to normal, and a careful restart is advisable only after extended observation. If the problem recurs, Nevirapine cannot be restarted. Where Nevirapine has to be restarted after an interruption, 200 mg daily should be given for 14 days, followed by the twice daily dose if there is no hypersensitivity reaction. No studies have been documented that suggest a Nevirapine dose for patients with hepatic dysfunction, renal insufficiency or those on dialysis.
Side Effects
Lamivudine can cause pancreatitis, paresthesia, peripheral neuropathy, cough, dizziness, fatigue, gastrointestinal problems, headache, insomnia, anaemia, neutropenia, drug induced skin rash and hair loss. With Zidovudine, headache has been reported in up to 63% of patients, and it may be severe. Asthenia has been reported in 9 to 69%. Malaise and fatigue, fever or chills, nausea (61% cases), diaphoresis, dyspnoea, rash and taste perversion have also been reported, as have skin rashes and myalgia. Prolonged use of Zidovudine has been associated with myopathy and myositis, with pathologic changes similar to those produced by HIV infection. The major adverse effect is bone marrow toxicity, which results in severe anaemia and/or neutropenia. Patients with low serum folate or vitamin B12 concentrations may be at increased risk of bone marrow toxicity during Zidovudine therapy. There are also limited data suggesting that the bone marrow of patients with fulminant acquired immunodeficiency syndrome (AIDS) may be more sensitive to Zidovudine induced toxicity than that of patients with less advanced disease (eg, AIDS related complex). Anaemia and granulocytopenia usually resolve when Zidovudine is stopped or the dose is decreased. Lactic acidosis (in the absence of hypoxaemia) and severe hepatomegaly with steatosis, including some fatalities, have been reported in patients receiving Zidovudine. With Nevirapine, the more frequent side effects are skin rash, diarrhoea, gastrointestinal problems, headache, nausea and stomach pain. The less frequent ones are aphthous stomatitis, fever, hepatitis and Stevens Johnson syndrome.
Cautions & Contraindications
Warnings & Precautions
Doctors should check the risk to the patient and act as needed if the patient has any of these conditions: chronic hepatitis B, hepatomegaly with steatosis, lactic acidosis, liver function impairment, severe renal function impairment or peripheral neuropathy.
Contraindications
Don't give this combination to anyone with a history of hypersensitivity to Lamivudine, Zidovudine or Nevirapine, or to any of the excipients in the formulation. It also shouldn't be used as initial therapy. At the start of treatment, Nevirapine is given at 200 mg once daily, whereas the fixed dose combination gives 200 mg of Nevirapine twice daily.
Pregnancy & Breastfeeding
Lamivudine + Zidovudine + Nevirapine is a Pregnancy Category C medicine. Studies in animals have shown a harmful effect on the fetus, and there are no adequate, well-controlled studies in humans. Even so, the possible benefits may justify using it in a pregnant woman despite the possible risks.
⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
Storage
Store this medicine in a cool, dry place.
Drug Interactions
Common questions about Triovix 150 mg+300 mg+200 mg
What is Triovix 150 mg+300 mg+200 mg Tablet?
Triovix 150 mg+300 mg+200 mg Tablet is a medicine that contains Lamivudine + Zidovudine + Nevirapine. It is made by Beximco Pharmaceuticals Ltd. It belongs to the Drugs for HIV / Anti-retroviral drugs group of medicines.
What is Triovix used for?
A fixed dose combination of Lamivudine, Zidovudine and Nevirapine is recommended for people with HIV-1 infection who can tolerate maintenance therapy with Nevirapine 200 mg twice daily. All three medicines are taken twice daily, and each tablet holds half of the daily dose of every component.
What are the side effects of Triovix?
Lamivudine can cause pancreatitis, paresthesia, peripheral neuropathy, cough, dizziness, fatigue, gastrointestinal problems, headache, insomnia, anaemia, neutropenia, drug induced skin rash and hair loss. With Zidovudine, headache has been reported in up to 63% of patients, and it may be severe.
Can I take Triovix during pregnancy or while breastfeeding?
Lamivudine + Zidovudine + Nevirapine is a Pregnancy Category C medicine. Studies in animals have shown a harmful effect on the fetus, and there are no adequate, well-controlled studies in humans. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
How should I store Triovix?
Store this medicine in a cool, dry place.
Can I take other medicines with Triovix?
Some medicines can interact with Lamivudine + Zidovudine + Nevirapine, for example: Fluconazole, Ribavirin, Lamivudine, Doxorubicin Hydrochloride, Valacyclovir, Zidovudine. Tell your doctor or pharmacist about every medicine you take.
Is there a cheaper medicine with the same ingredient?
Triovix is already among the lowest-priced brands of Lamivudine + Zidovudine + Nevirapine at this strength.
Do I need a prescription for Triovix?
Triovix is a prescription (Rx) medicine. Take it as your doctor advises.