DAGYNIL 0.625mg Price

Overview

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This medicine contains an important and useful components, as it consists of
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Name

Abacavir + Lamivudine + Zidovudine

Precaution

- **Hepatic Impairment**: Caution should be exercised when using this combination in patients with liver disease, particularly those with a history of hepatitis B or C, as liver function can deteriorate. Regular liver function monitoring is advised. - **Lactic Acidosis**: This combination has been associated with an increased risk of lactic acidosis, especially in patients who are also receiving other antiretrovirals or those with other risk factors like obesity or prolonged use. Close monitoring for symptoms such as nausea, vomiting, and abdominal pain is required. - **Hypersensitivity Reaction (Abacavir)**: Abacavir is associated with a hypersensitivity reaction in some patients. The reaction can be life-threatening, with symptoms like fever, rash, gastrointestinal distress, and respiratory symptoms. Patients should be tested for the HLA-B*5701 allele before starting therapy to minimize the risk of hypersensitivity. - **Renal Impairment**: Kidney function should be monitored in patients receiving this combination, especially for those with pre-existing renal conditions. Lamivudine and zidovudine may require dose adjustments in patients with renal impairment. - **Bone Marrow Suppression (Zidovudine)**: Zidovudine may cause bone marrow suppression, leading to anemia or neutropenia. Blood counts should be regularly monitored, particularly in patients with pre-existing hematologic abnormalities. - **Pregnancy and Breastfeeding**: This combination is generally considered safe during pregnancy (category C for abacavir and lamivudine, and B for zidovudine) and can be used in HIV-positive pregnant women to reduce transmission. Zidovudine is commonly used during labor and delivery. However, the risks and benefits must be assessed for each patient. - **Drug Interactions**: This combination may interact with other drugs, including methadone and certain anticonvulsants, potentially altering drug levels. Careful monitoring for drug interactions is needed when used with other medications.

Indication

- **HIV Infection**: The combination of abacavir, lamivudine, and zidovudine is primarily indicated for the treatment of HIV-1 infection in adults and pediatric patients. It helps reduce viral load, increases CD4 cell counts, and improves immune function. - **Prevention of Mother-to-Child HIV Transmission**: This combination can be used in pregnant women with HIV to reduce the risk of transmitting the virus to the infant, especially during labor and delivery. - **Post-Exposure Prophylaxis (PEP)**: In some cases, this combination is used in post-exposure prophylaxis following potential HIV exposure. - **Combination Therapy**: This regimen is often part of a combination antiretroviral therapy (cART) and is typically prescribed alongside other HIV medications to enhance treatment efficacy.

Contra indication

- **Hypersensitivity to Abacavir**: The combination is contraindicated in patients who have a known hypersensitivity to abacavir. Testing for the HLA-B*5701 allele is recommended prior to starting abacavir-containing regimens to prevent this potentially fatal reaction. - **Severe Hepatic Impairment**: This combination is contraindicated in patients with severe hepatic impairment due to the increased risk of toxicity. - **Lactic Acidosis**: Contraindicated in patients who have previously experienced lactic acidosis related to nucleoside reverse transcriptase inhibitors (NRTIs). - **Severe Renal Impairment**: Caution is required in patients with severe renal impairment (e.g., creatinine clearance <30 mL/min) as dosage adjustments for lamivudine and zidovudine may be necessary. - **Use with Stavudine or Didanosine**: This combination should not be used with stavudine or didanosine due to an increased risk of adverse effects, including mitochondrial toxicity. - **Pregnancy Category C**: While generally considered safe in pregnancy, the combination should only be used when the benefits outweigh the risks, especially in the first trimester. Zidovudine is typically preferred in pregnancy.

Side Effect

- **Common Side Effects**: - Gastrointestinal issues such as nausea, diarrhea, and vomiting. - Headache and dizziness. - Fatigue and malaise. - Insomnia. - Rash and hypersensitivity reactions (particularly with abacavir). - **Serious Side Effects**: - Lactic acidosis and severe hepatomegaly with steatosis, a potentially fatal condition that may require discontinuation of therapy. - Bone marrow suppression, including anemia, neutropenia, and thrombocytopenia (especially with zidovudine). - Hepatic failure, particularly in patients with pre-existing liver disease. - Hypersensitivity reaction to abacavir, including fever, rash, and respiratory issues. - Increased risk of opportunistic infections due to immunosuppression. - **Long-term Use**: Chronic use may increase the risk of cardiovascular issues, metabolic disturbances, and mitochondrial toxicity. Regular monitoring for these complications is advised.

Pregnancy Category ID

3

Mode of Action

- **Abacavir**: Abacavir is a nucleoside reverse transcriptase inhibitor (NRTI) that works by inhibiting reverse transcriptase, an enzyme HIV needs to replicate its genome. By blocking reverse transcriptase, abacavir reduces viral load and prevents HIV replication. - **Lamivudine**: Lamivudine is also an NRTI that functions similarly to abacavir by inhibiting reverse transcriptase, thereby blocking the conversion of HIV RNA into DNA, which is essential for HIV replication. - **Zidovudine**: Zidovudine is another NRTI that inhibits reverse transcriptase. It is phosphorylated by cellular enzymes into its active form, zidovudine triphosphate, which incorporates into the growing HIV DNA strand, causing premature termination of the DNA chain. - **Combined Action**: When used together, abacavir, lamivudine, and zidovudine act synergistically to inhibit HIV replication at different stages of the viral life cycle, significantly lowering the viral load and increasing immune function by raising CD4+ T-cell counts. - **Immune System Restoration**: This combination helps restore immune function, reduce the risk of HIV-related complications, and prevent progression to AIDS.

Interaction

- **Methadone**: Abacavir and lamivudine may increase the plasma concentration of methadone, possibly requiring dose adjustments. - **Rifampin**: Rifampin, a potent enzyme inducer, can decrease the effectiveness of this combination by lowering plasma concentrations of abacavir, lamivudine, and zidovudine. Alternative antiretrovirals or increased doses may be necessary. - **Anticonvulsants (Carbamazepine, Phenytoin)**: These drugs may reduce the effectiveness of abacavir and lamivudine. Close monitoring and possible dose adjustments may be required. - **Doxorubicin**: Zidovudine may increase the risk of bone marrow suppression when used in combination with doxorubicin. - **Lopinavir/Ritonavir or Atazanavir/Ritonavir**: These protease inhibitors may interact with zidovudine and abacavir, affecting their plasma concentrations. Dosing adjustments may be required for these combinations. - **Valproate**: Zidovudine may interact with valproate, increasing the risk of hepatotoxicity. Caution is needed when using these drugs together. - **Other NRTIs**: The use of other nucleoside analogs (e.g., stavudine) with this combination should be avoided due to an increased risk of toxicity.

Pregnancy Category Note

Information not available

Adult Dose

- **For HIV Treatment**: - **Initial Dosage**: The typical dosage is one tablet containing 300 mg of abacavir, 150 mg of lamivudine, and 300 mg of zidovudine, once daily or twice daily, depending on the specific formulation and patient tolerance. - **Dose Adjustments**: For patients with renal or hepatic impairment, dose adjustments may be necessary. - **Alternative Regimens**: In cases of intolerance or treatment failure, the regimen may need to be altered to include other NRTIs or protease inhibitors. - **Combination Therapy**: This drug is part of combination antiretroviral therapy (cART) and is typically used in conjunction with other HIV medications to achieve viral suppression.

Child Dose

- **For HIV Treatment**: - **Children aged 3 months to 18 years**: The dosage is generally based on weight and may be adjusted by a healthcare provider. Typical dosing may range from 4–10 mg/kg per day of abacavir, 2–4 mg/kg of lamivudine, and 4–6 mg/kg of zidovudine, divided into two doses. - **Maximum Dosing**: The maximum daily dose should not exceed the recommended adult dose of 600 mg abacavir, 300 mg lamivudine, and 600 mg zidovudine, depending on the child’s age and weight. - **Pediatric Administration**: Children may be prescribed a liquid form of this combination or the tablet form if they are old enough to swallow pills.

Renal Dose

- **Renal Impairment**: - In patients with mild renal impairment (creatinine clearance 50-80 mL/min), the standard dose may be used, but frequent monitoring of renal function is necessary. - In moderate renal impairment (creatinine clearance 30-50 mL/min), dose adjustments for lamivudine and zidovudine should be considered. - In severe renal impairment (creatinine clearance <30 mL/min), the combination should be used cautiously, and zidovudine and lamivudine doses should be reduced. Regular monitoring of renal function and side effects is necessary. - **Dialysis**: Since the drug is not significantly removed by hemodialysis, dosing does not need to be adjusted in patients undergoing dialysis, but monitoring is recommended.

Administration

Information not available