HEPA-MERZ 3g Price

Overview

Welcome to Dwaey, specifically on HEPA-MERZ 3g page.
This medicine contains an important and useful components, as it consists of
Ornithine aspartateis available in the market in concentration

Name

Abacavir + Lamivudine + Zidovudine

Precaution

Abacavir, lamivudine, and zidovudine are three antiretroviral medications commonly combined to treat HIV infection. The combination of these drugs comes with several important precautions: - **Hypersensitivity reactions (Abacavir)**: Abacavir carries a risk of severe hypersensitivity reactions, which can include fever, rash, gastrointestinal symptoms (nausea, vomiting, diarrhea), respiratory symptoms (dyspnea, cough), and generalized malaise. This reaction is more likely to occur within the first six weeks of treatment. Testing for the HLA-B*5701 allele prior to initiating treatment is recommended, as individuals carrying this allele are at a higher risk for this hypersensitivity reaction. If hypersensitivity occurs, the drug must be immediately discontinued, as re-challenge can be fatal. - **Lactic acidosis and hepatic steatosis (Zidovudine)**: Zidovudine has been associated with mitochondrial toxicity, which can lead to lactic acidosis (a potentially life-threatening condition) and hepatic steatosis (fatty liver). Risk factors for these conditions include prolonged use of zidovudine, advanced liver disease, or the use of other drugs with mitochondrial toxicity. Liver function should be closely monitored, and discontinuation may be necessary if signs of these conditions develop. - **Bone marrow suppression (Zidovudine)**: Zidovudine can cause bone marrow suppression, leading to anemia, neutropenia, and thrombocytopenia. Complete blood counts (CBC) should be monitored regularly, and dose adjustments may be required for patients experiencing significant hematologic side effects. - **Renal function**: All three drugs in this combination are renally cleared. For patients with pre-existing renal impairment, especially those with creatinine clearance <50 mL/min, dose adjustments or close monitoring of kidney function are necessary. - **Pregnancy and breastfeeding**: The combination of abacavir, lamivudine, and zidovudine is often used during pregnancy for the treatment of HIV. Zidovudine has been shown to reduce perinatal HIV transmission and is recommended for use during pregnancy and labor. However, there are potential risks, including the aforementioned hematologic and mitochondrial side effects, that should be weighed against the benefits of therapy. It is also excreted in breast milk, so breastfeeding is generally not recommended to prevent transmission of HIV. - **Drug-drug interactions**: This combination can interact with other medications, including those that affect renal function, or those that may cause additive hematologic toxicity. Careful management is required to avoid potential harmful interactions.

Indication

The combination of abacavir, lamivudine, and zidovudine is indicated for the treatment of **human immunodeficiency virus (HIV)** infection: - **HIV-1 infection**: This combination is used as part of a comprehensive antiretroviral therapy (ART) regimen to reduce the viral load, improve immune function, and reduce the risk of HIV-related complications, including opportunistic infections. The combination is particularly useful for treatment-naive patients as well as those who are switching from less effective regimens. - **Prevention of maternal-fetal transmission**: Zidovudine, in particular, is used to prevent the transmission of HIV from mother to child during pregnancy, labor, and delivery. The use of this combination in pregnant women is considered a key strategy for reducing the risk of perinatal transmission of HIV. - **Off-label uses**: While this specific combination is primarily used for HIV, there may be off-label uses for other retroviral conditions, depending on the patient’s clinical needs. However, off-label use is not common, as other treatment regimens have generally become more popular in practice.

Contra indication

Contraindications to the combination of abacavir, lamivudine, and zidovudine include the following: - **Hypersensitivity to abacavir**: As mentioned above, a known hypersensitivity to abacavir is a major contraindication. This is a potentially life-threatening condition, and re-challenge with abacavir after the occurrence of such reactions can result in fatal outcomes. - **Severe hepatic impairment**: These drugs should be avoided in patients with severe hepatic impairment, as they are metabolized in the liver and may exacerbate liver toxicity. Zidovudine can contribute to mitochondrial toxicity, while abacavir also affects liver function, leading to potential complications in individuals with compromised liver function. - **Renal failure**: Patients with severe renal impairment (e.g., creatinine clearance <50 mL/min) should not use this combination without appropriate dose adjustments and careful monitoring. Zidovudine, abacavir, and lamivudine are all renally cleared, and their accumulation in the bloodstream in patients with renal insufficiency can lead to toxicity. - **Hematologic abnormalities**: Severe anemia, neutropenia, or thrombocytopenia should be addressed before starting treatment, as zidovudine can exacerbate these conditions. Regular monitoring of CBC is recommended. - **Pregnancy (first trimester)**: While this combination is recommended during pregnancy to prevent transmission of HIV to the baby, its use during the first trimester should be considered carefully due to the risk of certain fetal effects, especially from zidovudine.

Side Effect

Side effects associated with the combination of abacavir, lamivudine, and zidovudine include both common and serious reactions: - **Common side effects**: - **Gastrointestinal issues**: Nausea, vomiting, diarrhea, and abdominal discomfort are common, especially during the early stages of treatment. - **Fatigue**: Patients may experience tiredness or weakness, which is often attributed to the hematologic effects of zidovudine. - **Headache**: A mild headache is a frequent side effect for those taking this combination. - **Serious side effects**: - **Hypersensitivity reactions (Abacavir)**: This can present as fever, rash, gastrointestinal symptoms, and respiratory symptoms. Discontinuation is mandatory if such a reaction occurs. - **Bone marrow suppression (Zidovudine)**: Anemia, neutropenia, and thrombocytopenia can occur, requiring regular CBC monitoring. If severe, dose reduction or discontinuation may be necessary. - **Lactic acidosis and hepatic steatosis**: These conditions are more commonly associated with long-term use of zidovudine and other nucleoside reverse transcriptase inhibitors. Symptoms include fatigue, nausea, vomiting, and liver enlargement. - **Renal toxicity**: Abacavir and lamivudine may cause kidney issues, especially in patients with pre-existing renal conditions. - **Management of side effects**: Many side effects, such as nausea and headache, are mild and transient. Hematologic issues require ongoing monitoring and dose adjustments. Severe hypersensitivity or lactic acidosis requires immediate discontinuation of therapy.

Pregnancy Category ID

3

Mode of Action

Each component of this combination acts through different mechanisms to inhibit HIV replication: - **Abacavir**: Abacavir is a nucleoside reverse transcriptase inhibitor (NRTI) that works by inhibiting the reverse transcriptase enzyme, which is essential for the replication of HIV. It is incorporated into the growing viral DNA chain, resulting in chain termination and halting further replication. - **Lamivudine**: Like abacavir, lamivudine is an NRTI that inhibits reverse transcriptase by incorporating into the viral DNA, preventing further replication of HIV. Lamivudine is often preferred due to its relatively mild side effect profile compared to other NRTIs. - **Zidovudine**: Zidovudine, another NRTI, works similarly to abacavir and lamivudine, incorporating into the viral DNA and causing chain termination, thus preventing HIV replication. Zidovudine also exhibits activity against other retroviruses. The combination of these three drugs helps to provide potent, complementary inhibition of HIV replication at different stages of the process, leading to a reduction in viral load and an increase in CD4 cell counts, thereby improving immune function.

Interaction

The combination of abacavir, lamivudine, and zidovudine can interact with various drugs, affecting either their efficacy or safety: - **Methadone**: Zidovudine and methadone may interact, potentially enhancing the sedative effects of methadone. Monitoring for signs of sedation and dose adjustment may be required. - **Rifampin and other inducers of cytochrome P450 enzymes**: Rifampin, an antibiotic used for tuberculosis, and other drugs that induce cytochrome P450 enzymes, can reduce the effectiveness of abacavir, lamivudine, and zidovudine. Alternative treatments or increased doses may be necessary when using these medications concurrently. - **Didanosine**: Co-administration of zidovudine and didanosine can increase the risk of lactic acidosis and liver toxicity. These two drugs should not be used together. - **Anticoagulants**: Zidovudine may enhance the effects of anticoagulants like warfarin, increasing the risk of bleeding. Regular monitoring of the international normalized ratio (INR) is recommended for patients on both drugs. - **Alcohol**: Alcohol consumption can increase the risk of side effects, particularly for zidovudine, as it may exacerbate liver toxicity and hematologic side effects. - **Other antiretrovirals**: Caution is advised when combining this regimen with other antiretrovirals, as overlapping toxicities may lead to additive side effects or drug resistance.

Pregnancy Category Note

Information not available

Adult Dose

The recommended dose for adults taking this combination of abacavir, lamivudine, and zidovudine is typically one tablet twice daily. However, the dosage may vary depending on the specific formulation and individual factors such as kidney and liver function. For patients with renal impairment or other comorbidities, dosage adjustments may be necessary.

Child Dose

- **Children aged 3 months to 18 years**: The dosage for children is generally weight-based. The recommended dose is 8 mg/kg for abacavir, 4 mg/kg for lamivudine, and 10 mg/kg for zidovudine, administered twice daily. This dosing is adjusted based on the child’s weight and specific clinical situation.

Renal Dose

For patients with renal impairment, dosage adjustments are required: - **Creatinine clearance <50 mL/min**: This combination should be used cautiously, and dose adjustments for each drug in the regimen may be necessary. In severe renal impairment, alternative treatment options should be considered.

Administration

Information not available