Epzicom

The length of this section is meant to be informative, not scary. Common side effects may include headache, nausea, fatigue, depressed mood, dizziness, diarrhea, and insomnia. Of note is the hypersensitivity reaction (HSR, an allergic-like reaction) warning on abacavir (see Ziagen for details of symptoms). To minimize the risk for HSR, a blood test for HLA-B*5701 (a genetic marker) should be done prior to starting an HIV regimen containing Epzicom to identify patients at higher risk for this reaction. A negative HLA-B*5701 test does not mean you won’t have HSR, but the risk is reduced to 1% from clinical studies. This test is covered by most insurance and also by LabCorp/ViiV (see company contact on co-pay chart).

An HSR can technically occur at any time, regardless of how long you have taken the medication, however, it is much more likely to occur when you start (or re-start) the medication (90% occur within the first 6 weeks of treatment). Symptoms of an HSR usually worsen, very slowly, with every dose. Call your healthcare provider right away to find out if you should stop taking Epzicom. If you stop Epzicom because of an allergic reaction, never take Epzicom or an abacavir-containing regimen such as Triumeq, Trizivir, or Ziagen again (called “rechallenging”). Rechallenging could cause a rare life-threatening reaction. This does not apply to a missed dose when HSR is not suspected, but talk with your healthcare provider and watch for symptoms if you’ve stopped the drug for at least a few days.

Some large observational studies suggest abacavir may increase the risk of cardiovascular events, including myocardial infarction (MI, or heart attack), in people with greater risk factors such as smoking, diabetes, high blood pressure, older age, high cholesterol, family history of heart disease, and drug use.  Other studies have found no increased risk. To date, no consensus has been reached on the association of abacavir with cardiac risk or a possible mechanism for the association. People who have high risk for heart disease should discuss risks with their provider, and they should be monitored more closely. If you have HIV and HBV, guidelines recommend treatment for both viruses. The lamivudine component of Epzicom can be used to treat HIV and HBV simultaneously. If you are co-infected with HBV and HIV, you should not stop Epzicom without medical supervision because it can cause your HBV to flare up and cause you to experience signs and symptoms of acute hepatitis. HBV should be closely monitored by your provider.

Do not take with Epivir-HBV, used for the treatment of hepatitis B. Alcohol can increase the levels of abacavir and therefore can increase the possibility of side effects. Epzicom may be used with hepatitis C drugs such as Daklinza, Epclusa, Harvoni, Olysio, Sovaldi, Viekira Pak, or Zepatier, depending on the third drug in the HIV regimen. There have been rare reports of depression and suicidal ideation, primarily in patients with a history of psychiatric illnesses, in people receiving INSTI-based regimens. Avoid use of sorbitol-containing medicines with lamivudine; there are many, such as acetaminophen liquid (Tylenol liquid and others). Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not, as there are other drug interactions not listed here.

Triumeq, a single-tablet regimen (STR) containing Tivicay and Epzicom, is a DHHS recommended initial therapy in most people (again, test for HLA-B*5701 first). Otherwise, the guidelines recommend Descovy or Truvada over Epzicom as the backbone NRTI component of an HIV drug combination for first-time therapy, with Epzicom listed as an alternative NRTI backbone. One of the reasons abacavir is a DHHS alternative drug is that the ACTG A5202 study found that abacavir/lamivudine (Epzicom) was inferior to tenofovir/emtricitabine (Truvada) in getting people undetectable when their pre-treatment viral load was over 100,000 copies/mL. However, when combined with Tivicay (dolutegravir), Epzicom performed just as well as Truvada in people with high viral loads (over 100,000 copies/mL). Hence, Triumeq is the only abacavir-containing regimen recommended by DHHS as initial therapy for most HLA-B*5701 negative people. The lamivudine portion of Epzicom is also used to treat the hepatitis B virus (HBV); see Epivir. Epzicom is recommended by DHHS as one of the preferred NRTI combination components of an ART regimen in pregnancy.

Dr. David Hardy says:

Approved on the same day in 2004 as Truvada, Epzicom is also a two-drugs-in-one-pill, two-nuke combination “backbone” to which a third drug is added to build a three-drug combination or “cocktail” ART regimen (just like Truvada). Because Epzicom contains Ziagen (abacavir), a one-time blood or mouth swab test must be done to look for a genetic marker (HLA-B*5701) which predicts a severe allergic reaction to Ziagen if present. In 2008, a European cohort study raised concern about an association of Ziagen with the increased occurrence of heart attacks. Although many other studies have weighed in, trying to confirm or refute this finding, there still remains controversy whether cardiovascular disease (heart attacks) is a true side effect of Ziagen or a false association. Not long after this, a large clinical trial comparing first-time ART regimens for PLWH with either Epzicom or Truvada found that Epzicom was not as potent for PLWH with high viral loads (greater than 100,000 copies/mL). These two findings diminished the use of Epzicom and Ziagen in favor of Truvada. A generic version of Epzicom has been available in the U.S. since September 2016. Today most Epzicom use is prescribed as two of the three medications in the STR Triumeq (Tivicay/Ziagen/Epivir).

Activist Moisés Agosto-Rosario says:

Epzicom is a fixed-dose combination tablet containing abacavir and lamivudine. Epzicom is used as an alternative to Truvada in patients who can’t tolerate tenofovir due to kidney toxicity or loss of bone density. Epzicom may increase the risk of heart attacks and cardiovascular disease due to abacavir. It is not as effective in patients whose viral load is more than 100,00 copies. It is combined with dolutegravir in the fixed-dose tablet branded as Triumeq. Epzicom is recommended as first-line treatment in combination with dolutegravir.