Standard DoseOne tablet once daily, without regard to food. The tablet contains 600 mg abacavir and 300 mg lamivudine. It must be taken in combination with another antiretroviral(s) that does not contain the medications in this drug combination.
Take the missed dose as soon as possible, unless it is closer to the time of your next dose. Do not double up on your next dose. Approved for adults and children weighing 55 pounds (25 kg) or more. According to the drug label, Epzicom is not recommended for those with decreased kidney function (creatinine clearance less than 50 mL/min) due to lamivudine component, or those with moderate or severe liver impairment due to abacavir component. This medication combination, however, is often used in the reduced renal function below 50, due to relatively minimal risk of lamivudine accumulation and side effects. In addition, alternative doses may be obtained by using the individual components of this medication as needed.
See the individual drugs contained in Epzicom: Epivir and Ziagen.
See package insert for more complete information on potential side effects and interactions.
AWP1,550.05/month; generic: $1,395.05/month
Potential Side Effects and Toxicity
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 abacavir 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% or less from clinical studies. This test is covered by most insurances 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 restart) 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 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 absolute consensus has been reached on the association of abacavir with cardiac risk or a possible mechanism for the association. People who have a 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.
Potential Drug Interactions
See the individual drugs contained in Epzicom, Epivir and Ziagen. It is important to take Epzicom only with other HIV medications recommended by your provider because Epzicom and its equivalent drugs are contained in other HIV medications: Atripla, Biktarvy, Cimduo, Combivir, Complera, Delstrigo, Descovy, Emtriva, Epivir, Genvoya, Odefsey, Stribild, Symfi, Symfi Lo, Symtuza, Temixys, Triumeq, Trizivir, Truvada, or Ziagen; also 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 Epclusa, Harvoni, or Zepatier, depending on the third drug in the HIV regimen. 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 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. Ross Slotten says:
Epzicom, which contains abacavir and lamivudine (3TC), was originally approved as a single tablet two-nucleoside backbone for HIV therapy, like Truvada. However, subsequent studies have shown that it is inferior to Truvada when given to patients with high viral loads (greater than 100,000 copies/mL). In one of its earlier iterations, Trizivir (AZT, abacavir, 3TC), 80 per cent of patients achieved and maintained undetectable viral loads as compared to other 3-drug combinations, which had a greater than 90 % success rate in maintaining maximal viral suppression. Today, most abacavir/3TC use is in combination with Tivicay (dolutegravir), which has been given an AI rating in the DHHS HIV drug guidelines because Tivicay is both potent and has a low barrier to resistance. Before prescribing Epzicom, it is critical to screen for the presence of the genetic marker HLA-B*5701, which predicts a severe allergic reaction to abacavir. Moreover, as mentioned elsewhere, there has been concern about the association of abacavir with an increased risk for heart attacks, an association that has not been definitively proven in clinically controlled studies.
Activist Bridgette Picou says:
Epzicom is a combination tablet containing abacavir and lamivudine (also found in Triumeq). The abacavir component has been known to cause both trouble sleeping and vivid dreams as side effects, but it is still
a good alternative for those who are unable to take Truvada. There is a simple blood test that should be taken before starting Epzicom to test for an allergic sensitivity to abacavir. This is called a hypersensitivity reaction and can be fatal. Your viral load is also a consideration as with higher viral loads over 100,000 copies it may not be as effective. There are also concerns that it may increase the risk of cardiac disease.