Epzicom

Common side effects may include headache, nausea, fatigue, depressed mood, dizziness, diarrhea, rash, or 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 simple blood test for HLA-B*5701 (a genetic marker) should be done before starting an HIV regimen containing abacavir to identify people 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).

Some large observational studies suggest abacavir may increase the risk of cardiovascular events, including myocardial infarction (MI, or heart attack), in people with risk factors such as smoking, diabetes, uncontrolled 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 high risk for heart disease should discuss risks with their provider, and they should be monitored more closely. 

Prior to initiation, people should be tested for hepatitis B virus (HBV) infection. Severe exacerbations of hepatitis B have been reported in people co-infected with hepatitis B who have discontinued Epzicom (due to elimination of the lamivudine component, which also treats HBV). Monitor liver enzymes closely in people co-infected with hepatitis B and, if appropriate, initiation of anti-hepatitis B therapy may be warranted upon Epzicom discontinuation. Call your health care provider right away if you develop any of the following signs or symptoms of hepatitis: yellowing of the skin or whites of the eyes; dark or tea-colored urine; pale-colored bowel movements; nausea or vomiting; loss of appetite; or pain, aching, or tenderness on the right side below the ribs.

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, Dovato, 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 the 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 for 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 above 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 hepatitis B virus; see Epivir. Epzicom is recommended by DHHS as one of the preferred NRTI combination components of an ART regimen in pregnancy.

Dr. Melanie Thompson:

Abacavir/lamivudine (ABC/3TC) is recommended for initial therapy in most persons only in combination with dolutegravir (including as Tivicay). Higher levels of virologic failure were seen in people whose viral load was greater than 100,000 copies/mL when ABC/3TC was used with other anchor drugs, such as efavirenz or boosted atazanavir. 

Screening for HLA-B*5701 is necessary before prescribing an abacavir-containing regimen, due to the possibility of abacavir hypersensitivity syndrome. (See Ziagen.)

Coformulated ABC/3TC is available in generic form, which may be less expensive in some situations.

Because of an inconsistent association with the development of cardiovascular disease, Epzicom probably should be avoided by people with known cardiac disease or who are at high risk for its development. (See Ziagen.)

Activist Bridgette Picou:

Before starting Epzicom you should have a simple blood test to check for an allergic reaction to the abacavir component of Epzicom. Epzicom is a combination of abacavir and lamivudine, which may be familiar as it is also found in Triumeq. Consideration should be given to your viral load, as Epzicom is most effective if your viral load is less than 100,000 before starting the medication. There are concerns about cardiovascular disease with the abacavir component.