Three-time daily dosing and the high incidence of neuropathy have made zalcitabine a second- or third-choice medicine in the treatment of HIV.
Stavudine (also known as d4T) is the fourth nucleoside drug approved for the treatment of AIDS and is usually combined with didanosine and lamivudine. It should not be used with AZT because those two drugs work against each other.
The usual dose is one 30 or 40 mg pill twice daily, taken with or without food. The main side effect is neuropathy and it should be used with caution when combined with didanosine or zalcitabine, because those drugs also cause neuropathy. Neuropathy is more likely to develop in people with advanced HIV/AIDS. If a patient feels any symptom of neuropathy, they should tell their physician. Rarely, stavudine causes headaches or stomach upset.
This drug (formerly 3TC), which was approved in 1995 to treat AIDS, is usually combined with AZT, abacavir, stavudine, or didanosine. The usual dose is one 150 mg pill twice daily, taken with or without food. Some studies show that the entire 300 mg dose can be taken once a day. Lamivudine is combined with AZT in a single pill called Combivir, which is taken twice a day. A second combination pill, Trizivir is also available. It contains AZT, lamivudine, and abacavir.
Lamivudine has very few side effects. Pancreatitis is a potentially fatal risk in pediatric patients. If a child has a history of pancreatitis or other significant risk factors for pancreatitis, the drug should be used with caution. If signs or symptoms of pancreatitis develop, lamivudine should not be used.
Abacavir was the sixth nucleoside drug approved to treat HIV infection and was approved in 1998. Studies have shown that it is 5 to 10 times more potent than the other nucleosides. It is especially effective when used with AZT and lamivudine plus a protease inhibitor or non-nucleoside.
The usual dose of Abacavir is one 300 mg pill twice daily, taken with or without food. A second combination pill, Trizivir, is also available. It contains contain AZT, lamivudine, and abacavir.
In clinical studies, about 5% of people who take abacavir develop a hypersensitivity reaction that may be fatal. This reaction causes fever, nausea, vomiting, diarrhea, upset stomach, skin rash, body aches, and fatigue; usually develops within the first 6 weeks of treatment; and gets worse with every dose. If a patient develops hypersensitivity, he or she must contact to his or her physician immediately, stop taking the drug, and never take it again.
Because of the serious, possibly fatal consequences of a hypersensitivity reaction, it is important for patients who are taking abacavir to be closely monitored by a health care practitioner.
This nucleoside, which is also called TDF, was approved in 2001 to treat HIV/AIDS. A combination pill, Truvada® is also available. It contains tenofovir and emtricitabine.
This drug is approved to treat HIV-1 infection in adults. It is taken as a tablet once a day, with or without food, and is used in combination with other antiretrovirals. Common side effects include nausea, vomiting, and diarrhea. Viread may cause serious liver or kidney problems and lactic acidosis (severely elevated blood lactate level), and may worsen hepatitis B infections.
This drug received FDA approval in July 2003. It is also available in a combination pill, Truvada®, which contains tenofovir and emtricitabine. Emtriva should not be used with some other antiretrovirals (e.g., Atripla, Combivir, Epivir, Epzicom). It is available in tablets and an oral solution, and is used to treat children and adults. Side effects include headache, nausea, vomiting, and skin rash. This drug can also cause lactic acidosis and severe liver and kidney problems.
This NRTI was approved in 2004 to treat HIV/AIDS in adults. It is used in combination with other antiretroviral drugs and can be taken with or without food and liquids.
Patients who have experienced a hypersensitivity reaction to abacavir should not take Epzicom. This drug may cause lactic acidosis and severe liver and kidney problems.
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