Epzicom (abacavir + lamivudine) - HIV Drug Information

Drug Usage, Considerations and Contraindications

Photograph Courtesy Bristol-Myers Squibb


Epzicom is fixed dose combination drug used in the treatment of HIV, which is comprised of two antiretroviral agents, abacavir (Ziagen) plus lamivudine (Epivir). Both of the constituent drugs are classified as nucleoside reverse transcriptase inhibitors (NRTIs) and work by blocking an enzyme needed to complete the synthesis of viral DNA in an infected cell. By doing so, HIV is unable to replicate and spread to other cells.

Epzicom was approved for use in adults by the U.S. Food and Drug Administration (FDA) on August 2, 2004. Outside of the U.S., the drug is marketed under the trade name Kivexa.

Drug Formulation

Epzicom is available in tablet form with a 600mg of abacavir and 300mg of lamivudine. The film-coated tablets are oblong in shape, orange, and embossed with "GS FC2" on one side.


One tablet daily taken orally with or without food. Epzicom is never taken on its own and must be used in combination therapy with one or more antiretroviral drugs.

Common Side Effects

The most common side effects associated with Epzicom use (occurring in up to 9% cases) include:

  • Drug hypersensitivity (see below)
  • Insomnia
  • Depression
  • Headache/migraine
  • Dizziness
  • Nausea
  • Diarrhea
  • Rash
  • Fever
  • Abdominal pain

Most of the symptoms are generally short-lasting although individuals with symptoms of drug hypersensitivity should seek immediate medical attention.

Drug Hypersensitivity Warning

Drug hypersensitivity is sometimes noted in patients exposed to abacavir-containing drug regimens and can be fatal if left untreated. It is characterized by two or more of the following five symptom groups:

  • Fever
  • Rash
  • Gastrointestinal symptoms (nausea, diarrhea, vomiting, abdominal pain)
  • Exhaustion, malaise, fatigue, muscular/joint pains
  • Respiratory symptoms (sudden onset of coughing, shortness of breath, sore throat)

Symptoms of hypersensitivity generally appear within the first six weeks of exposure, although they can actually appear at any stage of drug use. Generally speaking, however, most incidences of hypersensitivity occur within the first 10 days or so.

If hypersensitivity is suspected, Epzicom should be stopped immediately. Patients should also immediately contact their doctor and/or go to their nearest clinic or emergency rooms without delay.

Prior to initiating therapy with abacavir, physicians are advised to screen for the HLA-B*5701 allele as patients with this genetic allele are known to be a high risk for abacavir hypersensitivity.

Clinical studies have shown that approximately 8% of patients on abacavir will experience a hypersensitive reaction, sometimes serious.


  • Previous abacavir hypersensitivity: Patients with previous hypersensitivity reaction to (Ziagen) abacavir should not be prescribed Epzicom.
  • Liver impairment: Patients with any hepatic (liver) impairment should avoid Epzicom. Please advise your doctor if you have or suspect any such liver impairment, or if you have been infected (or suspect you may have been infected) with hepatitis A, hepatitis B or hepatitis C. Severe exacerbation of hepatitis B has been reported in HIV coinfected patients, while some patients on hepatitis C therapies containing interferon and/or ribavirin may experience a worsening symptoms.

Drug Interactions

  • Ethanol (drinking alcohol): slows the elimination of abacavir from the system
  • Methadone (used in the treatment of narcotic addiction): decreases the efficacy of methadone in a small number of patient

It is advised that patients reduce alcohol consumption while on Epzicom, while patients on methadone should advise their doctor if Epzicom is prescribed.

Treatment Considerations

Patients with renal (kidney) impairment should not be prescribed Epzicom if the creatinine clearance is below 50mL/minute. In patients with a risk of renal dysfunction, include estimated creatinine clearance, serum phosphorus, urine glucose and urine protein when performing routine monitoring tests.

While some animal studies have suggested an increased risk of fetal abnormalities in rats and rabbits exposed to abacavir or lamivudine, no such differences have been reported in pregnant women exposed to the drugs versus those in the general population.

In the developed world, it is recommended that mothers with HIV avoid breastfeeding due the increased risk of transmitting HIV to their babies.


U.S. Food and Drug Administration (FDA). "FDA Approves Two Fixed-Dose Combination Drug Products For the Treatment of HIV-1 Infection." Silver Spring, Maryland; issued August 2, 2004.

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