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Abacavir

Class
Antiretroviral agents
Subclass
Non-nucleoside reverse-transcriptase inhibitors
Generic name
Abacavir sulfate
Brand names
Ziagen®
Common formulations
Tablet
Contained in
Abacavir / dolutegravir / lamivudine (Triumeq®)
Dosage and administration
Adults patients
Treatment of HIV infection
•
600 mg PO daily, in 1-2 divided doses
Indications for use
Labeled indications
Adults
•
Treatment of HIV infection
Safety risks
Boxed warnings
Abacavir hypersensitivity reaction
•
Screening for the HLA-B*5701 allele is recommended prior to using abacavir.
Warnings and precautions
Immune reconstitution inflammatory syndrome
•
Use caution in patients who are initiating antiretroviral therapy. Evaluate for and treat opportunistic infections.
Myocardial infarction
•
Use caution with known high cardiovascular risk. Consider the underlying risk of coronary heart disease before use, and address all modifiable risk factors (e.g. hypertension, hyperlipidemia, diabetes mellitus, and smoking).
Nucleoside analog-induced lactic acidosis
•
Use caution with obesity, female gender or prolonged exposure. Monitor for the development of hepatomegaly or hepatic steatosis.
Specific populations
Renal replacement therapy
Any modality
•
Avoid high doses.
Continuous renal replacement
•
Avoid high doses. Avoid prolonged use. Dose as in CrCl 10-20 mL/min. Reduce dose by 50%. Start at a dose of 100 mg BID. Maximal dose of 200 mg BID. Maximal frequency of BID. Monitor electrocardiogram.
Peritoneal dialysis
•
Cap dose.
Hepatic impairment
Child-Pugh A (mild)
•
Use with caution. Reduce dose. Start at dose of 50 mg BID. Maximal dose of 200 mg BID. Monitor serum aminotransferases.
Child-Pugh B (moderate)
•
Do not use.
Child-Pugh C (severe)
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
Second trimester • Australia Category: B3
•
Insufficient evidence.
Third trimester • Australia Category: B3
•
Use with caution.
Breastfeeding
Strongly consider avoiding breastfeeding in HIV-positive mothers who have access to formula feeding.
•
Replacement with formula or banked pasteurized donor human milk is recommended to eliminate the risk of postnatal HIV transmission through breastfeeding. Individuals with HIV and who are on antiretroviral therapy with undetectable viral load and choose to breastfeed should be supported in their decision.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
No overt adverse effects reported in breastfed infants.
No overt adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Hypotonia
Common 1-10%
•
Hypotonia, ↑ serum triglycerides, abdominal pain, bloating, depression, dizziness, insomnia, musculoskeletal pain, nightmares, skin rash, vomiting
Rare < 0.1%
•
Hypospadias
Unknown frequency
•
Acute pancreatitis, lactic acidosis, toxic epidermal necrolysis, erythema multiforme, Stevens-Johnson syndrome, myocardial infarction, acute liver failure, acute kidney injury, rhabdomyolysis, anaphylaxis, acute respiratory distress syndrome, ↓ blood lymphocyte count, hypersensitivity reactions, lactic acidosis, severe Hepatomegaly with Statosis, immune reconstitution inflammatory syndrome, myocardial infarction, abdominal pain, paresthesia, lymphadenopathy, conjunctivitis, mouth sores, urticaria, erythema multiforme, ↑ serum CK, ↑ serum creatinine, diarrhea, ↑ liver enzymes, dyspnea
Interactions
Drug(s)
Check Interactions
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