An HIV Information Site & HIV Educational Resource Site (HIS & HERS)

Epzicom - a combination of lamivudine and abacavir

General Information This drug is actually a combination of two antiviral drugs in one pill - abacavir and lamivudine.  Epzicom is used as one component of a multiple drug combination.
Specifics Epzicom is a new combination drug approved in August 2004 for the treatment of HIV infection 

Epzicom works by inhibiting the formation of HIV's genetic material.  The two components in Epzicom are called nucleoside reverse transcriptase inhibitors (NRTIs) or nukes.

Dosing Generally Epzicom is taken as 1 pill once a day.
(this refers to your willingness, ability, and actual performance in taking your medications)

For further information and tips on adherence, go to the Adherence section of this site.

As with any antiviral drug or antibiotic, try not to ever miss a dose.  If you miss a dose and notice that you have done so within a few hours of its scheduled time, you may take the dose as usual and take the next dose at its regular time.

Do not change the dose or timing of Epzicom without speaking to your healthcare provider.

Because Epzicom contains abacavir, it is recommended that you do NOT stop this medication without consulting with your healthcare provider or someone experienced with the use of abacavir.

If you miss more than one dose, look at the reasons why you missed them and come up with a plan to avoid it in the future.  For example, if you fell asleep too early, take the medicine earlier in the evening, with your later meal, set an alarm, or have someone appointed to wake you up for your medicine.  

It is strongly recommended that you consider using weekly pill boxes and arrange all of your doses a week in advance.  Buy a small pill box so that you can carry a dose or two of your medicines with you in case you are away from home.

Possible Side Effects
The package insert for most drugs including Epzicom is often overwhelming and scary with perhaps an overemphasis on side effects.  We have summarized the important and more common problems here.

Most people take Epzicom without many side effects.

Possible side effects include nausea (which usually gets better over time,) headache, muscle aches, liver problems, or allergy.  Usually you will have blood tests done in the first month to look for the beneficial effects of Epzicom and any side effects. 

Many minor side effects will either stay constant or get better with time.  It is mainly the side effects that are severe or get worse that may cause significant health risks for you.

Approximately 5-8% of patients who take abacavir (which is one of the components of Epzicom) develop allergy or "hypersensitivity" to it.  This is a well-recognized problem and it is easy to diagnose and treat.  The allergic symptoms usually consist of SEVERAL of the following that always get worse as you take the drug: fever, body rash, cough, diarrhea, and nausea.  All of these symptoms will get steadily worse over time as you take the medicine, and you will notice a worsening after each dose.  These symptoms may occur with other problems such as flu, food poisoning and allergies to other drugs.  Therefore you should remember to inform your healthcare provider of any of these symptoms that tend to get worse and worse or more numerous as you continue to take Epzicom.  It is very important that you do not stop the Epzicom unless instructed to by your healthcare provider or someone who is familiar with Epzicom or abacavir (Ziagen.)

All drugs of this type can cause or contribute to abnormal fat redistribution characterized by thinning of the face, arms, or legs.  In most cases this would be also accompanied by elevated cholesterol levels, elevated triglyceride levels, and perhaps a tendency to develop diabetes. 

Rarely, a build-up of (lactic) acid may occur due to taking medications of this type.  Persons taking multiple nukes (NRTIs), those taking d4T (stavudine, Zerit), those on the combination of d4T (stavudine, Zerit) and ddI (didanosine, Videx), and those persons with hepatitis C are the most likely to encounter this rare, but potentially fatal problem.  Pregnancy may also raise the risk of this problem.  The symptoms are vague but troublesome including nausea, vomiting, muscle aches, weakness, turning yellow with jaundice, and just feeling plain bad.

If you have hepatitis B and you stop Epzicom suddenly, your liver may be damaged.

This refers to the way that Epzicom affects other medications and how Epzicom is affected by other medications.
There are no significant interactions. 
Do not take Epzicom with lamivudine (Epivir) pills or abacavir (Ziagen) pills so that you do not get too much of those drugs.
Do not take Epzicom with emtricitabine (Emtriva) pills as emtricitabine would be useless with Epzicom.
Report to you healthcare provider or go to an Emergency Room if you have severe side effects, increasing side effects, shortness of breath, uncontrollable diarrhea, fever, weakness, jaundice (eyes and skin turn yellow,) muscle pain, nausea and vomiting so that you cannot hold down your food and liquids.
You can download this handout in PDF format by clicking HERE.