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Date Posted: 13:14:37 01/26/02 Sat
Author: No name
Subject: DRUGS;ETC.

WHAT IS ddC?


ddC (Hivid®), is a drug used for antiviral therapy. It is manufactured by Roche. ddC is also known as zalcitabine or dideoxycytidine.

ddC is a nucleoside analog reverse transcriptase inhibitor, or nuke. These drugs block the reverse transcriptase enzyme. This enzyme changes HIV's genetic material (RNA) into the form of DNA. This has to occur before HIV's genetic code gets inserted into an infected cell's own genetic codes.



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WHO SHOULD TAKE ddC?

ddC was approved as an antiviral drug for people with HIV infection. Most doctors start antiviral therapy when a person has some symptoms of HIV disease, has a T-cell count (CD4+ cells) below 350, or has a viral load (a measure of the amount of virus in the blood) is over 30,000.

There are no absolute rules about when to start antiviral drugs. Some people want to "hit HIV hard and early", starting with the strongest drugs to preserve the immune system. Others want to save the strongest drugs until they are needed, later in the course of HIV disease. You and your doctor should consider your T-cell count, your viral load, any symptoms you are having, and your attitude about taking HIV medications.



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WHAT ABOUT DRUG RESISTANCE?

The HIV virus is sloppy when it makes copies of its genetic code (RNA). Many new copies of HIV are mutations: they are slightly different from the original. Some mutations can keep multiplying even when you are taking an antiviral drug. When this happens, the drug will stop working. This is called "developing resistance" to the drug.

With combination therapy (taking more than one antiviral drug at the same time), HIV mutates much more slowly and it takes much longer for resistance to develop.



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HOW IS ddC TAKEN?

ddC is available in tablets of 0.75mg or 0.375mg. The normal adult dose is one 0.75mg tablet three times a day.

ddC should be taken on an empty stomach: 2 hours after eating, or 1 hour before a meal.

Be sure your doctor knows if you have had liver or kidney problems. Your liver and kidney will have to be watched carefully if you take ddC, and your doctor might decide that you should not use ddC at all.



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WHAT ARE THE SIDE EFFECTS?


When you start any anti?viral treatment you may have temporary side effects such as headaches, hypertension, or a general sense of feeling ill. These side effects usually get better or disappear over time.

The most common side effects of ddC are rashes, chest pain, fever, nausea, changes in liver function, and mouth sores.

The most serious side effects of ddC are peripheral neuropathy and, in rare cases, pancreatitis.

Peripheral neuropathy is a form of nerve damage. It usually shows up as tingling, numbness, or a sharp burning sensation in the feet, legs, or hands. The nerve damage is usually temporary and will go away if you stop taking ddC, or reduce the dose. If you continue to take ddC after nerve damage shows up, it may become permanent.

Pancreatitis is an inflammation of the pancreas, a large gland located behind the stomach. Pancreatitis can be fatal. If you are taking ddC and have sharp pain near your stomach, back, or sides, with nausea and vomiting, you should stop taking ddC immediately and call your doctor.



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HOW DOES ddC REACT WITH OTHER DRUGS?

ddC is more effective if taken with other antiviral drugs.

ddC should not be combined with 3TC (lamivudine, Epivir®), d4T (stavudine, Zerit®), or ddI (didanosine, Videx®).

Blood levels of ddC may be decreased by antacids or cimetidine.

Blood levels of ddC may be increased by aminoglycosides, amphotericin B, foscarnet, or probenecid.

Several other medications can make the side effects of ddC worse. Be sure your doctor knows about all the medications you are taking.



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Revised February 14, 2001



WHAT IS ddI?

ddI (Videx®), is a drug used for antiviral therapy. It is manufactured by Bristol-Myers Squibb. ddI is also known as didanosine or dideoxyinosine.

ddI is a nucleoside analog reverse transcriptase inhibitor, or nuke. These drugs block the reverse transcriptase enzyme. This enzyme changes HIV's genetic material (RNA) into the form of DNA. This has to occur before HIV's genetic code gets inserted into an infected cell's own genetic codes.



--------------------------------------------------------------------------------


WHO SHOULD TAKE ddI?

ddI was approved as an antiviral drug for people with HIV infection. Most doctors start antiviral therapy when a person has some symptoms of HIV disease, has a T-cell count (CD4+ cells) below 350, or has a viral load (a measure of the amount of virus in the blood) over 30,000. Pregnant women should not take ddI and d4T at the same time.

There are no absolute rules about when to start antiviral drugs. Some people want to "hit HIV hard and early", starting with the strongest drugs to preserve the immune system. Others want to save the strongest drugs until they are needed, later in the course of HIV disease. You and your doctor should consider your T-cell count, your viral load, any symptoms you are having, and your attitude about taking HIV medications.



--------------------------------------------------------------------------------


WHAT ABOUT DRUG RESISTANCE?

The HIV virus is sloppy when it makes copies of its genetic code (RNA). Many new copies of HIV are mutations: they are slightly different from the original. Some mutations can keep multiplying even when you are taking an antiviral drug. When this happens, the drug will stop working. This is called "developing resistance" to the drug.

If you take a "nuke" by itself, resistance can develop in about 6 to 12 months. When you take more than one antiviral drug at the same time, HIV mutates much more slowly and it takes much longer for resistance to develop.

Sometimes, if you develop resistance to one drug, you will also have resistance to other antiviral drugs. This is called "cross-resistance".



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HOW IS ddI TAKEN?


ddI is available as a chewable tablet (which can also be dissolved in water) and as a powder that is dissolved in water. The recommended dose of ddI for adults is based on weight. For people weighing more than 132 pounds, the dose is 200mg (milligrams) in tablet form, or 250mg of powder, twice a day. For those weighing less than 132 pounds, the dose is 125mg in tablet form, or 167mg of powder, twice a day.

In November 1999, the FDA approved a new formulation of ddI that can be taken just once a day. The dosage is two 200 mg tablets taken at the same time. The new tablets cannot be used for twice a day dosing. However, in July 2000, the FDA said that twice-daily dosing of ddI is preferred. Once-daily dosing should only be used by adults with a special need to take their medications just once a day. If you want to change how often you take ddI, talk to your doctor.

If you have had liver or kidney problems, the dose of ddI may need to be reduced.

ddI cannot be absorbed in an acid environment. ddI contains a buffer to reduce the effects of stomach acid. ddI is taken on an empty stomach, one hour before eating or two hours after a meal. Taking ddI with food may reduce blood levels by as much as 50%.

Bristol-Myers Squibb developed a new "enteric coated" version of ddI called Videx EC. It can be taken as a single capsule once a day. Videx EC does not contain a buffer, so side effects and drug interactions could be reduced. The FDA approved Videx EC in October 2000.



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WHAT ARE THE SIDE EFFECTS?


When you start any antiviral treatment you may have temporary side effects such as headaches, hypertension, or a general sense of feeling ill. These side effects usually get better or disappear over time.

The most common side effects of ddI are diarrhea, headaches, vomiting and rash. Diarrhea, caused by the buffer in the tablets, is sometimes severe.

The most serious side effects of ddI are peripheral neuropathy, pancreatitis, and lactic acidosis:

Peripheral neuropathy is a form of nerve damage. It usually shows up as tingling, numbness, or a sharp burning sensation in the feet, legs, or hands. The nerve damage is usually temporary and will go away if you stop taking ddI, or reduce the dose. If you continue to take ddI after nerve damage shows up, it may become permanent. See Fact Sheet 553 for more information.

Pancreatitis is an inflammation of the pancreas, a large gland located behind the stomach. Pancreatitis can be fatal. If you are taking ddI and have sharp pain near your stomach, back, or sides, with nausea and vomiting, stop taking ddI immediately and call your doctor.

Lactic acidosis is a buildup of lactic acid in the blood. This is a by-product of abnormal energy production by the cells. It may be caused by damage to the mitochondria. See Fact Sheet 554 for more information on mitochondrial toxicity. Lactic acidosis can cause severe damage to the pancreas and liver. Symptoms of lactic acidoss can include weight loss, abdominal pain, and severe fatigue.



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HOW DOES ddI REACT WITH OTHER DRUGS?

ddI may be more effective if taken with hydroxyurea. However, this increases the risk of developing pancreatitis.

Methadone decreases blood levels of ddI

ddI should not be combined with ddC (zalcitabine, Hivid®).

Pregnant women should not take ddI and d4T at the same time due to an increased risk of lactic acidosis.

Do not take ddI at the same time as a protease inhibitor. Separation times are different for different protease inhibitors. Check the instructions for your medications.



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Revised February 14, 2001



WHAT IS d4T?

d4T (Zerit®), is a drug used for antiviral therapy. It is manufactured by Bristol-Myers Squibb. d4T is also known as stavudine or didehydro-deoxythymidine.

d4T is a nucleoside analog reverse transcriptase inhibitor, or nuke. These drugs block the reverse transcriptase enzyme. This enzyme changes HIV's genetic material (RNA) into the form of DNA. This has to occur before HIV's genetic code gets inserted into an infected cell's own genetic codes.



--------------------------------------------------------------------------------


WHO SHOULD TAKE d4T?

d4T was approved as an antiviral drug for people with HIV infection. Most doctors start antiviral therapy when a person has some symptoms of HIV disease, has a T-cell count (CD4+ cells) below 350, or has a viral load (a measure of the amount of virus in the blood) is over 30,000. Pregnant women should not take d4T and ddI at the same time.

There are no absolute rules about when to start antiviral drugs. Some people want to "hit HIV hard and early", starting with the strongest drugs to preserve the immune system. Others want to save the strongest drugs until they are needed, later in the course of HIV disease. You and your doctor should consider your T-cell count, your viral load, any symptoms you are having, and your attitude about taking HIV medications.



--------------------------------------------------------------------------------


WHAT ABOUT DRUG RESISTANCE?

The HIV virus is sloppy when it makes copies of its genetic code (RNA). Many new copies of HIV are mutations: they are slightly different from the original. Some mutations can keep multiplying even when you are taking an antiviral drug. When this happens, the drug will stop working. This is called "developing resistance" to the drug.

With combination therapy (taking more than one antiviral drug at the same time), HIV mutates much more slowly and it takes much longer for resistance to develop.



--------------------------------------------------------------------------------


HOW IS d4T TAKEN?

d4T is available in capsules of 15mg, 20mg, 30mg, and 40mg. The normal adult dose depends on body weight. If you weigh more than 60 kilograms (132 pounds), the dose is 40 mg twice daily. If you weigh less, the dose is 30 mg twice daily.

Be sure your doctor knows if you have had liver problems. Your liver will have to be watched carefully if you take d4T, and your doctor might decide that you should not use d4T at all.



--------------------------------------------------------------------------------


WHAT ARE THE SIDE EFFECTS?

When you start any anti?viral treatment, you may have temporary side effects such as headaches, hypertension, or a general sense of feeling ill. These side effects usually get better or disappear over time.

The most serious side effects of d4T are peripheral neuropathy and lactic acidosis.

Peripheral neuropathy is a form of nerve damage. It usually shows up as tingling, numbness, or a sharp burning sensation in the feet, legs, or hands. The nerve damage is usually temporary and will go away if you stop taking d4T, or reduce the dose. If you continue to take d4T after nerve damage shows up, it may become permanent.

Lactic acidosis is a buildup of lactic acid in the blood. This is a by-product of abnormal energy production by the cells. It may be caused by damage to the mitochondria. See Fact Sheet 554 for more information on mitochondrial toxicity. Lactic acidosis can cause severe damage to the pancreas and liver. Symptoms of lactic acidosis can include weight loss, abdominal pain, and severe fatigue.



--------------------------------------------------------------------------------

HOW DOES d4T REACT WITH OTHER DRUGS?


d4T is more effective if taken with other antiviral drugs.

d4T should not be taken with AZT (zidovudine, Retrovir®) or ddC (zalcitabine, Hivid®).

d4T's side effects may be worse if taken with ganciclovir or pentamidine.

Pregnant women should not take d4T and ddI at the same time due to an increased risk of lactic acidosis.



--------------------------------------------------------------------------------

Revised February 14, 2001



WHAT IS 3TC?

3TC (Epivir®), is a drug used for antiviral therapy. It is manufactured by GlaxoSmithKline. 3TC is also known as lamivudine.

3TC is a nucleoside analog reverse transcriptase inhibitor, or nuke. These drugs block the reverse transcriptase enzyme. This enzyme changes HIV's genetic material (RNA) into the form of DNA. This has to occur before HIV's genetic code gets inserted into an infected cell's own genetic codes.



--------------------------------------------------------------------------------


WHO SHOULD TAKE 3TC?

3TC was approved as an antiviral drug for people with HIV infection. Most doctors start antiviral therapy when a person has some symptoms of HIV disease, has a T-cell count (CD4+ cells) below 350, or has a viral load (a measure of the amount of virus in the blood) over 30,000.

There are no absolute rules about when to start antiviral drugs. Some people want to "hit HIV hard and early", starting with the strongest drugs to preserve the immune system. Others want to save the strongest drugs until they are needed, later in the course of HIV disease. You and your doctor should consider your T-cell count, your viral load, any symptoms you are having, and your attitude about taking HIV medications.



--------------------------------------------------------------------------------


WHAT ABOUT DRUG RESISTANCE?

The HIV virus is sloppy when it makes copies of its genetic code (RNA). Many new copies of HIV are mutations: they are slightly different from the original. Some mutations can keep multiplying even when you are taking an antiviral drug. When this happens, the drug will stop working. This is called "developing resistance" to the drug.

Resistance to 3TC can appear in a few months if it is taken by itself. With combination therapy (taking more than one antiviral drug at the same time), HIV mutates much more slowly and it takes much longer for resistance to develop.

3TC seems to be able to reverse resistance to AZT. That is, after people develop resistance to AZT and then take 3TC, AZT seems to work for them again.



--------------------------------------------------------------------------------


HOW IS 3TC TAKEN?

3TC is available in tablets of 150 milligrams (mg). It is also available in liquid form. The normal dose of 3TC is 150 mg (one tablet) twice a day. The dosage should be reduced for people who weigh less than 50 kilograms (110 pounds).

3TC can be taken with food or between meals.

Be sure your doctor knows if you have had kidney problems: your dose of 3TC may need to be lowered.

3TC is also available in Combivir and Trizivir. Combivir contains AZT and 3TC. Trizivir contains AZT, 3TC, and abacavir. For more information, see Fact Sheet 426 on Combivir or Fact Sheet 427 on Trizivir.



--------------------------------------------------------------------------------


WHAT ARE THE SIDE EFFECTS?

When you start any anti?viral treatment, you may have temporary side effects such as headaches, hypertension, or a general sense of feeling ill. These side effects usually get better or disappear over time.

The most common side effects of 3TC are nausea, vomiting, fatigue, and headaches. Some people have trouble sleeping. There have been rare cases of hair loss.



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HOW DOES 3TC REACT WITH OTHER DRUGS?


3TC is more effective if taken with other antiviral drugs.

3TC should not be combined with ddC (zalcitabine, Hivid®).

Blood levels of 3TC may be increased by bactrim or septra. See Fact Sheet 535 for more information on these drugs.



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Revised February 14, 2001

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