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Generic Name:

lamivudine-zidovudine, Oral tablet

All Brands

  • Combivir
SECTION 1 of 4

Highlights for lamivudine-zidovudine

Oral tablet
1

This drug combines two different drugs, lamivudine and zidovudine, to treat HIV infection when used with at least one more drug.

2

This drug comes as the brand-name drug Combivir. It’s also available in its generic form.

3

Most side effects of this drug are mild and may include fatigue, headache, diarrhea, nausea, cough, and runny nose. These usually go away within a few weeks.

IMPORTANT INFORMATION

FDA warning

Warning:

Lactic acidosis and liver enlargement warning. These are possible effects of this drug. Lactic acidosis is a serious change in the body’s chemical balance. In this condition, lactic acid builds up in the blood. This can cause nausea and weakness. If you experience these symptoms along with swelling or enlargement of your abdomen, see a doctor right away. Women are at increased risk for lactic acidosis.

Warning for people with both hepatitis B and HIV. If you take this drug to treat both HIV and hepatitis B virus infections and then stop taking it, your hepatitis B can become much more severe. Your healthcare provider will need to monitor your liver function very carefully. You may need to restart treatment for hepatitis B.

Blood toxicity warning. Zidovudine (one of this drug’s ingredients) has caused decreases in infection-fighting white blood cells and severe anemia. Anemia is a decrease in your red blood cells. Symptoms include weakness, tiredness, pale and cold skin, and increased heart rate. You could also have an increased number of infections. These effects are most likely to occur if you have advanced HIV disease. Based on certain blood markers, your doctor can tell if you are at risk for blood toxicity due to zidovudine.

Muscle disease warning. Long-term use of zidovudine has been associated with muscle disease (myopathy). Symptoms include weakness and pain in your muscles.

May cause pancreatitis

Pancreatitis is inflammation of the pancreas. It’s a rare side effect of this drug. Symptoms include:

  • stomach bloating
  • pain
  • nausea
  • vomiting
  • tenderness when touching the stomach

If you’ve had pancreatitis before, you may be at greater risk.  

May cause immune reconstitution syndrome

In immune reconstitution syndrome, your recovering immune system may cause your body to have an enhanced inflammatory response to remnants of previous infections or due to other factors.

May cause changes in body fat

May cause fat redistribution. Some people experience a redistribution or accumulation of fat around the stomach or on the back. They can also have a loss of fat in the limbs and face.

What is lamivudine/zidovudine?

Lamivudine/zidovudine is a prescription drug that comes as an oral tablet. It’s available as a generic and as the brand-name drug Combivir. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version.

This medication is a combination drug. It contains two drugs: lamivudine and zidovudine. It’s important to know about all the drugs in the combination because each drug may affect you in a different way. This medication is not a complete treatment for HIV when used on its own, however. Typically, one more antiretroviral drug must be added to this treatment to make it complete.

Why it's used

This drug is used to treat HIV infection in combination with other antiretroviral agents.

More Details

How it works

Lamivudine and zidovudine both belong to a class of drugs called nucleoside reverse transcriptase inhibitors (NRTIs).

More Details

Why it's used

This drug is used to treat HIV infection in combination with other antiretroviral agents. It’s approved to treat adults and adolescents who weigh at least 66 pounds (30 kilograms). It’s also approved to treat children with HIV. Children’s dosage is based on their body weight.

How it works

Lamivudine and zidovudine both belong to a class of drugs called nucleoside reverse transcriptase inhibitors (NRTIs). A class of drugs is a group of medications that work in a similar way and are often used to treat similar conditions. NRTIs block an enzyme called reverse transcriptase. HIV needs this enzyme to copy itself. When the drug works, the virus can’t make copies and spread through your body as quickly.

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SECTION 2 of 4

lamivudine-zidovudine Side Effects

Oral tablet

Most Common Side Effects

The more common side effects of lamivudine/zidovudine can include:

  • cough

  • diarrhea

  • fatigue

  • headache

  • feeling of discomfort, illness, or unhappiness

  • nasal symptoms, such as a runny nose

  • nausea

  • tingling or pain in hands and feet (neuropathy)

Most of these mild side effects will disappear after a few weeks. If they persist or are bothersome, call your doctor.

Serious Side Effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Lactic acidosis and liver enlargement: Lactic acidosis is a serious change in the body’s chemical balance. In this condition, lactic acid builds up in the blood, and the amount of oxygen drops. This can cause nausea and weakness. If you experience these symptoms, or swelling or enlargement of your abdomen, see a doctor right away. Women are at increased risk for lactic acidosis.

  • Pancreatitis (inflammation of the pancreas): This is a rare side effect from this drug. If you’ve had pancreatitis before, you may be at greater risk. Signs can include:

    • stomach bloating
    • pain
    • nausea
    • vomiting
    • tenderness when touching the stomach 
  • Blood toxicity and anemia: Zidovudine (one of this drug’s ingredients) has caused severe anemia and decreased levels of infection-fighting white blood cells. Anemia is a decrease of your red blood cells. Symptoms include:

    • weakness
    • tiredness
    • pale and cold skin
    • increased heart rate
    • increased number of infections

    These effects are most likely if you have advanced HIV. Based on certain blood markers, your doctor can tell if you are at risk for blood toxicity due to zidovudine.

  • Myopathy (muscle disease): Long-term use of zidovudine has been associated with myopathy. Symptoms may include weakness and pain in your muscles

  • Immune reconstitution syndrome: In immune reconstitution syndrome, your recovering immune system may cause an enhanced inflammatory response to remnants of previous infections or other factors.

Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

Combivir does not cause drowsiness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 4

lamivudine-zidovudine May Interact with Other Medications

Oral tablet

This drug can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Medications That Might Interact with This Drug

Human immunodeficiency virus (HIV) drugs

Each tablet of this drug contains lamivudine and zidovudine. You should not take it with any other form of either lamivudine or zidovudine. This includes:

  • lamivudine (Epivir or Epivir-HBV)
  • zidovudine (Retrovir)
  • abacavir/lamivudine (Epzicom)
  • abacavir/lamivudine/zidovudine (Trizivir)

Other HIV drugs you should not combine with this drug include:

  • efavirenz/emtricitabine/tenofovir (Atripla)
  • emtricitabine (Emtriva)
  • emtricitabine/tenofovir (Truvada)
  • rilpivirine/emtricitabine / tenofovir (Complera)
  • stavudine (Zerit)

Drugs That Worsen This Drug’s Side Effects

Some drugs can seriously limit this drug’s effectiveness. These include:

  • ganciclovir (Cytovene), an intravenous antiretroviral drug. Using both ganciclovir and zidovudine can increase the risk of toxic effects such as decreased white and red blood cells.
  • interferon alfa alone or with ribavirin. There are many brands and generics of these drugs, which are used to treat hepatitis C and some forms of cancer. Most of these drugs are injectable. All of them are managed by specialist doctors and specialty pharmacies. If you’re treated for any of these conditions, ask your doctor if you should take Combivir.

Chemotherapy

Some chemotherapy drugs can prevent zidovudine from working well. They include:

  • doxorubicin

Cancer drugs

If you’re being treated for cancer or being treated with other drugs that prevent your bone marrow from making red and white blood cells, you shouldn’t take this drug. If you’re not sure, talk to your doctor before taking this drug.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Combivir warnings
bone marrow suppression
People with bone marrow suppression

If you have bone marrow suppression (a side effect of drugs like azathioprine and colchicine, as well as chemotherapy), your white blood cell count can be low. This could make it hard for you to fight infections. Your red blood cell count can also be low. This drug can affect both of these cell counts. Your doctor will likely monitor you and give you blood tests often if you take this drug. You may need to take a different drug. 

overweight
People who are overweight

If you have a body mass index of 30 or greater, you are considered obese. Being obese increases your risk of liver disease and lactic acidosis from this drug. Lactic acidosis is a serious change in the body’s chemical balance. In this condition, lactic acid builds up in the blood and the amount of oxygen drops. This can cause nausea and weakness.

pregnant women
Pregnant women

Studies done in humans have not shown an increase in birth defects in babies born to mothers who have taken this drug during pregnancy. More research may be needed. Some animal studies have shown adverse effects to the fetus when the mother is given lamivudine/zidovudine.

However, the drug may still be used if the benefits of taking it outweigh possible risks. If you’re pregnant or plan to become pregnant, talk to your doctor before taking lamivudine/zidovudine.

If you take this drug while pregnant, ask your doctor about taking part in the Antiretroviral Pregnancy Registry (APR), which tracks results of this drug usage.

breastfeeding
Women who are breastfeeding

Women should not breastfeed while taking lamivudine/zidovudine. This is mainly because the Centers for Disease Control and Prevention recommend that women with HIV do not breastfeed to avoid passing HIV through breast milk.

Lamivudine/zidovudine also passes into breast milk, though it’s not known what effects this drug could have on a breastfeeding child.

children
For children

This combination drug is sometimes given to children. However, it should not be given to children who weigh less than 66 pounds (30 kg). This drug comes in one strength, and smaller children may need a smaller dose than it can provide.

telephone
When to call the doctor

Call your doctor if you experience:

  • fever
  • weakness
  • chills
  • night sweats
  • sore throat
  • joint pain

These symptoms may indicate that the drug isn’t working and you may need a different treatment.

allergies
Allergies

It’s possible to have an allergic reaction to Combivir. Symptoms of an allergic reaction include:

  • rash
  • itching (urticaria)
  • anaphylaxis (a severe and dangerous allergic reaction). Symptoms of anaphylaxis may include tightening of the airway, swelling of the face, flushing of the skin, and dizziness due to low blood pressure.

See a doctor or go to an emergency room if you suddenly have:

  • skin flushing, itching, or rash
  • swelling of the face, tongue, or throat
  • wheezing
  • trouble breathing
SECTION 4 of 4

How to Take lamivudine-zidovudine (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on: 

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What Are You Taking This Medication For?

Human immunodeficiency virus (HIV) Infection

Generic: Lamivudine/zidovudine

Form: oral tablet
Strength: 150 mg lamivudine/300 mg zidovudine

Brand: Combivir

Form: oral tablet
Strength: 150 mg lamivudine/300 mg zidovudine
Adult Dosage (ages 18-64 years and 66 pounds or more)

Take one 150/300 mg tablet twice per day.

Child Dosage (ages 0-17 years and 66 pounds or more)

Take one 150/300 mg tablet twice per day.

Senior Dosage (ages 65 years and older)

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dose may cause levels of the drug to be higher than normal. If you’re a senior, you may need a lower dose or you may need a different schedule.

Special considerations

Children: This drug is not to be used in children weighing less than 66 lbs. Children who need both drugs may be able to take the drugs individually as lamivudine (Epivir) oral solution and zidovudine (Retrovir) syrup.

Reduced Kidney Function, Kidney Disease: If you have reduced kidney function, you shouldn’t take this drug. Reduced kidney function slows the body’s ability to clear the drug. If it isn’t cleared fast enough, it can increase the risk for toxic effects. Zidovudine (one of this drug’s ingredients) can be toxic for you if you take too much. Talk to your doctor before taking this drug.

Liver Disease: If you have liver disease, your body may have trouble processing Combivir. The dose of zidovudine in this combination product is fixed. Your doctor may choose to give you another product that allows for reduced dosing.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

There can be serious health consequences if you don’t take this drug exactly how your doctor tells you.

What To Do if I Miss a Dose

If you forget to take your dose, take it as soon as you remember. If it’s only a few hours until your next dose, wait and take only a single dose. Taking two tablets at once could result in toxic side effects, such as decreased white and red blood cells, muscle pain, nausea, weakness, or swelling of the abdomen.

If You Stop or Miss Doses

If you stop taking this medication or miss doses, your human immunodeficiency virus (HIV) can become resistant to the drug. If this happens, the drug may stop working and your immune system could become weak and unable to fight off infections.

If You Don’t Take It on Schedule

Your body needs a consistent amount of this drug to treat HIV. Taking your drug at the same time every day keeps a consistent amount of the drug in your body and increases your ability to keep the virus under control. Not taking it at the same time each day could make the amount of drug in your body inconsistent. This could cause the drug to lose effectiveness.

How Can I Tell if the Drug Is Working?

To see how well your treatment is working, your doctor will check your:

  • virus count. A virus count measures the number of copies of HIV in your body.
  • CD4 count. A CD4 count measures the amount of CD4 cells in your body. CD4 cells are white blood cells that fight infection. An increased CD4 count is a sign that your HIV treatment is working.

Combivir is a long-term drug treatment.

Important considerations for taking this drug

The tablets are film-coated and should not be crushed

The tablets are film coated and should not be crushed. However, scored lamivudine/zidovudine tablets are safe to break into two pieces along the score mark. A score mark is an indented line across the middle of a tablet.

Store at 36–86°F (2–30°C)

Keep this drug in its original bottle and away from light.

Note: Keep your drugs away from areas where they could get wet, such as bathrooms. Store them away from moisture and damp locations.

Clinical monitoring

Kidney & Liver Function: Your doctor will check your kidney and liver function before giving you this drug.

Complete Blood Count: Before and during treatment, your doctor will do a complete blood count to check your red and white blood cell levels. Depending on how low certain blood counts are, taking this drug could cause your blood cells to decrease even further. You will need more frequent blood counts than those with an earlier stage of human immunodeficiency virus (HIV).

CD4 and HIV Count: To see how well your treatment is working, your doctor will check your:

  • virus count. A virus count measures the number of copies of HIV in your body.
  • CD4 count. A CD4 count measures the amount of CD4 cells in your body. CD4 cells are white blood cells that fight infection. An increased CD4 count is a sign that your HIV treatment is working.

Not every pharmacy stocks this drug, so call ahead

If you only need a few tablets, you should call and ask if your pharmacy dispenses only a small number of tablets. Some pharmacies can't dispense only part of a bottle.

This drug is often available from specialty pharmacies through your insurance plan. These pharmacies operate like mail order pharmacies and ship the drug to you.

In larger cities, there will often be human immunodeficiency virus (HIV) pharmacies where you can have your prescriptions filled. Ask your doctor if there's an HIV pharmacy in your area.

Insurance

Many insurance plans will require a prior authorization before they will approve payment for this drug. This could delay treatment for 1 or 2 weeks.

It may be possible to have a small amount of the drug dispensed, but this drug is fairly expensive. Dispensing a small amount may depend on your ability to pay for the small supply out-of-pocket.

Are there any alternatives?

There are many drugs and combinations that can treat human immunodeficiency virus (HIV). Some may be more suitable for you than others. Talk to your doctor about possible alternatives.


Show Sources

Content developed in collaboration with Susan J. Bliss, RPh, MBA

Medically reviewed by University of Illinois-Chicago, Drug Information Group on June 15, 2017

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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