Interacting drugs- summary

Lamivudine + Zidovudine-                                                                                              coadmin of lamividine with zidovudine resulted in an increase of 33% of zidovudine Cmax

Trimethoprim-Sulphamethox-                                                                                          coadmin resulted in an increase in lamividine AUC, a decrease in Sulphamethox oral clearance and a decrease in renal clearance 

U.S FDA APPROVED DRUGS FROM 01-01-08 TO 31-12-08

Approved by the FDA in November 17. 1995

U.S FDA APPROVED  DRUGS DURING 2004

Headache, malaise and fatigue, Fever and chills, skin rashes, Nausea, diarrhea, anorexia, Abdominal pain abdominal cramps, Dyspepsia. Insomnia and sleep disorders.

Hypersens to the drug

Special precautions:

Renal function impairment, pregnancy, lactation, children

Approved by the FDA in november 17. 1995

HIV infections

EVIDENCE BASED MEDICINE (MIMS April 2003)

Post-herpetic Neuralgia

Comparitive effectiveness of various interventions

Prevention of post-herpetic neuralgia

Beneficial

1. Oral antiviral agents such as acyclovir, famciclovir, valaciclovir, netivudine

2. Tricyclic antidepressants (amitriptyline)

Unknown effectiveness

1. Levodopa

2. Amantadine

3. Isoprinosine

4. Adenosine monophosphate

Unlikely to be beneficial

1. Topical antiviral agents (idoxurine) for relief of acute oain only

2. Cimetidine

Ineffective or harmful

1. Corticosteroids

Relieving established post-herpetic neuralgia

Beneficial

1. Tricyclic antidepressants (amitriptyline)

2. Oxycodone (opiod)

3. Gabapentin (anticonvulasant)

Unknown effectiveness

1. Capsaicin (topical counterirritant)

2. Topical lignocaine

Ineffective or harmful

1. Epidural morphine

2. Dextromethorphan

KEY POINTS

1. Daily acyclovir reduced the relative risk of of post-herpetic pain at six months by about 50 % compared with placebo

2. Famciclovir significantly reduced pain duration after acute herpes zoster.

3. Idoxuridine was associated with short term pain relief in acute herpes zoster but did not prevent post-herpetic neuralgia

4. Conflicting evidence on whether corticosteroids alone prevent post-herpetic neuralgia. Limited evidence that high dose steroids and antiviral agents combined may speed healing of acute zoster. No evidence that it reduces post-herpetic neuralgia

5. Amitriptyline started during the acute episode reduced prevalence of post-herpetic neuralgia at six months

6. Insufficient evidence on the effect of other drug tretment.

Pharmacology:

Lamivudine, deoxycytidine analogue with antiviral properties is phosphorylated by host cell kinases to a triphosphate moiety that is active against hepatitis B virus(HBV). Lamivudine (formerly known as 3TC) is a synthetic nucleoside analog with activity against H IV

Pharmacokinetics:

Lamivudine was rapidly absorbed after oral administration in HIV patients. Absolute bioavailability in 12 adult patients was 86% for the tablet and 87% for the oral soln.

Lamivudine can be administered with or without food.

Pregnancy:

Use during pregnancy only when required

Lactation:

Instruct mothers to discontinue nursing while taking the drug.