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Introduction About DUOVIR N TABLET
DUOVIR N TABLET is a combination of Lamivudine, Nevirapine, and Zidovudine which belongs to the group of medicines called Antiretroviral drugs. It is used in adults and children (weighing at least 25 kgs) to manage HIV (human immunodeficiency virus) infection. HIV targets the immune system and weakens your defence against many infections that people with healthy immune systems can fight off.
As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient, and reach the most advanced stage of HIV infection called acquired immunodeficiency syndrome (AIDS). It may present with the symptoms of any other infection like fever, throat pain, extreme tiredness, weight loss, muscle pain, etc.
During the course of the management, your doctor might take regular blood tests to avoid any untoward side effects. Avoid consumption of alcohol while taking DUOVIR N TABLET as it may cause bone problems. DUOVIR N TABLET is not suitable for use in children (weighing less than 25 kgs). DUOVIR N TABLET is not recommended for use in patients with low red blood cell count, liver problems, or with medicines like rifampicin or St. John’s wort.
Before taking DUOVIR N TABLET, inform your doctor if you have any kidney problems. Inform your doctor if you are pregnant before taking DUOVIR N TABLET. You should not breastfeed while taking DUOVIR N TABLET. The most common side effects of taking DUOVIR N TABLET are feeling ill and tired, headache, nausea, vomiting, dizziness, stomach pain, diarrhoea, fever, red, raised, or itchy rash, joint or muscle pain, cough, trouble sleeping, hair loss, etc. Contact your doctor if any of the above side effects worsen.
Uses Of DUOVIR N TABLET
- Manage HIV infection
How DUOVIR N TABLET Works
DUOVIR N TABLET helps control HIV infection where nevirapine, lamivudine and zidovudine inhibit HIV replication through incorporation into viral DNA by binding to different sites of the enzyme HIV reverse transcriptase, resulting in obstruction of viral DNA synthesis.
How to use DUOVIR N TABLET
Take DUOVIR N TABLET as advised by your physician. Swallow the medicine with a glass of water. Do not crush or chew the medicine. Your doctor will decide the correct dose and duration for you depending upon your age, body weight and disease condition. Do not stop taking DUOVIR N TABLET unless your doctor advises you to stop.
Side Effects Of DUOVIR N TABLET
Common
- feeling ill and tired, headache, dizziness
- nausea, vomiting, stomach pain, diarrhoea
- fever
- red, raised, or itchy rash
- rise in certain liver enzymes
- joint pain or muscle pain and other muscle problems
- cough, nasal symptoms
- trouble sleeping
- hair loss
- low red blood cell count (tiredness, breathlessness)
- low white blood cell count (more chances of infections)
Uncommon
- general aches and pains
- drop in blood platelets (easy bruising)
Rare
- patchy colour changes inside the mouth
- change in nail and skin colour
- pure red cell aplasia (a blood disorder)
- heartburn
- cardiomyopathy (a heart muscle disease causing chest pain)
- breakdown of muscle tissue
- liver disorders like enlarged liver, fatty liver, inflammation of the liver, or pancreas
- sweating
- flu-like symptoms, chills
- frequent urination
- breast enlargement (men)
- loss of appetite, changes in taste
- tingling in arms or legs
- fits, inability to concentrate
- depression, anxiety
- lactic acidosis (excess lactic acid in the body)
Stop taking DUOVIR N TABLET and contact your doctor immediately if you experience any of the following side effects:
- liver injury (loss of appetite, nausea, yellow skin and whites of the eyes, dark urine, discoloured faeces, pain, and tenderness in the upper right area of stomach)
- allergic or skin reactions (rash with fever, blistering, mouth sores, eye inflammation, facial or general swelling, muscle or joint pain, low white blood cell count, feeling generally unwell, severe liver or kidney problems)
- changes in your body shape
- lactis acidosis (weakness, tiredness, feeling cold especially in your arms and legs, abnormal muscle pain, dizziness or light-headedness, fast or irregular heartbeat, deep fast breathing, drowsiness, nausea, vomiting, stomach pain)
- symptoms of infection
- osteonecrosis (bone cell death)
- muscle pain or weakness
- resistant HBV
How To Manage Side Effects
Diarrhea
Drink lots of fluids, such as water or fruit juice to keep yourself hydrated. Do not consume any medicine on your own without consulting your doctor. If diarrhea does not improve, contact your doctor.
Dizziness Or Drowsiness
Lie down until dizziness is gone, then get up slowly. Move slowly and carefully, do not hurry. Get adequate rest. Drink plenty of water and other fluids. Avoid coffee, cigarettes, alcohol, and drugs. If dizziness does not improve, contact your doctor.
Headache
Drink ample amount of water. Get adequate rest. Try to be relaxed and stress free. Ask your doctor before taking any medicine for headache. If headache does not improve, contact your doctor.
Nausea And Vomiting
In case of nausea, take DUOVIR N TABLET with, or just after meals. Stick to simple meals. Avoid eating oily or spicy foods. If nausea does not improve, contact your doctor.
In case of vomitting, get adequate rest. Drink lots of fluids, especially water. Have small sips if you feel sick. Eat when you feel like it – you do not need to eat or avoid any specific foods. Do not take any medicine for vomiting without asking your doctor. If vomiting does not improve, contact your doctor.
Stomach Pain
Try to rest and relax. Eat and drink slowly or try to have smaller meals more frequently. Keep a heat pad on your stomach. If the stomach pain does not improve, contact your doctor.
Warning & Precautions
Pregnancy
Monitoring requiredDUOVIR N TABLET should be used in pregnancy only if considered necessary by your doctor, as it is not known if it will harm your unborn baby. Consult your doctor before taking it.
Breastfeeding
ContraindicatedWomen taking DUOVIR N TABLET should not breastfeed. Consult your doctor before taking it and ask about the best way to feed your baby.
Driving and Using Machines
Use with CautionDo not drive or operate any machines if you feel dizzy or extremely tired after taking DUOVIR N TABLET.
Alcohol
ContraindicatedAvoid consumption of alcohol while taking DUOVIR N TABLET as it may cause bone problems.
Kidney
Use with CautionDUOVIR N TABLET should be used with caution in patients who have or had any kidney disease or undergoing dialysis. Consult your doctor before taking it.
Liver
Consult your doctorDUOVIR N TABLET is not recommended for use in patients with serious liver disease or marked changes in liver function, or if you previously experienced liver inflammation or injury. DUOVIR N TABLET should be used with caution in patients who have or had any liver disease like hepatitis B or C. Consult your doctor before taking it.
Allergy
ContraindicatedDo not take DUOVIR N TABLET if you are allergic to Lamivudine, Nevirapine, Zidovudine, or any of the other ingredients of this medicine.
Use In Pediatrics
ContraindicatedDUOVIR N TABLET is not recommended for use in children (weighing less than 25kgs). Consult your doctor before taking it.
Use In Geriatrics
Use with CautionDUOVIR N TABLET should be used with caution in elderly patients (65 years and older). Consult your doctor before taking it.
Others
DUOVIR N TABLET is not recommended for use if you:
- have very low red or white blood cell count
- previously experienced skin rash
Before taking DUOVIR N TABLET, inform your doctor if you:
- are a woman
- are overweight
- have trouble swallowing
Interactions
A. Drug - Drug interactions:
Before taking DUOVIR N TABLET, inform your doctor if you are taking any of the following medicines:
- medicines used to manage bacterial infections (Ex. rifampin, clarithromycin, rifabutin)
- St. John’s wort (used to manage depression)
- lamivudine (used to manage hepatitis B infection)
- medicines used to manage viral infections (Ex. zalcitabine, ganciclovir, foscarnet, stavudine, emtricitabine, efavirenz, tipranavir, atazanavir, ritonavir, fosamprenavir, indinavir, ribavirin)
- medicines used to manage fungal infections (Ex ketoconazole, itraconazole, fluconazole)
- probenecid (used to manage gout)
- medicines used to manage pregnancy (Ex. desogestrel, ethinyl estradiol)
- doxorubicin (used to manage certain types of cancer)
- warfarin (used to manage blood clots)
- medicines used to manage malaria (Ex. artemisinin, amodiaquine, artesunate, quinine, lumefantrine, halofantrine, atovaquone)
- medicines used to manage fits (Ex. phenytoin, valproic acid)
Overdosage:
If you or anyone else accidentally took too much of DUOVIR N TABLET, contact your doctor immediately.
Synopsis
| Drug | : | Nevirapine, Lamivudine, Zidovudine |
| Pharmacological Category | : | Non-nucleoside reverse transcriptase inhibitor (NNRTI), Nucleoside analogue reverse transcriptase inhibitor (NRTI) |
| Therapeutic Indication | : | HIV infection |
| Dosage Forms | : | Tablet |
More Information
- Keep DUOVIR N TABLET out of reach from children
- Do not store DUOVIR N TABLET above 30°C
FAQs About DUOVIR N TABLET
Q: Are women more prone to DUOVIR N TABLET side effects?
A: Women with CD4 counts more than 250 cells/mm3 are at a greater risk of having liver side effects and lactic acidosis with DUOVIR N TABLET. Consult your doctor before taking it.
Q: Can I develop rashes while taking DUOVIR N TABLET?
A: Skin rash is the most common side effect of DUOVIR N TABLET. Rashes can turn serious, so stop taking this medicine and go to your doctor the moment you develop a rash.
Q: Do I have more chances of getting side effects with DUOVIR N TABLET if I am overweight?
A: You might have more chances of getting a side effect called lactic acidosis with DUOVIR N TABLET if you are overweight. Consult your doctor before taking it.
Q: Can I drink alcohol with DUOVIR N TABLET?
A: Consuming alcohol with DUOVIR N TABLET may put you at a greater risk of developing a bone problem called osteonecrosis (bone cell death), so it is better to avoid it. Consult your doctor for further queries.
Q: How does DUOVIR N TABLET manage HIV infection?
A: DUOVIR N TABLET does not manage HIV infection. It reduces the amount of HIV virus in your body and increase CD4 cell counts (a type of white blood cell, which is important in maintaining a healthy immune system. It is important that you remain under the care of your doctor.
Q: Can DUOVIR N TABLET be taken in pregnancy?
A: DUOVIR N TABLET should be used in pregnant women only if considered necessary by your doctor. If you are pregnant, think you may be during pregnancy or are planning to get pregnant, consult your doctor before taking it. Inform your doctor immediately if you become pregnant during management with DUOVIR N TABLET.
Q: Can I still pass HIV to other during DUOVIR N TABLET management?
A: DUOVIR N TABLET does not lower the risk of passing HIV to other people. For yours and other health, it is important to take appropriate precautions. Ask your doctor about the management measures that you can take.
Q: Can DUOVIR N TABLET be crushed?
A: No. Do not chew, crush or split DUOVIR N TABLET. Simply swallow it wholly, with a glass of water.
Q: What if I vomit out DUOVIR N TABLET?
A: If you vomit out DUOVIR N TABLET, take another medicine. Do not wait until the next dose is scheduled.
Q: Can DUOVIR N TABLET change my body shape?
A: Management with DUOVIR N TABLET might cause redistribution, accumulation, or loss of body fat, which might lead to a change in your body shape. Contact your doctor if you notice any such changes.
Q: Can DUOVIR N TABLET be used on infants?
A: No. DUOVIR N TABLET is not recommended for use in children (weighing less than 25 kgs). Your doctor will decide the correct dose or select a suitable alternative therapy for your child.
Q: What if I miss a dose of DUOVIR N TABLET?
A: If you miss a dose of DUOVIR N TABLET, take it if you remember within 6 hours of missing the dose. However, omit if it is more than 6 hours past the missed dose. Do not take DUOVIR N TABLET twice to make up for a forgotten dose.
References
1. KD. Tripathi. Antiviral drugs. Essentials of Medical Pharmacology. Seventh edition. 2013. Page – 813.
2. Anderson PL, Rower JE. Zidovudine and Lamivudine for HIV Infection. NIH National Library of Medicine, National centre for biotechnology information. PubMed central. October 2010. [Accessed on 4th July 2022] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954111/
3. Nabila Rehman, Hoang Nguyen. Nevirapine. StatPearls [Internet]. StatPearls Publishing. July 2021. [Accessed on 4th July 2022] https://www.ncbi.nlm.nih.gov/books/NBK554477/#article-25853.s3
4. Sun Pharmaceutical Industries Limited. Lamivudine + Nevirapine + Zidovudine. [Revised in July 2018] [Accessed on 4th July 2022] https://extranet.who.int/pqweb/sites/default/files/HA323part3.pdf
5. Cipla Ltd. Lamivudine + Nevirapine + Zidovudine. [Revised in August 2020] [Accessed on 4th July 2022] https://www.ciplamed.com/content/duovir-n-tablets#patientcounselinginformation
Useful Diagnostic Tests
- Complete Blood Count (CBC)
- Viral Load Test
- CD4 Count Test
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