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Disturbed sleep is associated with the onset and maintenance of psychiatric disorders, as well as decrements in physical health including health care utilization, absenteeism, illness severity, and immune function. Fewer studies have evaluated sleep as a predictor, or mediator, of subsequent health outcomes. In the present study, we sought to evaluate the impact of subjective sleep complaints on subsequent mental and physical health outcomes in a sample of newly diagnosed cancer patients. Methods: We evaluated prospective relationships among sleep and health outcomes in a sample of 42 patients 6 female, 36 male; mean age of 56.5 years + 10.4 ; with newly diagnosed stage IV renal cell carcinoma who were recruited prior to participating in a phase II immunotherapy trial. Patients completed the Pittsburgh Sleep Quality Index, the Brief Symptom Inventory BSI ; , the CES-D, and the SF-36 at baseline, prior to vaccination, and 24 patients completed the same measures at a followup session 8 weeks later. Results: Regression analyses revealed that poorer sleep quality was subsequently associated with elevated symptoms of distress on the BSI Beta .43, p .02 ; and depression on the CES-D Beta .56, p .006 ; , after controlling for disease status and these measures at baseline. Among the 42 patients who completed the baseline assessment, logistic regression analyses revealed that sleep quality was a significant predictor of mortality during a 6-15 month follow-up period p .02 ; , after adjusting for indicators of medical prognosis, bodily pain, or other indices of quality of life at baseline. Conclusions: These data suggest that sleep is an important predictor of subsequent mental and physical health outcomes in cancer patients. In this sample, sleep was a stronger predictor of mortality than were traditional indices of disease severity including number and site of metastases. The nature of the relationship between sleep quality and health outcomes remains to be addressed. It will be important to determine whether sleep acts to signal vulnerability to, or plays a direct causal role in, adverse health outcomes. Pathways to outcomes may also differ depending on the outcome; for example, sleep-immune relationships may be especially important to mortality in cancer patients. Finally, relationships between laboratory-assessed sleep and subsequent health outcomes need to be determined as well. Research supported by MH01554, MH24652, MH30915, RR00056, & M.D. Anderson University Cancer Foundation 680.P Heart Rate Fluctuations of Successive Non-REM REM Transitions in IBS Patients Thompson JJ, Chen B, Orr WC Thomas N. Lynn Institute for Healthcare Research Introduction: Recent studies from our laboratory have described significant differences in sympatho-vagal balance during REM sleep in patients with irritable bowel syndrome Orr, et. al., 2000 ; . Heart rate is SLEEP, Vol. 24, Abstract Supplement 2001.

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For transdermal use only. Do not use if seal on sachet is broken Apply immediately upon removal from sachet. Read the package leaflet before use. 6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT OF THE REACH AND SIGHT OF CHILDREN and zidovudine, because combivir lamivudine.

Pygeum affricanum Studies conducted in Europe and the U.S.A. have attested that this herb is effective for BPH. Its prolactin-blocking property helps remove cholesterol accumulation that aggravates problems associated with prostate enlargement. More info on studies done. Pumpkin seeds Pumpkin seeds Cucurbita pepo ; are a particularly rich source of the mineral zinc. The highest concentration of this mineral is found in the prostate gland and prostatic fluids. Insufficient zinc can aggravate symptoms associated with an enlarged prostate. Taking plenty of zinc is important - increased estrogen levels in aging males interfere with zinc uptake. Pumpkin seeds possess mild diuretic properties to improve urinary flow and tone the bladder. These statements have not been evaluated by the U.S. Food & Drug Administration. This Product is not intended to diagnose, treat, cure or prevent any disease. Why is there no listing for Cokbivir and Trizivir on the report? and compazine. AZT also available via ODDMP for PEP indication ; b ; Expanded regimen 2 NRTIs + 1 PI ; Cmbivir AZT 300 mg 3TC 150 mg ; 1 tablet BID + nelfinavir 1250 mg BID c ; Other combinations of antiretrovirals may be used in special circumstances, including: Combviir AZT 300 mg 3TC 150 mg ; 1 tablet BID + lopinavir ritonavir 400 100 mg BID Cobmivir AZT 300 mg 3TC 150 mg ; 1 tablet BID + atazanavir 400 mg QD F A F 19.00 18.20 4 weeks 1041.60.

Special warnings about lamivudine, zidovudine remember that combivir does not totally eliminate hiv from the body and prochlorperazine. They should be given one pair IM or IV ampoules of high potency vitamins Pabrinex ; daily for three days. Pabrinex is presented as a pair of ampoules of vitamins B and C injection BPC for IV or IM injection. ; Treatment of established Wernicke's syndrome Two pairs IM or IV ampoules of Pabrinex are given daily for two days. If there is no response, the Pabrinex should be discontinued and the diagnosis checked. If symptoms respond, one pair of ampoules should be continued for a further three days.3 The risk of Pabrinex causing an allergic reaction anaphylaxis ; is low probably about one in a million doses.3 Nevertheless, resuscitation equipment and 1 in 1000 adrenaline injection should be made readily available. It is not sufficient to give vitamin supplements by mouth, even in large doses, because small intestine absorption is very limited in people who have recently been drinking heavily. The university buy levitra 10 mg of straw, he had donkeys in health career should buy combivir complete a faculty and a project focused on the university are ordinarily given in administrative matters buy combivir in the campus was still love and is a university of mine and coreg. ABSTRACT Cyclooxygenase-2 COX-2 ; inhibitors are safe medications widely prescribed for pain and arthritis. Recently, we evaluated a number of patients who developed severe dyspnea, some with irreversible lung damage, while taking COX-2 inhibitors. No other obvious etiologies were found after ex t e nsive evaluation. The possible mechanism of an uncontrolled inflammatory process with fibrosis as the result of inhibition of COX-2 is discussed based on available research data. INTRODUCTION Selective cyclooxygenase-2 COX-2 ; inhibitors have become a popular treatment for a variety of arthritic conditions. Over a 12-month period, we have seen several patients who developed unexplained dyspnea with or without severe pulmonary infi ltrates fibrosis and hy p oxemia while taking COX-2 inhibitors. We present case studies of four of these patients; 2 patients died despite aggr e s s ive supportive care and highdose steroids, because antiretroviral.
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Some medications are noted with N, QD, QL, or DS. The definitions for these symbols are listed below. Your benefit plan determines how these medications may be covered for you. Notification. There are a few medications that your doctor must notify us of to make sure their use is covered within your benefit. Quantity Duration. Some medications have a limited amount that can be covered for a specific period of time. Quantity Level. Some medications have a limited amount that can be covered at one time. Diabetic Supplies. Diabetic supplies may be covered by your benefit plan. Many benefit plans exclude coverage of medications that are classified by the Pharmacy and Therapeutics Committee as therapeutically equivalent to over-the-counter medications. Check your benefit plan documents for coverage information or call the Customer Care number on your ID card for more information. 100-7511 F1000 5 07 Advantage PDL and crestor. 02145286 00886882 00886890 CEFTIN - 250MG POUCH CEFTIN - 125MG TAB CEFTIN - 250MG TAB CEFTIN - 500MG TAB CEPTAZ - 500MG VIAL CEPTAZ - 1000MG VIAL CEPTAZ - 2000MG VIAL CEPTAZ - 10000MG VIAL CLAVULIN 25 6.25 CLAVULIN 250 125 CLAVULIN 40 5.7 CLAVULIN 50 12.5 CLAVULIN 500 125 CLAVULIN 80 11.4 CLAVULIN 875 125 COMBIVIR 150 300 COREG - 3.125MG TAB COREG - 6.25MG TAB COREG - 12.5MG TAB COREG - 25MG TAB DENAVIR - 10MG G EMEX - 5MG ML ENGERIX-B FLOVENT - 0.025MG DOSE FLOVENT - 0.05MG DOSE FLOVENT - 0.05MG DOSE FLOVENT - 0.1MG DOSE FLOVENT - 0.125MG DOSE FLOVENT - 0.25MG DOSE FLOVENT - 0.25MG DOSE FLOVENT - 0.5MG DOSE FLOVENT DISKUS - 0.05MG DOSE FLOVENT DISKUS - 0.1MG DOSE FLOVENT DISKUS - 0.25MG DOSE FLOVENT DISKUS - 0.5MG DOSE FLOVENT HFA - 0.05MG DOSE FLOVENT HFA - 0.125MG DOSE FLOVENT HFA - 0.25MG DOSE FORTAZ - 500MG VIAL FORTAZ - 1000MG VIAL FORTAZ - 2000MG VIAL FORTAZ - 6000MG VIAL FRAXIPARINE - 9500UNIT ML FRAXIPARINE FORTE - 19000UNIT ML HAVRIX 1440 - 1440UNIT ML HAVRIX 720 - 720UNIT ML cefuroxime axetil cefuroxime axetil cefuroxime axetil cefuroxime axetil ceftazidime pentahydrate ceftazidime pentahydrate ceftazidime pentahydrate ceftazidime pentahydrate amoxicillin trihydrate clavulanate potassium amoxicillin trihydrate clavulanate potassium amoxicillin trihydrate clavulanate potassium amoxicillin trihydrate clavulanate potassium amoxicillin trihydrate clavulanate potassium amoxicillin trihydrate clavulanate potassium amoxicillin trihydrate clavulanate potassium lamivudine zidovudine carvedilol carvedilol carvedilol carvedilol penciclovir metoclopramide hydrochloride hepatitis B vaccine fluticasone propionate fluticasone propionate fluticasone propionate fluticasone propionate fluticasone propionate fluticasone propionate fluticasone propionate fluticasone propionate fluticasone propionate fluticasone propionate fluticasone propionate fluticasone propionate fluticasone propionate fluticasone propionate fluticasone propionate ceftazidime pentahydrate ceftazidime pentahydrate ceftazidime pentahydrate ceftazidime pentahydrate nadroparin calcium nadroparin calcium hepatitis A vaccine inactivated ; hepatitis A vaccine inactivated ; J01DA J01DA J01DA J01DA J01DA J01DA J01DA J01DA J01CR J01CR J01CR J01CR J01CR J01CR J01CR J05AF C07AG C07AG C07AG C07AG D06BB A03FA J07BC R03BA R03BA R03BA R03BA R03BA R03BA R03BA R03BA R03BA R03BA R03BA R03BA R03BA R03BA R03BA J01DA J01DA J01DA J01DA B01AB B01AB J07BC J07BC powfer for oral suspension tablet tablet tablet powder for injectable solution powder for injectable solution powder for injectable solution powder for injectable solution oral suspension tablet oral suspension oral suspension tablet oral suspension tablet tablet tablet tablet tablet tablet topical cream injectable solution injectable suspension aerosol for inhalation aerosol for inhalation powder for inhalation powder for inhalation aerosol for inhalation aerosol for inhalation powder for inhalation powder for inhalation powder for inhalation powder for inhalation powder for inhalation powder for inhalation aerosol for inhalation aerosol for inhalation aerosol for inhalation powder for injectable solution powder for injectable solution powder for injectable solution powder for injectable solution injectable solution injectable solution injectable suspension injectable suspension not sold not sold.
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GlaxoSmithKline's investigational protease inhibitor 640385 brecanavir ; has potent anti-HIV activity against both resistant and sensitive virus, and is generally well tolerated when boosted by ritonavir and used in combination with Combivir, according to a 24 week interim analysis from a 48 week study presented to the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington DC. Laboratory studies have already shown that 640385 is a highly potent protease inhibitor with activity against HIV which has resistance to other drugs from this class. Early studies in HIV-negative volunteers have shown that the drug has a good pharmacokinetic profile and is well tolerated. Pharmacokinetic analysis is ongoing. Phase IIb studies of brecanavir will begin in 2006 and cymbalta.
Uppercase Brand-name medication lower case italics Generic medication PR Precertification required under most plans ST Step-therapy applies under most plans QL Quantity limit applies under most plans OTC Over-the-counter Generally not a covered drug under most plans ; SI Self-injectable medication Some plans may cover injectable medications through the medical benefit. See Page 8 for more information. ; Brand-name medication expected to become available generically during 2005. After the generic medication becomes available, the brand-name medication may be covered at a higher copayment and or added to the Formulary Exclusions List. Some medications listed in this booklet, such as contraceptives, infertility medications, erectile dysfunction medications and diabetic supplies, are not covered for every member. Our customer service and dedicated team of professionals, is just one reason why many are ordering their combvir from rxcarecanada.

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Please read this factsheet carefully together with the patient information leaflet before taking your medicine. If you have any questions or are unsure about anything, ask your doctor or pharmacist. Lamivudine, also known as 3TC or Epivir belongs to a class of drugs called nucleoside analogues or nucleoside reverse transcriptase inhibitors NRTIs ; . Please speak to your clinic doctor or pharmacist if you would like more information about how these drugs work. Before taking lamivudine Tell your doctor about: All other drugs that you are taking including any that you buy over the counter in a community pharmacy and herbal medicines Any previous allergy to any other medicine If you have ever had any liver disease If you have ever had any kidney disease Taking your lamivudine Lamivudine is available as a white diamond shaped tablet e gae wt " XC7 o o efc, n rv d i containing 150mg of lamivudine and a liquid containing 10mg per ml. It is also available in some clinics as a 300mg tablet. Combifir and Trizivir are combined pill preparations that also contain lamivudine. information please read the separate drug fact sheets. For more. 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Harnessing IP For Growth Reeling under over-regulation, the Indian pharma industry needs open transparent regulations for patent and data protection, says BV Mahalakshmi FE: Monday, November 13, 2006 at 0000 hours IST Strange it may sound but at a time when there is a strong case for corporatisation of the healthcare segment with an increased focus on foreign investment, the current Indian regulatory environment faces a significant challenge in terms of self-regulation. Consider this. Recently, a pharma-biotech company signed a non-disclosure agreement NDA ; with a Chennai-based company. Much to the dismay, the former was shocked to discover copies of the key documents in New Delhi! This incident and many more, bring to the forefront the basic question put forth by the knowledge-intensive industry: Do we have the right kind of IP infrastructure? Industry analysts point out that there are over-regulations in the country, which is the primary reason for the confusion prevailing in the industry. Says Kewal Handa, managing director, Pfizer: "The government mindset has to change in creating an optimum regulatory framework. The regulations have to be fact-based and transparent. They also need to be enforced evenly." Handa says that though an ambiguous patent law was passed in 2005, the patent examiner's guidelines are still not yet in place. Besides, there is still a delay in the decision on data exclusivity. Moreover, there are no drug reimbursements due to absence of an insurance sector and lack of code of marketing practices. The R&D efforts by the Indian pharma companies, however, have moved up from $40 million in 2002 to $200 million in 2004. "In India, the regulation is more of control in nature and it prohibits growth. Unlike the IT and telecom industry, the pharma industry is still struggling under the yoke of overregulation. There is a need for open transparent regulations and not some draconian laws. Regulations cannot be political driven, " he insists. Globally, the regulations in the pharma market include IP protection, product approval, drug reimbursement, market entry of generic drugs and marketing practice. However, in India, the perception of the industry towards patents and IPR is significantly different from that of the government. While the industry sees patents as safeguard of innovations, the government simply views them as a tool for WTO compliance. In an interesting highlight, Handa points out that the government spends only .09% of the GDP on health care whereas the WHO recommends a 7 to 8%. His prescription: The ideal role of regulations is to facilitate fair competition and shape the structure and conduct of the industry. Says Ranjit Shahani, vicechairman and managing director, Novartis: There is a need for both patent and data protection, which ensures that the first step of actual discovery occurs. The Organisation of Pharmaceutical Producers of India OPPI ; director general, Ajit V Dangi, says that India has the third largest scientific and most competitive brainpower that is equated to highest intellectual capital per dollar. "The whole IP infrastructure has to be changed. There is a lack of data exclusivity and protection in the system." While compulsory licensing has to be restricted for national emergencies, pre-grant opposition has resulted in frivolous objections delaying the patent, he observes. "An ecosystem has to be created with the IP infrastructure in place such as massive patent literacy programme on digitalisation, examiners and information processing. Besides there has to be a training of the judiciary for a quick and effective disposal apart from a dedicated IP court, " says Dangi. Co-relating IP with the tale of three blind men who have different views about the elephant, Sailesh Ayyangar, managing director, Aventis Pharma, says, "We have exclusive brain power, entrepreneurship and excellent manufacturing facilities. All we need is to build a reputation for ourselves and get out of the copycat label. We need to manage IPR for forging alliances and for clinical research." He goes on to say that in some industries, companies innovate to exploit the first-mover advantages and not to gain patent protection and lamivudine.

T.V.PHARM THAI NAKORN PATANA UNISON UTOPIAN B.M PHARMACY BURAPHA OSOTH GPO MACROPHAR NEW LIFE PHARMA NEW LIFE PHARMA T.P.DRUG LAB THAI NAKORN PATANA UNISON UNISON RX.CO-PH T.O.CHEMICAL T.O.CHEMICAL THAI NAKORN PATANA CONTINENTAL PHARM B.M PHARMACY BURAPHA OSOTH BURAPHA OSOTH INPAC PHARMA M.MARCH NEW LIFE PHARMA OSOTH INTER LABORA OSOTH INTER LABORA P.D CHEMICAL PATAR PHARMASANT LABS PHARMASANT LABS PROGRESS MED. PROGRESS MED. RX.CO-PH SEA PHARM CO SEA PHARM CO SEVEN STAR DISPENS SEVEN STAR DISPENS SINOPHARM SUPHONG BHAESAJ T.MAN PHARMA UTOPIAN V.S. PHARM 118. Ndc list ACYCLOVIR 400 MG TABLET ACYCLOVIR 400 MG TABLET ACYCLOVIR 400 MG TABLET PENTAZOCINE-NALOXONE TABLET PENTAZOCINE NALOXONE TABLET PENTAZOCINE NALOXONE TABLET PENTAZOCINE NALOXONE TABLET PENTAZOCINE NALOXONE TABLET PENTAZOCINE NALOXONE TABLET PENTAZOCINE NALOXONE TABLET PENTAZOCINE NALOXONE TABLET PENTAZOCINE NALOXONE TABLET PENTAZOCINE NALOXONE TABLET PENTAZOCINE-NALOXONE TABLET PENTAZOCINE NALOXONE TABLET COMBIVIR TABLET COMBIVIR TABLET COMBIVIR TABLET COMBIVIR TABLET COMBIVIR TABLET COMBIVIR TABLET COMBIVIR TABLET COMBIVIR TABLET DEXAMETHASONE 4 MG TABLET DEXAMETHASONE 4 MG TABLET DEXAMETHASONE 4 MG TABLET DEXAMETHASONE 4 MG TABLET DEXAMETHASONE 4 MG TABLET DEXAMETHASONE 4 MG TABLET DEXAMETHASONE 4 MG TABLET EFFEXOR XR 75 MG CAPSULE SA EFFEXOR XR 75 MG CAPSULE SA NYSTATIN 100, 000 UNIT GM CREAM NYSTATIN 100, 000 UNIT GM CREAM URINARY ANTISEPTIC F.C. TAB URINARY ANTISEPTIC F.C. TAB CIPROFLOXACIN 0.3% EYE DROP NYSTATIN-TRIAMCINOLONE CRM NYSTATIN-TRIAMCINOLONE CRM NYSTATIN-TRIAMCINOLONE OINT NYSTATIN-TRIAMCINOLONE OINT PHENERGAN 12.5 MG SUPPOS PHENERGAN 12.5 MG SUPPOS SULF-PRED 10-0.25% EYE DROP PROMETHAZINE VC SYRUP PROVENTIL HFA 90 MCG INHALER RETIN-A 0.025% CREAM SULFACETAMIDE 10% EYE OINT EPIDERM FOOT BALM HYDROCODONE COMPOUND SYRUP HYDROCORTISONE 0.5% CREAM HYDROXYZINE 10 MG 5 SYRUP Page 485.

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Pain medicine: different types of pain medicine get rid of a cold sore prednizone side effects - should i be worried if i take this drug. CLINORIL .9 clioquinol hydrocortisone .65 clobetasol propionate .65 clobetasol propionate e.65 clobetasol propionate emo .65 clobevate.65 CLOBEX.65 CLODERM .65 CLOLAR .39 clomipramine hcl .25 clonidine hcl .34 CLORPRES .34 clotrimazole 1% cream.65 clotrimazole 1% solution .65 clotrimazole 10 mg troche .91 clotrimazole betamethason .65 clozapine 100 mg tablet.42 CLOZAPINE 12.5 MG TABLET.42 clozapine 25 mg tablet .42 CLOZAPINE 50 MG TABLET .42 CLOZARIL .42 COAL TAR BASE .65 CODEINE PHOSPHATE .13 CODEINE SULFATE.13 COGENTIN.42 co-gesic .13 COGNEX.107 COLAZAL.80 colchicine 0.6 mg tablet .82 coldec .60 coldec d .60 coldec ds .60 coldec-tr.60 COLESTID .33 COLESTID FLAVORED .33 colestipo .33 colestipol .33 colidrops .110 colistimethate sodium.37 colocort.18 COLY-MYCIN-M .37 COLY-MYCIN-S.103 COLYTE.83 COLYTE-FLAVOR PACKS .83 COLYTE-FLAVORED .83 COLYTROL .110 COLYTROL PEDIATRIC .110 COMBIPATCH .78 COMBIVENT .21 COMBIVIR .45 COMBUNOX .13 COMPAZINE 5 MG 5 SYRUP.42 COMPAZINE 5 MG ML VIAL .43 compro.43 COMTAN.42 COMVAX.114 co-natal fa .92 CONCERTA.7 CONDYLOX 0.5% GEL .65 CONDYLOX 0.5% TOPICAL SOLN .65 constulose.83. PART III: CONSUMER INFORMATION COMBIVIR lamivudine and zidovudine This leaflet is part III of a three-part "Product Monograph" published when COMBIVIR was approved for sale in Canada and is designed specifically for Consumers. This leaflet is a summary and will not tell you everything about COMBIVIR. Please read this leaflet carefully before you start to take your medicine. Contact your doctor or pharmacist if you have any questions about the drug. ABOUT THIS MEDICATION What the medication is used for: The name of your medicine is COMBIVIR lamivudine and zidovudine ; . COMBIVIR is a treatment that contains a combination of two active ingredients that are currently available as separate medicines: 3TC lamivudine ; and RETROVIR AZTTM ; zidovudine ; . COMBIVIR can only be obtained with a prescription from your doctor. You should not be taking RETROVIR AZTTM ; zidovudine ; nor 3TC lamivudine ; while taking COMBIVIR. What it does: The Human Immunodeficiency Virus HIV ; is a retrovirus. Infection with HIV damages the immune system and can lead to Acquired Immune Deficiency Syndrome AIDS ; and other related illnesses. COMBIVIR is an antiretroviral medication. COMBIVIR does not cure AIDS or kill the HIV virus, but helps to prevent further damage to the immune system by slowing down the production of new viruses. When it should not be used: Do not use COMBIVIR: If you previously had an allergic reaction to COMBIVIR or to any of the ingredients in the product See what the nonmedicinal ingredients are ; . If you have a very low red blood cell count anemia ; or very low white blood cell count neutropenia ; . The coadministration of COMBIVIR with 3TC or RETROVIR AZTTM ; is not recommended. What the medicinal ingredient is: Each COMBIVIR tablet contains 150 mg of lamivudine and 300 mg of zidovudine. What the important nonmedicinal ingredients are: Each COMBIVIR tablet also contains the non-medicinal ingredients colloidal silicon dioxide, hydroxypropyl methyl cellulose, magnesium stearate, microcrystalline cellulose. For Looking BetterHealth.? Here's YourNext Step. The company Glaxo Wellcome Operations submitted in 2001 an application for Combivir HA110 ; to be assessed with the aim for acceptance, in principle, of Combivir on the List of Prequalified pharmaceutical products for the treatment of HIV AIDS. Combivir was assessed according to the `Procedure for Assessing the Acceptability, in principle, of Pharmaceutical Products for purchase by United Nations Agencies' by the team of WHO assessors. The assessors are senior experts, mainly from National Authorities, invited by WHO to participate in the Prequalification assessment process. The country of origin for the assessor involved with Combivir is Finland. Licensing status: Combivir has been licensed registered in at least one of the ICH regions. 2. Steps taken for the assessment of the product During the September 2001 meeting of the assessors team the dossier submitted was reviewed and found to be in compliance with the relevant WHO requirements. On 18 March 2002 Combivir was accepted, in principle, to the list for prequalified medicines.
PHARMACOLOGY: Mode of Action: Zidovudine is an inhibitor of the in vitro replication of some retroviruses including HIV, whereas lamivudine is a potent, selective inhibitor of HIV-1 and HIV-2 replication in vitro. Lamivudine has been shown to be usually synergistic with zidovudine at inhibiting the replication of HIV in cell culture. Both drugs are metabolised sequentially by intracellular kinases to their 5 triphosphate TP ; derivatives. Lamivudine 5'-triphosphate and triphosphate are substrates for and competitive inhibitors of HIV reverse transcriptase. However, their main antiviral activity is through incorporation of the monophosphate form MP ; form into the viral DNA chain, resulting in chain termination. Lamivudine and zidovudine triphosphates show significantly less affinity for host cell DNA polymerases. The relationships between in vitro susceptibility of HIV to lamivudine and zidovudine and the clinical response to therapy remain under investigation. In vitro sensitivity testing has not been standardised and results may vary according to methodological factors. Individually, lamivudine and zidovudine therapy has resulted in HIV clinical isolates which show reduced sensitivity in vitro to the nucleoside analogue to which they have been exposed. However in vitro studies also indicate that zidovudine-resistant virus isolates may become sensitive again to zidovudine when they simultaneously acquire resistance to lamivudine. Furthermore in-vivo there is clinical evidence that lamivudine plus zidovudine delays the emergence of zidovudine resistance in anti-retroviral naive patients. Pharmacokinetics: Absorption: Lamivudine and zidovudine are well absorbed from the gut. The bioavailability of oral lamivudine in adults is normally between 80-85% and for zidovudine 60-70%. A bioequivalence study in healthy volunteers compared Combivir and lamivudine 3TC ; 150 mg tablets and zidovidine Retrovir ; 300 mg tablets taken together. In fasted subjects, Combivir was shown to be bioequivalent to lamivudine 150 mg and zidovudine 300 mg administered together as separate tablets. Following Combivir administration, the Cmax 95% confidence interval ; for lamivudine was 1.5 g mL 1.3-1.8 ; and for zidovudine was 1.8 g mL 1.5-2.2 ; . The median tmax range ; was 0.75 hours 0.50-2.00 ; and 0.50 hours 0.25-2.00 ; for lamivudine and zidovudine, respectively. The extent AUC ; of lamivudine and zidovudine absorption, and estimates of half life following administration of Combivir with food were similar when compared to fasted subjects. The rate of absorption, however, was reduced for both drugs. For lamivudine, mean Cmax was 85% of that in the fasted state while median t ax increased from 0.75 to 1.5 hours. For m zidovudine, the mean C max was 55% of that in the fasted state while the median t max was increased from 0.5 to 1.0 hours. The clinical significance of the effect of food on the absorption of Combivir is not known. Pharmacokinetics in Special Patient Groups: There are limited data on the pharmacokinetics of zidovudine in patients with renal or hepatic impairment. Dosage adjustment of zidovudine is required in patients with advanced renal failure and severe hepatic impairment. There are also limited data on the pharmacokinetics of zidovudine in pregnant women. No specific data are available on the pharmacokinetics of zidovudine in the elderly. A single dose pharmacokinetic study of lamivudine n 16 ; in HIV-infected patients with normal renal function and with moderate creatinine clearance 30 mL min and 10 mL min ; or end.