Abacavir/Lamivudine 600 mg/300 mg film-coated tablets

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

Abacavir/Lamivudine contains abacavir (which is also an active substance in medicines such as Kivexa, Trizivir, Triumeq and Ziagen). Some people who take abacavir may develop a hypersensitivity reaction (a serious allergic reaction), which can be life-threatening if they continue to take abacavir containing products.

You must carefully read all the information under ‘Hypersensitivity reactions’ in the panel in Section 4.

The Abacavir/Lamivudine pack includes an Alert Card, to remind you and medical staff about abacavir hypersensitivity. Detach this card and keep it with you at all times.

1. What Abacavir/Lamivudine is and what it is used for
2. What you need to know before you take Abacavir/Lamivudine
3. How to take Abacavir/Lamivudine
4. Possible side effects
5. How to store Abacavir/Lamivudine
6. Contents of the pack and other information

• if you are allergic to abacavir (or any other medicine containing abacavir (e.g. Kivexa, Trizivir, Triumeq or Ziagen), lamivudine or any of the other ingredients of this medicine (listed in Section 6)
  Carefully read all the information about hypersensitivity reactions in Section 4.
  Check with your doctor if you think this applies to you. Do not take Abacavir/Lamivudine

Some people taking Abacavir/Lamivudine or other combination treatments for HIV are more at risk of serious side effects. You need to be aware of the extra risks:

• if you have moderate or severe liver disease
• if you have ever had liver disease, including hepatitis B or C (if you have hepatitis B infection, do not stop Abacavir/Lamivudine without your doctor’s advice, as your hepatitis may come back)
• if you are seriously overweight (especially if you are a woman)
• if you have a kidney problem

Talk to your doctor if any of these apply to you before using Abacavir/Lamivudine. You may need extra check-ups, including blood tests, while you are taking your medicine. See Section 4 for more information.

Abacavir hypersensitivity reactions

Even patients who don’t have the HLA-B*5701 gene may still develop a hypersensitivity reaction (a serious allergic reaction).

Carefully read all the information about hypersensitivity reactions in Section 4 of this leaflet.

It cannot be excluded that abacavir may increase the risk of having cardiovascular events.

Tell your doctor if you have cardiovascular problems, if you smoke, or have other illnesses that may increase your risk of cardiovascular diseases such as high blood pressure, or diabetes. Do not stop taking Abacavir/Lamivudine unless your doctor advises you to do so.

Some people taking medicines for HIV infection develop other conditions, which can be serious. You need to know about important signs and symptoms to look out for while you are taking Abacavir/Lamivudine.

Read the information ‘Other possible side effects of combination therapy for HIV’ in Section 4 of this leaflet.

Tell your doctor or pharmacist if you are taking any other medicines, or if you have taken any recently, including herbal medicines or other medicines you bought without a prescription.

Remember to tell your doctor or pharmacist if you begin taking a new medicine while you are taking Abacavir/Lamivudine.

These medicines should not be used with Abacavir/Lamivudine:

• emtricitabine, to treat HIV infection
• other medicinal products containing lamivudine, used to treat HIV infection or hepatitis B infection
• high doses of trimethoprim/sulfamethoxazole, an antibiotic
• cladribine, used to treat hairy cell leukaemia

Tell your doctor if you are being treated with any of these.

Some medicines interact with Abacavir/Lamivudine

These include:

• phenytoin, for treating epilepsy.
  Tell your doctor if you are taking phenytoin. Your doctor may need to monitor you while you are taking Abacavir/Lamivudine.
• methadone, used as a heroin substitute. Abacavir increases the rate at which methadone is removed from the body. If you are taking methadone, you will be checked for any withdrawal symptoms. Your methadone dose may need to be changed.
  Tell your doctor if you are taking methadone.
• medicines (usually liquids) containing sorbitol and other sugar alcohols (such as xylitol, mannitol, lactitol or maltitol), if taken regularly.
  Tell your doctor or pharmacist if you are taking any of these.
• Riociguat, for treating high blood pressure in the blood vessels (the pulmonary arteries) that carry blood from the heart to the lungs. Your doctor may need to reduce your riociguat dose, as abacavir may increase riociguat blood levels.

Abacavir/Lamivudine is not recommended for use during pregnancy. Abacavir/Lamivudine and similar medicines may cause side effects in unborn babies.

If you have taken Abacavir/Lamivudine during your pregnancy, your doctor may request regular blood tests and other diagnostic tests to monitor the development of your child. In children whose mothers took NRTIs during pregnancy, the benefit from the protection against HIV outweighed the risk of side effects.

Breast-feeding

Breast-feeding is not recommended in women living with HIV, because HIV infection can be passed on to the baby in breast milk. A small amount of the ingredients in Abacavir/Lamivudine can also pass into your breast milk.

If you are breast-feeding, or thinking about breast-feeding, you should discuss it with your doctor as soon as possible.

Abacavir/Lamivudine may cause side effects which could affect your ability to drive or use machines.

Talk to your doctor about your ability to drive or operate machines while taking Abacavir/Lamivudine.

Abacavir/Lamivudine contains a colouring called sunset yellow (E110), this may cause allergic reactions in some people.

This medicine contains less than 1 mmol sodium (23 mg) per film coated tablet, that is to say essentially ‘sodium-free’.

Abacavir/Lamivudine helps to control your condition. You need to keep taking it every day to stop your illness getting worse. You may still develop other infections and illnesses linked to HIV infection.

Keep in touch with your doctor, and do not stop taking Abacavir/Lamivudine without your doctor’s advice.

If you accidentally take too much Abacavir/Lamivudine, tell your doctor or your pharmacist, or contact your nearest hospital emergency department for further advice.

If you forget to take a dose, take it as soon as you remember. Then continue your treatment as before.

Do not take a double dose to make up for a forgotten dose.

It is important to take Abacavir/Lamivudine regularly, because if you take it at irregular intervals, you may be more likely to have a hypersensitivity reaction.

If you have stopped taking Abacavir/Lamivudine for any reason —especially because you think you are having side effects, or because you have other illness:

Talk to your doctor before you start taking it again. Your doctor will check whether your symptoms were related to a hypersensitivity reaction. If the doctor thinks they may have been related, you will be told never again to take Abacavir/Lamivudine, or any other medicine containing abacavir (e.g. Kivexa, Trizivir, Triumeq or Ziagen). It is important that you follow this advice.

If your doctor advises that you can start taking Abacavir/Lamivudine again, you may be asked to take your first doses in a place where you will have ready access to medical care if you need it.

Abacavir/Lamivudine contains abacavir (which is also an active substance in medicines such as Kivexa, Trizivir, Triumeq and Ziagen). Abacavir can cause a serious allergic reaction known as a hypersensitivity reaction. These hypersensitivity reactions have been seen more frequently in people taking medicines that contain abacavir.

Who gets these reactions?

Anyone taking Abacavir/Lamivudine could develop a hypersensitivity reaction to abacavir, which could be life threatening if they continue to take Abacavir/Lamivudine.

You are more likely to develop this reaction if you have a gene called HLA-B*5701 (but you can get a reaction even if you do not have this gene). You should have been tested for this gene before Abacavir/Lamivudine was prescribed for you. If you know you have this gene, tell your doctor before you take Abacavir/Lamivudine.

About 3 to 4 in every 100 patients treated with abacavir in a clinical trial who did not have the HLA-B*5701 gene developed a hypersensitivity reaction.

What are the symptoms?

The most common symptoms are:

• fever (high temperature) and skin rash.

Other common symptoms are:

• nausea (feeling sick), vomiting (being sick), diarrhoea, abdominal (stomach) pain, severe tiredness.

Other symptoms include:

Pains in the joints or muscles, swelling of the neck, shortness of breath, sore throat, cough, occasional headaches, inflammation of the eye (conjunctivitis), mouth ulcers, low blood pressure, tingling or numbness of the hands or feet.

When do these reactions happen?

Hypersensitivity reactions can start at any time during treatment with Abacavir/Lamivudine, but are more likely during the first 6 weeks of treatment.

Contact your doctor immediately:

1. if you get a skin rash, OR
2. if you get symptoms from at least 2 of the following groups:

• fever
• shortness of breath, sore throat or cough
• nausea or vomiting, diarrhoea or abdominal pain
• severe tiredness or achiness, or generally feeling ill.

Your doctor may advise you to stop taking Abacavir/Lamivudine.

If you have stopped taking Abacavir/Lamivudine

If you have stopped taking Abacavir/Lamivudine because of a hypersensitivity reaction, you must NEVER AGAIN take Abacavir/Lamivudine, or any other medicine containing abacavir (e.g. Kivexa, Trizivir, Triumeq or Ziagen). If you do, within hours, your blood pressure could fall dangerously low, which could result in death.

If you have stopped taking Abacavir/Lamivudine for any reason —especially because you think you are having side effects, or because you have other illness:

Talk to your doctor before you start again. Your doctor will check whether your symptoms were related to a hypersensitivity reaction. If the doctor thinks they may have been, you will then be told never again to take Abacavir/Lamivudine, or any other medicine containing abacavir (e.g. Kivexa, Trizivir, Triumeq or Ziagen). It is important that you follow this advice.

Occasionally hypersensitivity reactions have developed in people who start taking abacavir containing products again, but who had only one symptom on the Alert Card before they stopped taking it.

Very rarely patients who have taken medicines containing abacavir in the past without any symptoms of hypersensitivity have developed a hypersensitivity reaction when they start taking these medicines again.

If your doctor advises that you can start taking Abacavir/Lamivudine again, you may be asked to take your first doses in a place where you will have ready access to medical care if you need it.

If you are hypersensitive to Abacavir/Lamivudine, return all your unused Abacavir/Lamivudine tablets for safe disposal. Ask your doctor or pharmacist for advice.

The Abacavir/Lamivudine pack includes an Alert Card, to remind you and medical staff about hypersensitivity reactions. Detach this card and keep it with you at all times.

Common side effects

These may affect up to 1 in 10 people:

• hypersensitivity reaction
• headache
• being sick (vomiting)
• feeling sick (nausea)
• diarrhoea
• stomach pains
• loss of appetite
• tiredness, lack of energy
• fever (high temperature)
• general feeling of being unwell
• difficulty in sleeping (insomnia)
• muscle pain and discomfort
• joint pain
• cough
• irritated or runny nose
• skin rash
• hair loss

Uncommon side effects

These may affect up to 1 in 100 people and may show up in blood tests:

• a low red blood cell count (anaemia) or low white blood cell count (neutropenia)
• an increase in the level of liver enzymes
• a decrease in the number of cells involved in blood clotting (thrombocytopenia).

Rare side effects

These may affect up to 1 in 1000 people:

• liver disorders, such as jaundice, enlarged liver or fatty liver, inflammation (hepatitis)
• inflammation of the pancreas (pancreatitis)
• breakdown of muscle tissue.

Rare side effects that may show up in blood tests are:

• increase in an enzyme called amylase.

Very rare side effects

These may affect up to 1 in 10,000 people:

• numbness, tingly feelings in the skin (pins and needles)
• sensation of weakness in the limbs
• skin rash, which may form blisters and looks like small targets (central dark spots surrounded by a paler area, with a dark ring around the edge) (erythema multiforme)
• a widespread rash with blisters and peeling skin, particularly around the mouth, nose, eyes and genitals (Stevens–Johnson syndrome), and a more severe form causing skin peeling in more than 30% of the body surface (toxic epidermal necrolysis).
• lactic acidosis (excess lactic acid in the blood).

Very rare side effects that may show up in blood tests are:

• a failure of the bone marrow to produce new red blood cells (pure red cell aplasia).

Tell your doctor or pharmacist if any of the side effects gets severe or troublesome, or if you notice any side effects not listed in this leaflet.

Combination therapy such as Abacavir/Lamivudine may cause other conditions to develop during HIV treatment.

Symptoms of infection and inflammation

Old infections may flare up

People with advanced HIV infection (AIDS) have weak immune systems, and are more likely to develop serious infections (opportunistic infections). Such infections may have been “silent” and not detected by the weak immune system before treatment was started. After starting treatment, the immune system becomes stronger, and may attack the infections, which can cause symptoms of infection or inflammation. Symptoms usually include fever, plus some of the following:

• headache
• stomach ache
• difficulty breathing

In rare cases, as the immune system becomes stronger, it can also attack healthy body tissue (autoimmune disorders). The symptoms of autoimmune disorders may develop many months after you start taking medicine to treat your HIV infection. Symptoms may include:

• palpitations (rapid or irregular heartbeat) or tremor
• hyperactivity (excessive restlessness and movement)
• weakness beginning in the hands and feet and moving up towards the trunk of the body.

If you get any symptoms of infection and inflammation or if you notice any of the symptoms above:

Tell your doctor immediately. Do not take other medicines for the infection without your doctor’s advice.

Some people taking combination therapy for HIV develop a condition called osteonecrosis. With this condition, parts of the bone tissue die because of reduced blood supply to the bone. People may be more likely to get this condition:

• if they have been taking combination therapy for a long time
• if they are also taking anti-inflammatory medicines called corticosteroids
• if they drink alcohol
• if their immune systems are very weak
• if they are overweight.

Signs of osteonecrosis include:

• stiffness in the joints
• aches and pains (especially in the hip, knee or shoulder)
• difficulty moving.

If you notice any of these symptoms:

Tell your doctor.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

• The active substances in each Abacavir/Lamivudine film-coated tablet are 600 mg of abacavir (as sulfate) and 300 mg of lamivudine.
• The other ingredients are microcrystalline cellulose, sodium starch glycollate (Type A), silica, colloidal anhydrous and magnesium stearate in the core of the tablet. The tablet coating contains Opadry YS-1-13065–A containing hypromellose, titanium dioxide (E171), macrogol 400, polysorbate 80 and sunset yellow FCF (E110).

Abacavir/Lamivudine film-coated tablets are orange coloured, capsule shaped tablets, of about 21.4 mm length and 8.3 mm width, debossed with “RF-90” on one side and plain on the other side.

Pack sizes:

Triplex blister pack: PVC/PE/PVDC/Al blister pack containing 30 tablets.

Cold form blister pack: PVC/PA/Al blister pack containing 30 tablets.

HDPE Bottle packs: HDPE bottle with polypropylene screw cap or with child-resistant closure, containing 30 or 90 tablets.

Not all pack sizes may be marketed.

Manufacturer

This medicine is authorised in the Member States of the European Economic Area and in the United Kingdom (Northern Ireland) under the following names:

United Kingdom (Northern Ireland) Abacavir/Lamivudine 600 mg/300 mg film-coated tablets

Spain Abacavir/Lamivudina SUN 600 mg/300 mg comprimidos recubiertos con pelicula EFG

Italy Abacavir e Lamivudina SUN

Germany Abacavir/Lamivudin Basics 600 mg/300 mg Filmtabletten

France Abacavir/Lamivudine SUN 600 mg/300 mg comprimé pelliculé

Romania Abacavir/ Lamivudină Terapia 600 mg/300 mg comprimate filmate