Formulary
Abacavir: Indications, Dosing, Side Effects and Interactions
Abacavir clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Abacavir: Indications, Dosing, Side Effects and Interactions
Abacavir clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**HIV infection in combination with other antiretroviral drugs**
- **Adult** (By Mouth): 600 mg daily in 1-2 divided doses.
**HIV infection in combination with other antiretroviral drugs for abacavir**
- **Child 3 months-11 years** (By mouth): 8 mg/kg twice daily (max. per dose 300 mg), alternatively 16 mg/kg once daily (max. per dose 600 mg).
- **Child 3 months-11 years (body-weight 14-20 kg)** (By mouth): 150 mg twice daily, alternatively 300 mg once daily.
- **Child 3 months-11 years (body-weight 21-29 kg)** (By mouth): 150 mg, taken in the morning and 300 mg, taken in the evening, alternatively 450 mg once daily.
- **Child 3 months-11 years (body-weight 30 kg and above)** (By mouth): 300 mg twice daily, alternatively 600 mg once daily.
- **Child 12-17 years** (By mouth): 300 mg twice daily, alternatively 600 mg once daily.
Cautions
HIV load greater than 100 000 copies/mL; patients at high risk of cardiovascular disease
Side effects
For all nucleoside reverse transcriptase inhibitors Common or very common Abdominal pain; anaemia (may require transfusion); asthenia; diarrhoea; dizziness; fever; flatulence; headache; insomnia; nausea; neutropenia; skin reactions; vomiting Uncommon Angioedema; pancreatitis Rare or very rare Lactic acidosis Frequency not known Immune reconstitution inflammatory syndrome; osteonecrosis; weight increased Side-effects, further information Osteonecrosis has been reported in patients with advanced HIV disease or following long-term exposure to combination antiretroviral therapy. Side-effects For abacavir Common or very common Appetite decreased; lethargy Rare or very rare Severe cutaneous adverse reactions (SCARs) Frequency not known Hypersensitivity Side-effects, further information Life-threatening hypersensitivity reactions have been reported- characterised by fever or rash and possibly nausea, vomiting, diarrhoea, abdominal pain, dyspnoea, cough, lethargy, malaise, headache, and myalgia; less frequently mouth ulceration, oedema, hypotension, sore throat, acute respiratory distress syndrome, anaphylaxis, paraesthesia, arthralgia, conjunctivitis, lymphadenopathy, lymphocytopenia and renal failure; rarely myolysis. Laboratory abnormalities may include raised liver function tests and creatine kinase; symptoms usually appear in the first 6 weeks, but may occur at any time. Discontinue immediately if any symptom of hypersensitivity develops and do not rechallenge (risk of more severe hypersensitivity reaction).
Interactions
**Severe interactions:**
- Clinical studies have shown that there are no clinically significant interactions between abacavir, zidovudine, and lamivudine.
**Other interactions (17):**
- The potential for P450 mediated interactions with other medicinal products involving abacavir is low.
- In vitro studies have shown that abacavir has potential to inhibit cytochrome P450 1A1 (CYP1A1).
- P450 does not play a major role in the metabolism of abacavir, and abacavir shows limited potential to inhibit metabolism mediated by CYP 3A4.
- Abacavir has also been shown in vitro not to inhibit CYP2C9 or CYP2D6 enzymes at clinically relevant concentrations.
- Potent enzymatic inducers such as rifampicin, phenobarbital and phenytoin may via their action on UDP-glucuronyltransferases slightly decrease the plasma concentrations of abacavir.
- Ethanol: the metabolism of abacavir is altered by concomitant ethanol resulting in an increase in AUC of abacavir of about 41%.
Pregnancy
For all nucleoside reverse transcriptase inhibitors Monitoring in pregnancy Mitochondrial dysfunction has been reported in infants exposed to nucleoside reverse transcriptase inhibitors in utero; the main effects include haematological, metabolic, and neurological disorders; all infants whose mothers received nucleoside reverse transcriptase inhibitors during pregnancy should be monitored for relevant signs or symptoms.
Hepatic impairment
For all nucleoside reverse transcriptase inhibitors In general, manufacturers advise caution in patients with chronic hepatitis B or C (increased risk of hepatic side-effects). Hepatic impairment For abacavir Manufacturer advises caution in mild impairment; consider avoiding in moderate to severe impairment (no information available).
Renal impairment
Manufacturer advises avoid in end-stage renal disease.
Medicinal forms
Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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