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HIV post exposure prophylaxis – Combivir and Kaletra (PDF)

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 Tha gach sgrìobhainn againn rim faotainn ann an diofar chànanan, clò
 nas motha, Braille (Beurla a-mhàin), teip claistinn no riochd eile a tha sibh
 airson a thaghadh.                                                                     HIV post-exposure
                                                                                        prophylaxis –
                                                                                        Combivir and Kaletra
                                                                                        Information for you


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 Last reviewed: March 2010                                                                   All our publications are available in other formats
 Leaflet reference: MIS10-080-GD
...Information for you...Information for you...Information for you...Information for you...Information for you...Information for you


  Prophylaxis means preventative treatment.                                Pregnancy
  You have been prescribed post-exposure                                   Your tablets seem to be safe when taken after
  prophylaxis, following sexual exposure (PEPSE)                           12 weeks of pregnancy. However, there is less
  because you may have been exposed to the                                 information about its safety when taken before 12
  human immunodeficiency virus (HIV).                                      weeks of pregnancy.
  It is vital that you start taking this medication                        You must tell your doctor if you could be
  within 72 hours of your exposure to the                                  pregnant.
  potential risk, as the medication is not effective
  after this time. The earlier you start taking the                        You should take precautions to avoid becoming
  medication, the better.                                                  pregnant or getting someone else pregnant while
                                                                           taking these medicines.
  The treatment consists of a combination of two
  tablets, containing three active drugs. These                            This medication will make contraceptive pills and
  are antiviral drugs, which are effective against                         implants less effective. Use condoms until you have
  HIV. Used together, there is evidence that they                          finished the course. This will also protect partners
  can reduce the risk of developing HIV infection                          in case you do develop HIV.
  following exposure to the virus.
                                                                           Further information
                                                                           Blood Borne Virus (BBV) clinic, Crosshouse Hospital
                                                                           Telephone: 01563 521133
                                                                           Sexual Health Department
                                                                           Telephone: 01294 323226
                                                                           Terrence Higgins Trust
                                                                           Telephone helpline: 0845 1221 200
                                                                           Website: www.tht.org.uk/informationresources/
                                                                           publications/gaymengerneralinformation/
                                                                           pepbooklet665.pdf

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...Information for you...Information for you...Information for you...Information for you...Information for you...Information for you


  •	 Difficulty sleeping Combivir     Take care when                       Before starting PEPSE
     or tiredness (one                driving or operating
                                                                           These drugs are currently not licensed to be used
     in ten people)                   machinery. Tell your
                                      doctor if it persists.               for post-exposure prophylaxis, following sexual
  •	 Dizziness or                                                          exposure. However, they are commonly used to try
     confusion (one in
     100 people)
                                                                           and prevent HIV infection.
  •	 Skin rash (one in     Kaletra    Tell your doctor if it               The medication needs to be taken for one month
     30 people)                       persists.                            for it to be effective.
                                                                           It can have unpleasant side effects, such as sickness
  Rare side effects Caused            What you should                      or diarrhoea.
                    by                do                                   If the medication does not work, and you are
  •	 Tiredness,            Combivir   Tell your doctor, as                 diagnosed with HIV, we cannot use this medication
     associated with       Kaletra    you may be anaemic                   in the future to help treat HIV, as you may have
     shortness of                                                          developed resistance to it.
     breath (less
     than one in 100                                                       We will need to monitor you carefully when you
     people)                                                               are taking the course of tablets, and for the three
  •	 Fever associated      Combivir   Tell your doctor, as
                                                                           months afterwards.
     with feeling          Kaletra    this could be due to a
     unwell and other                 low white cell count.
     symptoms (less
     than one in 100
     people)
  •	 Jaundice -            Combivir   Tell your doctor, as
     yellowing of the      Kaletra    this could be due to
     skin and eyes (less              liver toxicity.
     than one in 100
     people)



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...Information for you...Information for you...Information for you...Information for you...Information for you...Information for you


  Your medication                                                          Your doctor will take blood tests every week to
                                                                           check your blood and liver. You must tell your
  Combivir: White capsule-shaped tablet, marked
                                                                           doctor if you notice anything different.
            GXFC3.
                                                                           In a few people, anti-HIV drugs can cause changes
              Each tablet contains 300mg zidovudine
                                                                           in fat distribution and high blood sugar and
              and 150mg lamiduvine.
                                                                           cholesterol. This usually only occurs after several
                                                                           years of use.
                                                                            Common side            Caused     What you should
                                                                            effects                by         do
  Kaletra:    Yellow tablets, marked with the                               •	 Feeling sick (one   Combivir   Keep on taking the
                                                                               in 20 people)       Kaletra    tablets with food. It
              manufacturer’s logo and the letters KA.                                                         often settles. Tell your
                                                                            •	 Stomach pains or
              Each tablet contains 200mg lopinavir                             wind (one in 50                doctor if it persists or
              and 50mg ritonavir. Lopinavir is the                             people)                        becomes distressing.
              active substance and ritonavir acts to                        •	 Diarrhoea (one in
              slow its breakdown in the body.                                  four people)

                                                                            •	 Headache, joint     Combivir   Take a simple
                                                                               pains or muscle                painkiller such as
                                                                               pains (one in ten              paracetamol or
                                                                               people)                        ibuprofen. Tell your
  Your doctor has given you a four-day starter pack,                                                          doctor if it persists.
  but the treatment will normally continue for                              •	 Cough, nasal        Combivir   Tell your doctor if it
  four weeks. We will make arrangements for you                                irritation or runny            persists.
                                                                               nose (one in ten
  to attend the Blood Borne Virus (BBV) clinic at
                                                                               people)
  Crosshouse Hospital for a follow-up appointment
  and to get a further supply.



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  You should not breast feed while taking PEPSE                            Taking your medicine
  medication.
                                                                           For your treatment to be effective, it is vital that
                                                                           you take it properly. Treatment should be started
  Always remember:                                                         as soon as possible after you have been at risk of
  •	 Do not take more than the recommended dose.                           catching HIV.
  •	 Do not give your medicines to others.                                 Read the label on your medicines. You should
  •	 Keep your medicines in a cool, dark, dry place,                       take the tablets as follows:
     out of the reach of children.                                          Medicine          Morning            Evening
  Side effects                                                              Combivir          Take one          Take one
                                                                                              tablet with       tablet after
  The most common side effects of PEPSE medication                                            your breakfast    your evening
  are nausea (feeling sick), diarrhoea, headache,                                                               meal, ideally
  tiredness, weakness and muscle soreness.                                                                      12 hours after
  These usually settle if you keep taking the                                                                   the breakfast
  medicines as directed. Simple painkillers or tablets                                                          dose.
  to help sickness and diarrhoea may help. Tell your                        Kaletra           Take two          Take two
  doctor if the symptoms persist.                                                             tablets with      tablets after
  Serious side effects are rare. However, they include:                                       your breakfast    your evening
  •	 allergic reactions;                                                                                        meal, ideally
                                                                                                                12 hours after
  •	 liver toxicity;                                                                                            the breakfast
  •	 reduced production of red blood cells, which can                                                           dose.
     cause anaemia; and
                                                                           Swallow the tablets whole with plenty of water,
  •	 reduced production of white blood cells, which                        while sitting or standing in an upright position. It is
     can make you prone to infections.                                     important that they are not chewed or crushed.


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...Information for you...Information for you...Information for you...Information for you...Information for you...Information for you


  Take all the medicines at the approximate times                          Do not start any new medication without
  indicated, even if you have not actually had a                           discussing it with your doctor first.
  meal.                                                                    Some of the drugs which can interact with Kaletra
  If you forget to take a dose, take it as soon as                         and Combivir include:
  possible and then continue as before. If you have                        •	 Methadone - used for opiate addiction
  difficulty remembering tablets, use an alarm to
  remind you – for example, set up a reminder on                           •	 Warfarin - used to thin the blood
  your mobile phone.                                                       •	 Phenytoin or sodium valproate - used to treat
  To prevent side effects, you will need to take the                          epilepsy
  following tablets:                                                       •	 Rifampicin, erythromycin or clarithromycin -
  Metoclopramide 10mg tablets to prevent and                                  antibiotics
  treat sickness - take one tablet three times a day if                    •	 Terfenidine or astemizole - used to treat allergy
  you feel sick.                                                              symptoms and hayfever
  Loperamide 2mg tablets to prevent and treat                              •	 Amiodarone or quinidine - used to treat an
  diarrhoea – take two tablets (4mg), followed by                             irregular heart beat
  another tablet (2mg) after each time you have                            •	 Triazolam, midazolam - used to treat anxiety and
  loose stools. Do not take more than eight tablets in                        poor sleep
  24 hours (6 mg).
                                                                           •	 Ergot derivatives - used to treat migraine
  With this treatment, there is a risk of problems
  developing if you are taking other medication or if                      •	 St John’s Wort - used to treat depression
  you have other medical problems, such as liver or                        •	 Simvastatin or lovastatin - used to lower
  kidney problems.                                                            cholesterol levels
  You must tell your doctor about any medical                              •	 Hormonal methods of contraception, including
  problems you have and about any medication                                  implants, the combined pill and the progestogen
  you are taking. This includes prescribed                                    only pill.
  medicine, medicines bought over the counter or
  street drugs.
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