Stavudine Information
Stavudine (Stavudine; lamivudine; nevirapine) Description
Stavudine (Stavudine; lamivudine; nevirapine) (d4T), a synthetic thymidine nucleoside analogue, active against the human immunodeficiency virus (HIV).
Stavudine (Stavudine; lamivudine; nevirapine) Capsules are supplied for oral administration in strengths of 15, 20, 30, and 40 mg of Stavudine (Stavudine; lamivudine; nevirapine) . Each capsule also contains inactive ingredients microcrystalline cellulose, sodium starch glycolate, lactose anhydrous, and magnesium stearate. The hard gelatin shell consists of gelatin, sodium lauryl sulfate, titanium dioxide, and iron oxides.The capsules are printed with Black ink containing black iron oxide E172 dye.
The chemical name for Stavudine (Stavudine; lamivudine; nevirapine) is 2',3'-didehydro-3'-deoxythymidine. Stavudine (Stavudine; lamivudine; nevirapine) has the following structural formula:
Stavudine (Stavudine; lamivudine; nevirapine) is a white to off-white crystalline solid with the molecular formula C H N O and a molecular weight of 224.2. The solubility of Stavudine (Stavudine; lamivudine; nevirapine) at 23° C is approximately 83 mg/mL in water and 30 mg/mL in propylene glycol. The n-octanol/water partition coefficient of Stavudine (Stavudine; lamivudine; nevirapine) at 23° C is 0.144.
Stavudine (Stavudine; lamivudine; nevirapine) Microbiology
The cell culture antiviral activity of Stavudine (Stavudine; lamivudine; nevirapine) was measured in peripheral blood mononuclear cells, monocytic cells, and lymphoblastoid cell lines. The concentration of drug necessary to inhibit HIV-1 replication by 50% (EC) ranged from 0.009 to 4 μM against laboratory and clinical isolates of HIV-1. In cell culture, Stavudine (Stavudine; lamivudine; nevirapine) exhibited additive to antagonistic activity in combination with zidovudine. Stavudine (Stavudine; lamivudine; nevirapine) in combination with either abacavir, didanosine, tenofovir, or zalcitabine exhibited additive to synergistic anti-HIV-1 activity. Ribavirin, at the 9-45 μM concentrations tested, reduced the anti-HIV-1 activity of Stavudine (Stavudine; lamivudine; nevirapine) by 2.5- to 5-fold. The relationship between cell culture susceptibility of HIV-1 to Stavudine (Stavudine; lamivudine; nevirapine) and the inhibition of HIV-1 replication in humans has not been established.
Stavudine (Stavudine; lamivudine; nevirapine) Clinical Pharmacology
Following an 80-mg dose of C-Stavudine (Stavudine; lamivudine; nevirapine) to healthy subjects, approximately 95% and 3% of the total radioactivity was recovered in urine and feces, respectively. Radioactivity due to parent drug in urine and feces was 73.7% and 62.0%, respectively. The mean terminal elimination half-life is approximately 2.3 hours following single oral doses. Mean renal clearance of the parent compound is approximately 272 mL/min, accounting for approximately 67% of the apparent oral clearance
In HIV-infected patients, renal elimination of unchanged drug accounts for about 40% of the overall clearance regardless of the route of administration (Table 2). The mean renal clearance was about twice the average endogenous creatinine clearance, indicating active tubular secretion in addition to glomerular filtration.
(see )
Zidovudine:
Doxorubicin: In vitro
Stavudine (Stavudine; lamivudine; nevirapine) does not inhibit the major cytochrome P450 isoforms CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4; therefore, it is unlikely that clinically significant drug interactions will occur with drugs metabolized through these pathways.
Because Stavudine (Stavudine; lamivudine; nevirapine) is not protein-bound, it is not expected to affect the pharmacokinetics of protein-bound drugs.
Tables 5 and 6 summarize the effects on AUC and C, with a 95% confidence interval (CI) when available, following coadministration of Stavudine (Stavudine; lamivudine; nevirapine) with didanosine, lamivudine, and nelfinavir. No clinically significant pharmacokinetic interactions were observed.
Stavudine (Stavudine; lamivudine; nevirapine) Indications And Usage
Stavudine (Stavudine; lamivudine; nevirapine) capsules , in combination with other antiretroviral agents, is indicated for the treatment of HIV-1 infection (see ).
Stavudine (Stavudine; lamivudine; nevirapine) Clinical Studies
The combination use of Stavudine (Stavudine; lamivudine; nevirapine) is based on the results of clinical studies in HIV-infected patients in double- and triple-combination regimens with other antiretroviral agents.
One of these studies (START 1) was a multicenter, randomized, open-label study comparing Stavudine (Stavudine; lamivudine; nevirapine) (40 mg twice daily) plus lamivudine plus indinavir to zidovudine plus lamivudine plus indinavir in 202 treatment-naive patients. Both regimens resulted in a similar magnitude of inhibition of HIV RNA levels and increases in CD4 cell counts through 48 weeks.
Stavudine (Stavudine; lamivudine; nevirapine) Contraindications
Stavudine (Stavudine; lamivudine; nevirapine) is contraindicated in patients with clinically significant hypersensitivity to Stavudine (Stavudine; lamivudine; nevirapine) or to any of the components contained in the formulation.
Stavudine (Stavudine; lamivudine; nevirapine) Warnings
Particular caution should be exercised when administering Stavudine (Stavudine; lamivudine; nevirapine) to any patient with known risk factors for liver disease; however, cases of lactic acidosis have also been reported in patients with no known risk factors. Generalized fatigue, digestive symptoms (nausea, vomiting, abdominal pain, and unexplained weight loss); respiratory symptoms (tachypnea and dyspnea); or neurologic symptoms (including motor weakness, see ) might be indicative of the development of symptomatic hyperlactatemia or lactic acidosis syndrome.
Treatment with Stavudine (Stavudine; lamivudine; nevirapine) should be suspended in any patient who develops clinical or laboratory findings suggestive of symptomatic hyperlactatemia, lactic acidosis, or pronounced hepatotoxicity (which may include hepatomegaly and steatosis even in the absence of marked transaminase elevations).
The safety and efficacy of Stavudine (Stavudine; lamivudine; nevirapine) have not been established in HIV-infected patients with significant underlying liver disease. During combination antiretroviral therapy, patients with preexisting liver dysfunction, including chronic active hepatitis, have an increased frequency of liver function abnormalities, including severe and potentially fatal hepatic adverse events, and should be monitored according to standard practice. If there is evidence of worsening liver disease in such patients, interruption or discontinuation of treatment must be considered.
An increased risk of hepatotoxicity may occur in patients treated with Stavudine (Stavudine; lamivudine; nevirapine) in combination with didanosine and hydroxyurea compared to when Stavudine (Stavudine; lamivudine; nevirapine) is used alone. Deaths attributed to hepatotoxicity have occurred in patients receiving this combination. This combination should be avoided.
In vitro
hepatic decompensation (some fatal) has occurred in HIV/HCV co-infected patients receiving combination antiretroviral therapy for HIV and interferon and ribavirin.
the complete prescribing information for interferon and ribavirin).
CLINICAL PHARMACOLOGY: Drug Interactions
Motor weakness has been reported rarely in patients receiving combination antiretroviral therapy including Stavudine (Stavudine; lamivudine; nevirapine) . Most of these cases occurred in the setting of lactic acidosis. The evolution of motor weakness may mimic the clinical presentation of Guillain-Barré syndrome (including respiratory failure). Symptoms may continue or worsen following discontinuation of therapy.
Peripheral neuropathy, manifested by numbness, tingling, or pain in the hands or feet, has been reported in patients receiving Stavudine (Stavudine; lamivudine; nevirapine) therapy. Peripheral neuropathy has occurred more frequently in patients with advanced HIV disease, with a history of neuropathy, or in patients receiving other drugs that have been associated with neuropathy, including didanosine (see ).
Stavudine (Stavudine; lamivudine; nevirapine) Information For Patients
Patients should be informed of the importance of early recognition of symptoms of symptomatic hyperlactatemia or lactic acidosis syndrome, which include unexplained weight loss, abdominal discomfort, nausea, vomiting, fatigue, dyspnea, and motor weakness. Patients in whom these symptoms develop should seek medical attention immediately. Discontinuation of Stavudine (Stavudine; lamivudine; nevirapine) therapy may be required.
Patients should be informed that an important toxicity of Stavudine (Stavudine; lamivudine; nevirapine) is peripheral neuropathy. Patients should be aware that peripheral neuropathy is manifested by numbness, tingling, or pain in hands or feet, and that these symptoms should be reported to their physicians. Patients should be counseled that peripheral neuropathy occurs with greatest frequency in patients who have advanced HIV disease or a history of peripheral neuropathy, and that dose modification and/or discontinuation of Stavudine (Stavudine; lamivudine; nevirapine) may be required if toxicity develops.
Caregivers of young children receiving Stavudine (Stavudine; lamivudine; nevirapine) therapy should be instructed regarding detection and reporting of peripheral neuropathy.
Patients should be informed that when Stavudine (Stavudine; lamivudine; nevirapine) is used in combination with other agents with similar toxicities, the incidence of adverse events may be higher than when Stavudine (Stavudine; lamivudine; nevirapine) is used alone. An increased risk of pancreatitis, which may be fatal, may occur in patients treated with the combination of Stavudine (Stavudine; lamivudine; nevirapine) and didanosine. Patients treated with this combination should be closely monitored for symptoms of pancreatitis. An increased risk of hepatotoxicity, which may be fatal, may occur in patients treated with Stavudine (Stavudine; lamivudine; nevirapine) in combination with didanosine and hydroxyurea. This combination should be avoided.
Patients should be informed that Stavudine (Stavudine; lamivudine; nevirapine) is not a cure for HIV infection, and that they may continue to acquire illnesses associated with HIV infection, including opportunistic infections. Patients should be advised to remain under the care of a physician when using Stavudine (Stavudine; lamivudine; nevirapine) . They should be advised that Stavudine (Stavudine; lamivudine; nevirapine) therapy has not been shown to reduce the risk of transmission of HIV to others through sexual contact or blood contamination. Patients should be informed that the long-term effects of Stavudine (Stavudine; lamivudine; nevirapine) are unknown at this time.
Patients should be informed that the Centers for Disease Control and Prevention (CDC) recommend that HIV-infected mothers not nurse newborn infants to reduce the risk of postnatal transmission of HIV infection.
Patients should be informed that redistribution or accumulation of body fat may occur in individuals receiving antiretroviral therapy and that the cause and long-term health effects of these conditions are not known at this time.
Patients should be advised of the importance of adherence to any antiretroviral regimen, including those that contain Stavudine (Stavudine; lamivudine; nevirapine) .
Stavudine (Stavudine; lamivudine; nevirapine) Drug Interactions
Zidovudine competitively inhibits the intracellular phosphorylation of Stavudine (Stavudine; lamivudine; nevirapine) . Therefore, use of zidovudine in combination with Stavudine (Stavudine; lamivudine; nevirapine) should be avoided.
Stavudine (Stavudine; lamivudine; nevirapine) Carcinogenesis, Mutagenesis, Impairment Of Fertility
In 2-year carcinogenicity studies in mice and rats, Stavudine (Stavudine; lamivudine; nevirapine) was noncarcinogenic at doses which produced exposures (AUC) 39 and 168 times, respectively, human exposure at the recommended clinical dose. Benign and malignant liver tumors in mice and rats and malignant urinary bladder tumors in male rats occurred at levels of exposure 250 (mice) and 732 (rats) times human exposure at the recommended clinical dose.
Stavudine (Stavudine; lamivudine; nevirapine) was not mutagenic in the Ames, reverse mutation, or the CHO/HGPRT mammalian cell forward gene mutation assays, with and without metabolic activation. Stavudine (Stavudine; lamivudine; nevirapine) produced positive results in the human lymphocyte clastogenesis and mouse fibroblast assays, and in the mouse micronucleus test. In the assays, Stavudine (Stavudine; lamivudine; nevirapine) elevated the frequency of chromosome aberrations in human lymphocytes (concentrations of 25 to 250 μg/mL, without metabolic activation) and increased the frequency of transformed foci in mouse fibroblast cells (concentrations of 25 to 2500 μg/mL, with and without metabolic activation). In the micro-nucleus assay, Stavudine (Stavudine; lamivudine; nevirapine) was clastogenic in bone marrow cells following oral Stavudine (Stavudine; lamivudine; nevirapine) administration to mice at dosages of 600 to 2000 mg/kg/day for 3 days.
No evidence of impaired fertility was seen in rats with exposures (based on C) up to 216 times that observed following a clinical dosage of 1 mg/kg/day
Stavudine (Stavudine; lamivudine; nevirapine) Pregnancy
Reproduction studies have been performed in rats and rabbits with exposures (based on C) up to 399 and 183 times, respectively, of that seen at a clinical dosage of 1 mg/kg/day and have revealed no evidence of teratogenicity. The incidence in fetuses of a common skeletal variation, unossified or incomplete ossification of sternebra, was increased in rats at 399 times human exposure, while no effect was observed at 216 times human exposure. A slight post-implantation loss was noted at 216 times the human exposure with no effect noted at approximately 135 times the human exposure. An increase in early rat neonatal mortality (birth to 4 days of age) occurred at 399 times the human exposure, while survival of neonates was unaffected at approximately 135 times the human exposure. A study in rats showed that Stavudine (Stavudine; lamivudine; nevirapine) is transferred to the fetus through the placenta. The concentration in fetal tissue was approximately one-half the concentration in maternal plasma. Animal reproduction studies are not always predictive of human response.
There are no adequate and well-controlled studies of Stavudine (Stavudine; lamivudine; nevirapine) in pregnant women. Stavudine (Stavudine; lamivudine; nevirapine) should be used during pregnancy only if the potential benefit justifies the potential risk.
Fatal lactic acidosis has been reported in pregnant women who received the combination of Stavudine (Stavudine; lamivudine; nevirapine) and didanosine with other antiretroviral agents. It is unclear if pregnancy augments the risk of lactic acidosis/hepatic steatosis syndrome reported in nonpregnant individuals receiving nucleoside analogues (see ). Healthcare providers caring for HIV-infected pregnant women receiving Stavudine (Stavudine; lamivudine; nevirapine) should be alert for early diagnosis of lactic acidosis/hepatic steatosis syndrome.
Stavudine (Stavudine; lamivudine; nevirapine) Nursing Mothers
Stavudine (Stavudine; lamivudine; nevirapine) Pediatric Use
Use of Stavudine (Stavudine; lamivudine; nevirapine) in pediatric patients from birth through adolescence is supported by evidence from adequate and well-controlled studies of Stavudine (Stavudine; lamivudine; nevirapine) in adults with additional pharmacokinetic and safety data in pediatric patients.
Adverse events and laboratory abnormalities reported to occur in pediatric patients in clinical studies were generally consistent with the safety profile of Stavudine (Stavudine; lamivudine; nevirapine) in adults. These studies include ACTG 240, where 105 pediatric patients ages 3 months to 6 years received Stavudine (Stavudine; lamivudine; nevirapine) 2 mg/kg/day for a median of 6.4 months; a controlled clinical trial where 185 newborns received Stavudine (Stavudine; lamivudine; nevirapine) 2 mg/kg/day either alone or in combination with didanosine from birth through 6 weeks of age; and a clinical trial where 8 newborns received Stavudine (Stavudine; lamivudine; nevirapine) 2 mg/kg/day in combination with didanosine and nelfinavir from birth through 4 weeks of age.
Stavudine (Stavudine; lamivudine; nevirapine) pharmacokinetics have been evaluated in 25 HIV-infected pediatric patients ranging in age from 5 weeks to 15 years and in weight from 2 to 43 kg after IV or oral administration of single doses and twice-daily regimens and in 30 HIV-exposed or -infected newborns ranging in age from birth to 4 weeks after oral administration of twice-daily regimens (see ).
Stavudine (Stavudine; lamivudine; nevirapine) Geriatric Use
Clinical studies of Stavudine (Stavudine; lamivudine; nevirapine) did not include sufficient numbers of patients aged 65 years and over to determine whether they respond differently than younger patients. Greater sensitivity of some older individuals to the effects of Stavudine (Stavudine; lamivudine; nevirapine) cannot be ruled out.
In a monotherapy Expanded Access Program for patients with advanced HIV infection, peripheral neuropathy or peripheral neuropathic symptoms were observed in 15 of 40 (38%) elderly patients receiving 40 mg twice daily and 8 of 51 (16%) elderly patients receiving 20 mg twice daily. Of the approximately 12,000 patients enrolled in the Expanded Access Program, peripheral neuropathy or peripheral neuropathic symptoms developed in 30% of patients receiving 40 mg twice daily and 25% of patients receiving 20 mg twice daily. Elderly patients should be closely monitored for signs and symptoms of peripheral neuropathy.
Stavudine (Stavudine; lamivudine; nevirapine) is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, it may be useful to monitor renal function. Dose adjustment is recommended for patients with renal impairment (see ).
Stavudine (Stavudine; lamivudine; nevirapine) Adverse Reactions
Fatal lactic acidosis has occurred in patients treated with Stavudine (Stavudine; lamivudine; nevirapine) in combination with other antiretroviral agents. Patients with suspected lactic acidosis should immediately suspend therapy with Stavudine (Stavudine; lamivudine; nevirapine) . Permanent discontinuation of Stavudine (Stavudine; lamivudine; nevirapine) should be considered for patients with confirmed lactic acidosis.
Stavudine (Stavudine; lamivudine; nevirapine) therapy has rarely been associated with motor weakness, occurring predominantly in the setting of lactic acidosis. If motor weakness develops, Stavudine (Stavudine; lamivudine; nevirapine) should be discontinued.
Stavudine (Stavudine; lamivudine; nevirapine) therapy has also been associated with peripheral sensory neuropathy, which can be severe, is dose related, and occurs more frequently in patients being treated with other drugs that have been associated with neuropathy (including didanosine), in patients with advanced HIV infection, or in patients who have previously experienced peripheral neuropathy.
Patients should be monitored for the development of neuropathy, which is usually manifested by numbness, tingling, or pain in the feet or hands. Stavudine (Stavudine; lamivudine; nevirapine) -related peripheral neuropathy may resolve if therapy is withdrawn promptly. In some cases, symptoms may worsen temporarily following discontinuation of therapy. If symptoms resolve completely, patients may tolerate resumption of treatment at one-half the dose (see ). If neuropathy recurs after resumption, permanent discontinuation of Stavudine (Stavudine; lamivudine; nevirapine) should be considered.
Selected clinical adverse events that occurred in adult patients receiving Stavudine (Stavudine; lamivudine; nevirapine) in a controlled monotherapy study (Study AI455-019) are provided in Table 7.
Pancreatitis was observed in 3 of the 412 adult patients who received Stavudine (Stavudine; lamivudine; nevirapine) in a controlled monotherapy study.
Selected clinical adverse events that occurred in antiretroviral- naive adult patients receiving Stavudine (Stavudine; lamivudine; nevirapine) from two controlled combination studies are provided in Table 8.
Pancreatitis resulting in death was observed in patients treated with Stavudine (Stavudine; lamivudine; nevirapine) plus didanosine, in controlled clinical studies and in postmarketing reports.
Selected laboratory abnormalities reported in a controlled monotherapy study (Study AI455-019) are provided in Table 9.
Selected laboratory abnormalities reported in two controlled combination studies are provided in Tables 10 and 11.
The following events have been identified during post-approval use of Stavudine (Stavudine; lamivudine; nevirapine) . Because they are reported voluntarily from a population of unknown size, estimates of frequency cannot be made. These events have been chosen for inclusion due to their seriousness, frequency of reporting, causal connection to Stavudine (Stavudine; lamivudine; nevirapine) , or a combination of these factors.
Digestive Disorders
Hematologic Disorders
Metabolic Disorders
Musculoskeletal
Stavudine (Stavudine; lamivudine; nevirapine)
Stavudine (Stavudine; lamivudine; nevirapine)
Stavudine (Stavudine; lamivudine; nevirapine) How Supplied
Stavudine (Stavudine; lamivudine; nevirapine) capsules are supplied by as follows:
Stavudine (Stavudine; lamivudine; nevirapine) Storage:
Stavudine (Stavudine; lamivudine; nevirapine) Capsules should be stored in tightly closed containers at 25° C (77° F); excursions permitted to 15° to 30° C (59° to 86°F) (see USP Controlled Room Temperature).
Stavudine (Stavudine; lamivudine; nevirapine) Patient Information
Stavudine (Stavudine; lamivudine; nevirapine) is a prescription medicine used in combination with other drugs to treat adults and children who are infected with HIV (the human immunodeficiency virus), the virus that causes AIDS. Stavudine (Stavudine; lamivudine; nevirapine) belongs to a class of drugs called nucleoside reverse transcriptase inhibitors (NRTIs). By reducing the growth of HIV, Stavudine (Stavudine; lamivudine; nevirapine) helps your body maintain its supply of CD4 cells, which are important for fighting HIV and other infections.
Stavudine (Stavudine; lamivudine; nevirapine) will not cure your HIV infection. At present there is no cure for HIV infection. Even while taking Stavudine (Stavudine; lamivudine; nevirapine) , you may continue to have HIV-related illnesses, including infections caused by other disease-producing organisms. Continue to see your doctor regularly and report any medical problems that occur.
Stavudine (Stavudine; lamivudine; nevirapine) does not prevent a person infected with HIV from passing the virus to other people. To protect others, you must continue to practice safe sex and take precautions to prevent others from coming in contact with your blood and other body fluids.
There is limited information on the long-term use of Stavudine (Stavudine; lamivudine; nevirapine) .
Do not take Stavudine (Stavudine; lamivudine; nevirapine) if you are allergic to any of its ingredients, including its active ingredient, Stavudine (Stavudine; lamivudine; nevirapine) , and the inactive ingredients. (See at the end of this leaflet.) Tell your doctor if you think you have had an allergic reaction to any of these ingredients.
Your doctor will determine your dose (the amount in each capsule) based on your body weight, kidney and liver function, and any side effects that you may have had with other medicines. Take Stavudine (Stavudine; lamivudine; nevirapine) exactly as instructed. Try not to miss a dose, but if you do, take it as soon as possible. If it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Stavudine (Stavudine; lamivudine; nevirapine) may be taken with food or on an empty stomach.
Stavudine (Stavudine; lamivudine; nevirapine) capsules are usually taken twice a day (every 12 hours). Store Stavudine (Stavudine; lamivudine; nevirapine) capsules in a tightly closed container at room temperature away from heat and out of the reach of children and pets. Do NOT store this medicine in a damp place such as a bathroom medicine cabinet or near the kitchen sink.
If you suspect that you or someone else has taken an overdose of Stavudine (Stavudine; lamivudine; nevirapine) , get medical help right away. Contact a doctor or a poison control center.
Tell your doctor or pharmacist about any other medicine, vitamin, supplement, or herbal preparation you are taking.
Let your doctor know if you or a child taking Stavudine (Stavudine; lamivudine; nevirapine) has ever had peripheral neuropathy, because this condition occurs more often in patients who have had it previously. Peripheral neuropathy is also more likely to occur in patients taking drugs that affect the nerves and in patients with advanced HIV disease, but it can occur at any disease stage. If you develop peripheral neuropathy, your doctor may tell you to stop taking Stavudine (Stavudine; lamivudine; nevirapine) . In some cases the symptoms worsen for a short time before getting better. Once symptoms of peripheral neuropathy go away completely, Stavudine (Stavudine; lamivudine; nevirapine) may be started again at a lower dose.
People who take Stavudine (Stavudine; lamivudine; nevirapine) along with other medicines that may cause similar side effects may have a higher chance of developing these side effects than if they took Stavudine (Stavudine; lamivudine; nevirapine) alone.
Changes in body fat have been seen in some patients taking antiretroviral therapy. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the trunk. Loss of fat from the legs, arms, and face may also happen. The cause and long-term health effects of these conditions are not known at this time.
This medicine was prescribed for your particular condition. Do not use Stavudine (Stavudine; lamivudine; nevirapine) for another condition or give it to others. Keep Stavudine (Stavudine; lamivudine; nevirapine) and all other medicines out of the reach of children and pets at all times. Do not keep medicine that is out of date or that you no longer need. Dispose of unused Stavudine (Stavudine; lamivudine; nevirapine) through community take-back disposal programs when available or by placing it in an unrecognizable closed container in the household trash.
This summary does not include everything there is to know about Stavudine (Stavudine; lamivudine; nevirapine) . Medicines are sometimes prescribed for purposes other than those listed in a Patient Information Leaflet. If you have questions or concerns, or want more information about Stavudine (Stavudine; lamivudine; nevirapine) , your physician and pharmacist have the complete prescribing information upon which this leaflet was based. You may want to read it and discuss it with your doctor or other healthcare professional. Remember, no written summary can replace careful discussion with your doctor.
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