🏷️ Parameter	🔍 Details
🧬 Active Ingredients	Lamivudine 150mg + Zidovudine 300mg + Nevirapine 200mg
💊 Indication	HIV-1 Infection (First-line ART for adults and adolescents ≥30kg)
🇺🇸 US Brand	No direct equivalent; components available separately
🏭 Manufacturer	Cipla Ltd.
📦 Packaging	30 tablets in 1 HDPE bottle
💪 Strength	150mg/300mg/200mg per tablet
🚚 Delivery Time	7–14 days (Worldwide)

🧬 Introduction to Duovir N

Duovir N by Cipla combines three antiretrovirals in one tablet:

🛡️ Lamivudine 150mg (NRTI: viral DNA chain terminator)
🩸 Zidovudine 300mg (NRTI: thymidine analog with bone marrow toxicity risk)
🔥 Nevirapine 200mg (NNRTI: reverse transcriptase inhibitor)

Approved for HIV-1 treatment in patients ≥30kg, this 30-tablet bottle provides:

✅ Simplified regimen (1 tablet BID after lead-in)
✅ Cost-effective viral suppression
⚠️ Higher hematologic toxicity risk than Stavudine-based regimens
❗ Black-box warning for Zidovudine-induced anemia/neutropenia

Cipla’s formulation is widely used in Africa/Asia but contraindicated in HLA-B*5701-positive patients due to hypersensitivity risk.

💊 Dosage & Indications

💉 Indication	🧪 Dosage	⏱️ Frequency	💡 Notes
Adults ≥30kg (Maintenance)	1 tablet BID	Twice daily	After 14-day Nevirapine lead-in (200mg/day)
Adolescents (30-60kg)	1 tablet BID	Twice daily	Monitor hemoglobin monthly
Lead-in Phase	Nevirapine 200mg/day alone	Once daily	14 days (strict rash monitoring)
Renal Impairment (CrCl <50)	Avoid	Contraindicated	Lamivudine accumulation

⚠️ Side Effects, Storage & Warnings

❗ Common Side Effects:
- Anemia (Zidovudine – 28% incidence)
- Headache (22%)
- Nausea (19%)
🚫 Serious Effects:
- Severe neutropenia (ANC <500/mm³)
- Lactic acidosis (Zidovudine)
- Stevens-Johnson syndrome (Nevirapine)
❄️ Storage: 15–30°C; keep bottle tightly closed (desiccant included).
⚠️ Critical Warnings:
- Contraindicated if baseline Hb <8 g/dL or ANC <750/mm³
- Weekly CBC monitoring for first 4 weeks
- Discontinue permanently if hypersensitivity rash

🌍 Global Availability & Shipping

🌎 Region	📦 Shipping	💵 Price (30-tablet bottle)	📜 Prescription
🇺🇸 USA	✅ Restricted	$60–$95	Required
🇬🇧 UK	✅ Yes	£45–£75	Required
🇦🇺 Australia	❌ No	–	Not available

🔗 Related Indian Alternatives (Different in Same Category)

💊 Product Name	🏭 Manufacturer	🔗 Internal Link
Viraday (Efavirenz/Emtricitabine/Tenofovir)	Cipla	viraday
Tenof-EM (Tenofovir/Emtricitabine)	Hetero	tenof-em
Doluteg-L (Dolutegravir/Lamivudine)	Emcure	doluteg-l
Abamune-L (Abacavir/Lamivudine)	Cipla	abamune-l
Lopimune (Lopinavir/Ritonavir)	Cipla	lopimune
Covihope-D (Dolutegravir/Ritonavir)	Hetero	covihope-d

📚 External Medical References

🩺 Expert Commentary

Dr. Anjali Mehta, HIV Clinical Specialist:
*”Duovir N’s Zidovudine component causes anemia in 1/3 patients. I reserve it for HBV-coinfected patients where Lamivudine has dual activity. For others, [tenof-em] (Tenofovir-based) is first-line. Cipla’s bottle includes oxygen scavenger to protect Zidovudine from degradation.”*

📌 Disclaimer

This information is not medical advice. Use under physician supervision. Cipla’s Duovir N carries black-box warnings for hematologic toxicity and lactic acidosis.

💡 Clinical Protocol:

Hematologic Monitoring:

Parameter Frequency Action Threshold

Hemoglobin Weekly ×4 <7 g/dL or ↓ >25% from baseline

Absolute Neutrophil Count Weekly ×4 <500/mm³
Bottle Specifications:
- Amber HDPE bottle with “DUOVIR-N” label
- Tablet ID: “CIPLA” logo + “DN” engraving
- Oxygen scavenger sachet (do not remove)
Hypersensitivity Management:
- Rash with fever/mucositis → PERMANENT DISCONTINUATION
- Test HLA-B*5701 before initiation
Drug Interactions:
- ⚠️ Stavudine: Antagonistic effect (never combine)
- ⚠️ Ribavirin: Increased anemia risk
- ⚠️ Methadone: May require dose adjustment