Nucleoside/nucleotide analogue reverse transcriptase inhibitors (NRTIs/NtRTIs)

Major toxicities More common: Nausea, vomiting, fever, headache, diarrhea, rash, and anorexia. Less common (more severe): Approximately 5% of adults and children receiving ABC develop a potentially fatal hypersensitivity reaction. Symptoms include fever, fatigue , malaise, nausea, vomiting, diarrhea, and abdominal pain or respiratory symptoms such as shortness of breath. Physical findings include lymphadenopathy, ulceration of mucous membranes, and maculopapular or ur ticarial skin rash. The hypersensitivity reaction can occur without a rash. Laboratory abnormalities include elevated liver function tests, elevated creatine phosphokinase, elevated creatinine, and lymphopenia. This reaction generally occurs in the first six weeks of therapy. Patients suspected of having a hypersensitivity reaction should have ABC stopped and not restar ted since hypotension and death have occurred upon rechallange. Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases have been repor ted. Rare: Pancreatitis, increased liver enzymes, elevated blood glucose , elevated tr iglycerides, and fatigue.