TM Owner ViiV Healthcare
Triumeq 50mg + 300mg + 600mg Tablet
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Indications & Clinical Uses
- Triumeq 50mg/300mg/600mg, made by ViiV Healthcare (UK), is a fixed-dose combination of the integrase inhibitor dolutegravir with the nucleoside reverse transcriptase inhibitors lamivudine and abacavir, used as a complete single-tablet regimen for HIV-1 infection.
- It is approved in adults and in children and adolescents from 3 months of age weighing at least 6 kg, either treatment-naive or replacing a stable existing regimen; a separate oral suspension, Triumeq PD, is available for smaller children at lower per-tablet strengths and must never be substituted tablet-for-tablet with this adult formulation.
- Triumeq must also not be confused with Trizivir, an older triple-nucleoside HIV combination (abacavir, lamivudine, zidovudine) that contains no integrase inhibitor and is a chemically distinct regimen, even though both are made by ViiV Healthcare.
- Before starting, patients are tested for the HLA-B*5701 gene, since carriers face a high risk of serious abacavir hypersensitivity.
Side Effects
- Insomnia, headache and fatigue are the most commonly reported reactions with Triumeq (dolutegravir/lamivudine/abacavir), generally mild to moderate.
- Triumeq carries a boxed warning for abacavir hypersensitivity reactions, which have been fatal in rare cases; symptoms include fever, rash, nausea, extreme tiredness and breathing difficulty appearing usually within the first six weeks, and once suspected the drug must be stopped immediately and never restarted.
- People testing positive for the HLA-B*5701 allele must not take Triumeq.
- The label also warns that stopping treatment in a person also infected with hepatitis B can cause a severe flare of liver disease, so liver function is monitored closely after discontinuation.
- Other reported effects include diarrhoea, nausea, dizziness and depression, plus changes in weight, blood lipids or blood sugar.
- Seek urgent care for any rash with fever or breathing trouble.
Precautions & Warnings
- Before starting Triumeq, every patient should be tested for the HLA-B*5701 allele, since carriers are at high risk of a severe, sometimes fatal, hypersensitivity reaction to the abacavir component.
- Triumeq is not recommended in severe hepatic impairment, and dose review may be needed in significant renal impairment.
- Anyone also infected with hepatitis B virus should not stop Triumeq without close medical supervision, because of the risk of a severe post-treatment flare.
- Triumeq must not be given with dofetilide, and use with metformin can raise metformin levels, needing dose review.
- Anyone who could become pregnant should discuss contraception and pregnancy planning with their healthcare provider, since dolutegravir taken around the time of conception has been linked to a small increased risk of neural tube defects; folate supplementation is advised.
- Report any unexplained muscle pain, weakness or signs of liver problems promptly.
Avoid Interactions
- Dolutegravir levels in Triumeq are reduced by drugs that induce UGT1A1 or CYP3A enzymes, including rifampicin, carbamazepine, phenytoin, phenobarbital, oxcarbazepine and St John's Wort, which can require an extra dolutegravir dose or should be avoided; efavirenz, etravirine without a boosted protease inhibitor, and ritonavir-boosted tipranavir also lower dolutegravir exposure.
- Antacids, laxatives, sucralfate, and calcium or iron supplements reduce dolutegravir absorption and should be taken 2 hours before or 6 hours after Triumeq.
- Triumeq must not be combined with dofetilide, as dolutegravir raises dofetilide to potentially fatal levels, nor with any other abacavir-, lamivudine- or dolutegravir-containing product, including Trizivir, to avoid double-dosing.
- Metformin doses may need adjusting.
- Tell your healthcare provider about all prescription, over-the-counter and herbal medicines, including vitamins, before starting Triumeq.
References
Frequently Asked Questions
Triumeq (dolutegravir, lamivudine and abacavir) is a single-tablet regimen that treats HIV-1 infection in adults and children from 3 months of age weighing at least 6 kg. It combines an integrase inhibitor with two nucleoside reverse transcriptase inhibitors to suppress the virus. A separate oral suspension suits smaller children.
Take one Triumeq tablet by mouth once daily, with or without food, at around the same time each day. Swallow it whole rather than chewing or crushing it. Never take an extra dose, and never combine Triumeq with another product containing abacavir, lamivudine or dolutegravir.
The most common Triumeq side effects are insomnia, headache and fatigue. Its boxed warning covers abacavir hypersensitivity: fever, rash, nausea and breathlessness can signal a serious, sometimes fatal reaction, usually in the first six weeks. Stop Triumeq and seek urgent care if these occur, and never restart it.
Avoid dofetilide, rifampicin, St John's Wort and other enzyme-inducing medicines, which can weaken Triumeq's effect. Do not take antacids, calcium or iron within 2 hours before or 6 hours after your dose. Never take Triumeq alongside Trizivir or another abacavir- or lamivudine-containing product.
Yes. Everyone must be tested for the HLA-B*5701 gene before starting Triumeq, because carriers have a much higher risk of a severe abacavir hypersensitivity reaction. If you test positive, your healthcare provider will prescribe a different HIV regimen instead of Triumeq.
Triumeq can be used in children and adolescents from 3 months of age weighing 6 kg or more, with a lower-strength oral suspension for smaller children. If you could become pregnant, discuss contraception first, since dolutegravir taken around conception carries a small risk to the baby.
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