Indications for TRIUMEQ:
HIV-1 infection in patients weighing ≥40kg.
Limitations of Use:
Not recommended alone in patients with resistance-associated integrase substitutions or suspected INSTI resistance due to insufficient dolutegravir dose in Triumeq in these subpopulations.
Adults and Children:
<40kg: not recommended. ≥40kg: 1 tab daily. Concomitant efavirenz, fosamprenavir/ritonavir, tipranavir/ritonavir, carbamazepine, rifampin: give additional dolutegravir 50mg separated by 12hrs from Triumeq.
Presence of HLA-B*5701 allele. Previous hypersensitivity reaction to any of the components. Concomitant dofetilide. Moderate or severe hepatic impairment.
Hypersensitivity reactions. Exacerbation of hepatitis B.
Screen for presence of HLA-B*5701 allele prior to starting therapy or reinitiation; if (+), abacavir is contraindicated. Discontinue immediately if hypersensitivity is suspected, regardless of HLA-B*5701 status and even when other diagnoses are possible. If hypersensitivity cannot be ruled out, do not restart. If stopped for reasons other than hypersensitivity, restart only if medical care can be readily accessed. Lamivudine not established for chronic HBV infection; closely monitor patients co-infected with HBV and HIV for several months after stopping treatment (discontinuing therapy may exacerbate HBV infection); if appropriate, initiate anti-hepatitis B therapy may be warranted. Increased risk for worsening/development of elevated transaminases in patients with underlying hepatitis B or C. Suspend if lactic acidosis or pronounced hepatotoxicity (eg, hepatomegaly, steatosis) occurs. Immune reconstitution syndrome. Underlying risk of coronary heart disease (eg, hypertension, hyperlipidemia, diabetes, smoking). Renal impairment (CrCl <50mL/min): not recommended; if lamivudine dose reduction is required, use individual components. Mild hepatic impairment: if abacavir dose reduction is required, use individual components. Women. Obesity. Elderly. Embryo-fetal toxicity: increased risk of neural tube defects (avoid use at time of conception through 1st trimester). Pregnancy: exclude status prior to initiation; if confirmed in 1st trimester, consider switching to alternative HIV regimen. Advise females of reproductive potential to use effective contraception. Nursing mothers: not recommended.
Nucleoside reverse transcriptase inhibitors (NRTIs) + integrase strand transfer inhibitor (INSTI).
Dolutegravir may be affected by drugs that induce or inhibit UGT1A1, CYP3A, UGT1A3, UGT1A9, BCRP, and P-gp enzymes or transporters. Avoid concomitant nevirapine, oxcarbazepine, phenytoin, phenobarbital, St. John’s wort. Concomitant etravirine without atazanavir/ritonavir, darunavir/ritonavir, or lopinavir/ritonavir: not recommended. Concomitant efavirenz, fosamprenavir/ritonavir, tipranavir/ritonavir, carbamazepine, rifampin: requires extra dolutegravir dose (see Adults and Children). Potentiates metformin (limit metformin dose to 1g/day); adjust metformin dose when stopping Triumeq; monitor blood glucose. Avoid concomitant sorbitol-containing products. Concomitant cation-containing antacids, laxatives, sucralfate, buffered drugs, or oral iron/calcium supplements (also can give together with a meal): give Triumeq 2hrs before or 6hrs after. Ethanol may increase abacavir levels. Abacavir may antagonize methadone. Monitor for toxicity (eg, hepatic decompensation) with interferon-alfa (+/– ribavirin); consider reducing dose or discontinue one or both drugs.
Insomnia, headache, fatigue; hypersensitivity reactions (may be fatal), hepatotoxicity (monitor).