Triumeq
For adults and children. Triumeq PD, which are tablets that are dissolved in 20 ml of water and taken within 30 minutes of mixing, are for pediatric patients 22–55 pounds (10–25 kg). Triumeq PD is not interchangeable with the adult formulation. Therefore, adults should not take the pediatric formulation. Take missed dose as soon as possible, as long as it is at least 12 hours before your next dose. Do not double up on your next dose. Dose cannot be adjusted for people with kidney or liver problems. According to the drug label, Triumeq is not recommended for people who have decreased kidney function (creatinine clearance less than 30 mL/min) due to lamivudine component, or individuals with mild, moderate or severe liver impairment due to abacavir component. This medication combination, however, is often used in reduced renal function below 30 mL/min, due to relatively minimal risk of lamivudine accumulation and side effects. If an alternative dosage form is required, may consider using individual components available in other formulations.
- See the individual drugs contained in Triumeq: Tivicay, Ziagen, and Epivir.
- See package insert for more complete information on potential side effects and interactions.
viivhealthcare.com; triumeq.com
(877) 844-8872
JO-ANN JOSE, MD, MPH:
Triumeq was once a very popular medication but is now less commonly prescribed due to the potential for increased cardiovascular risk and weight gain. Triumeq is a large pill, which some people may find hard to tolerate, and it cannot be used in the context of certain [drug resistance] mutations. Some people can also have a rare but very serious allergic reaction to one of the ingredients, abacavir, so it is essential to have a negative HLA-B*5701 test in order for Triumeq to be considered safe for you.
Do not take with the antiarrhythmic dofetilide (a heart medication). Triumeq should be taken two hours before or six hours after taking antacids or laxatives, sucralfate, iron or calcium supplements or buffered medications. Triumeq can be taken together with iron- or calcium-containing supplements if taken with food. Other acid reducers/heartburn medications (e.g., Aciphex, Dexilant, Nexium, Pepcid, Prevacid, Prilosec and Zantac) are okay to use. Avoid co-administration with eslicarbamazepine, oxcarbazepine, phenobarbital, phenytoin or St. John’s wort. Start metformin at lowest dose and titrate based on tolerability and clinical effect. Monitor for metformin adverse effects. Avoid use of sorbitol-containing medicines with lamivudine; there are many, such as acetaminophen liquid (Tylenol liquid and others). May increase levels of dalfampridine, which may increase the risk of seizures. When taking carbamazepine, rifampin, Sustiva or Rukobia or Aptivus + Norvir, take an additional dose of dolutegravir (Tivicay) 12 hours after taking Triumeq dose. The additional dose of dolutegravir is based on the individual’s weight. Tell your provider or pharmacist about all medications, herbals and supplements you are taking or thinking of taking, prescribed or not, as there are other drug interactions that are not listed here.
The most common side effects include insomnia, headache and fatigue. Data associate INSTIs with weight gain. The pediatric ODYSSEY/PENTA-29 trial reported in 2021 did not observe the weight gain observed in adults. DTG can cause a small, reversible increase in serum creatinine within the first few weeks of treatment but does not affect actual kidney function. There have been rare reports of depression and suicidal ideation with INSTIs, primarily in people with a history of psychiatric illnesses. HHS guidelines recommend closely monitoring people with pre-existing psychiatric conditions. Conflicting data suggest people who have a high risk of cardiovascular problems have a potential for heart problems when using abacavir-containing regimens. Monitor for signs of hypersensitivity reaction (HSR) to abacavir; see warning card that comes with Triumeq. Prior to starting Triumeq, all individuals should be given a simple blood test to identify people at risk for this reaction. This test is covered by most insurance and by LabCorp/ViiV. Prior to initiation, test for hepatitis B virus (HBV). Triumeq by itself is not enough to treat HBV and must be taken with an additional HBV medication. Severe exacerbations of hepatitis B have been reported in people with co-infection who have discontinued Triumeq (due to elimination of the lamivudine component, which also treats HBV). Monitor liver enzymes closely. Initiation of HBV therapy may be warranted upon discontinuation of Triumeq. Call your health care provider right away if you develop any of the following signs of hepatitis: yellowing of the skin or whites of the eyes; dark or tea-colored urine; pale-colored bowel movements; nausea or vomiting; loss of appetite or pain, aching or tenderness on the right side below the ribs.
Triumeq has relatively few drug interactions and is well tolerated. Triumeq does not cover hepatitis B as well as other STRs and should not be taken by itself if there is HBV. Triumeq therefore requires another anti-HBV medication in addition to its lamivudine component. Triumeq is a relatively large tablet, which can potentially be an issue for individuals who have difficulty swallowing. Other STRs containing dolutegravir are Juluca and Dovato. Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; GO TO apregistry.com.
JUAN MICHAEL PORTER II:
Back in 2015, when I started treatment, Triumeq was considered one of the best HIV medications available because it had fewer side effects than other options, could be taken at any time of the day and with or without food. Now we know that it has a number of side effects that make it unsuitable for some people. It’s also a big pill, size wise. That wasn’t a problem for me, but I switched from it after my doctor said Biktarvy was a better option and would lower my creatinine levels.