Triumeq

Triumeq is generally well tolerated. The most common side effects that occurred in 2–3% of study subjects are insomnia, headache, and fatigue. New data associate INSTIs and TAF with weight gain; see “Weighty Concerns,” beginning on page 8, and go to aidsinfo.nih.gov. Dolutegravir can cause a small, reversible increase in serum creatinine within the first few weeks of treatment without affecting actual kidney function. There have been rare reports of depression and suicidal ideation, primarily in patients with a history of psychiatric illnesses, in people receiving INSTI-based regimens. The DHHS guidelines recommend closely monitoring patients with pre-existing psychiatric conditions on an INSTI. Conflicting data suggest a potential risk for heart problems when using abacavir-containing regimens in people with high risk for cardiovascular disease. Monitor for signs of hypersensitivity reaction (HSR) to abacavir. Prior to starting Triumeq, all individuals should be given a blood test for HLA-B*5701 (a genetic marker) to identify patients at risk for this reaction. This test is covered by most insurance and by LabCorp/ViiV (see company contact on co-pay chart). Read more about HSR on the Ziagen page. Prior to initiation, people should be tested for hepatitis B (HBV) infection. Severe exacerbations of hepatitis B have been reported in people who are co-infected with hepatitis B and have discontinued the lamivudine component. Monitor liver enzymes closely in people co-infected with hepatitis B and, if appropriate, initiation of anti-hepatitis B therapy may be warranted. See “More Information.”

Do not take with the anti-arrhythmic dofetilide. Triumeq should be taken two hours before or six hours after taking antacids or laxatives, the ulcer medication Carafate, 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, Prilosec, Pepcid, Zantac, Prevacid) are okay to use. Avoid co-administration with oxcarbazepine, phenobarbital, phenytoin, or St. John’s wort. Start metformin at lowest dose and titrate based on glycemic control. Monitor for metformin adverse effects. Avoid use of sorbitol-containing medicines with lamivudine; there are many, such as acetaminophen liquid (Tylenol liquid and others). Not intended to be taken with other HIV medications, unless prescribed that way. When taking rifampin, take an additional dose of dolutegravir (in the form of one Tivicay tablet) 50 mg 12 hours after taking your Triumeq dose. 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 which are not listed here.

Dolutegravir is now a preferred medication in pregnancy as well as an alternative drug for those who are trying to conceive, according to U.S. HIV perinatal treatment guidelines updated in December 2019 (go to aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0). This clears preliminary concerns over the potential for birth defects with dolutegravir, raised in 2018 by a study in Botswana. Triumeq is the only single-tablet regimen (STR) that contains Epzicom as the NRTI backbone. Compared to other INSTIs, dolutegravir has a relatively high genetic barrier against the development of drug resistance, similar to the protease inhibitors (such as Prezista). In addition, dolutegravir-containing regimens have demonstrated virologic superiority over Prezista-containing regimens. Triumeq has relatively few drug interactions and is well tolerated. Triumeq does not cover HBV as well as other STRs and therefore requires another anti-HBV medication in addition to its lamivudine component. Triumeq is a relatively large STR tablet, which can potentially be an issue for individuals who have difficulty swallowing. Other STRs containing dolutegravir are Juluca and Dovato.

Dr. Ross Slotten says:

Like Biktarvy, Triumeq, approved in 2014, has earned an A1 rating from the DHHS expert panel. Its INSTI, dolutegravir, has a high barrier to resistance. Except in a handful of anecdotal cases, viral mutations to dolutegravir have not been detected in people who have failed therapy, although failure is usually due to noncompliance rather than drug potency. The pill itself is quite small, making it easier to take for those with pill phobia. Like Biktarvy, it’s not fussy. Its absorption is not dependent on a full or empty stomach and it has few drug-to-drug interactions. The main drawback to Triumeq is that you have to test for hypersensitivity to one of its components, abacavir. ViiV, its manufacturer, claims that such hypersensitivity is rare, but I’ve detected it on a number of occasions, more frequently than I was led to expect. The reaction is potentially dangerous, even life-threatening, so testing for the genetic marker HLA-B*5701 is essential before prescribing it. Another concern is the risk of a cardiovascular event, like a heart attack, especially after initiating therapy. On this issue, the data are conflicting. No randomized controlled study to prove a cause and effect relationship has been conducted. Competitors have exploited this gray area and given the drug an undeserved bad rap, but all is fair in war (whether against HIV or a pharmaceutical opponent). Dolutegravir should not be used in the first trimester (14 weeks) of pregnancy because of potential neural tube defects; but it is one of the preferred treatments in the second and third trimesters of pregnancy. Like Biktarvy, this is an excellent first-line therapy.

Activist Bridgette Picou says:

Another single-tablet regimen, Triumeq requires a specific blood test because of the abacavir component. If you have the genetic sensitivity the test looks for—called HLA-B*5701—you cannot take Triumeq. You should also know that if you develop an allergy, stop taking the drug and notify your doctor. You should not take the medication again. There has been discussion of the abacavir component and cardiac concerns. You can discuss this and other risks and benefits with your doctor. Triumeq may cause a feeling of being tired, or may also cause insomnia. Adjusting the time of day you take it may help with these effects.