Triumeq

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). Severe exacerbations of HBV 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.

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.

Triumeq has relatively few drug interactions and is well tolerated. Triumeq does not cover hepatitis B 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. Triumeq, as well as its individual components, is recommended as a preferred initial regimen in pregnancy. Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; GO TO apregistry.com.

Dr. Melanie Thompson:

Abacavir, which is a component of Triumeq, has fallen out of favor for initial therapy. Abacavir hypersensitivity can be life-threatening, although its incidence is greatly reduced by HLA-B*5701 genetic testing. A negative test result is needed before prescribing regimens containing abacavir; therefore, Triumeq cannot be used for “rapid” or “same day” start, before labs are available. There also are longstanding concerns that abacavir may increase the risk of cardiovascular disease.

Triumeq shares side effects common to all INSTIs, including insomnia or, rarely, worsening of depression or suicidal ideation, particularly if there are pre-existing mental health issues. Dolutegravir has been associated with weight gain, so keep track of your weight and pay attention to diet and exercise if you are starting Triumeq. Dolutegravir also slightly raises the level of creatinine in the blood by 0.1-0.15 mg/dL by blocking its secretion at the kidney, not by causing kidney damage.

Drug interactions with dolutegravir are few but some are important. Do not take dofetilide or St. John’s wort; talk with your HIV care provider if you are taking metformin or medications for seizures or tuberculosis. As with all INSTIs, Triumeq should be taken 2 hours before or 6 hours after aluminum, magnesium, zinc, calcium, or iron supplements, although calcium and iron can be taken with Triumeq if taken with a meal. For more info on drug interactions, see the comments about Tivicay.

Activist Joey Wynn:

The size of the pill alone poses a big challenge, especially for someone not comfortable with taking pills in the first place. This option has a number of drug-drug interactions that make it a second-line choice, based on the ease of other options. People with hepatitis B should definitely pass on this option. Probably not a first line choice if you’re just starting out on pills.