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AIDS and HIV Information

AIDS and HIV Information

Triumeq Drug Interactions

Triumeq Drug Interactions


This 3-in-1, once daily, antiretroviral medication contains the anti-HIV drugs Tivicay (dolutegravir) and Epzicom (abacavir and lamivudine). As per the Department of Health and Human Services HIV guidelines, these drugs are not sufficient to treat HIV-1 infection when used alone. They have to be combined with other antiretroviral agents or included in a single-tablet regimen (STR), like Triumeq, to be considered as a complete antiretroviral therapy (ART).

Composition

Triumeq (DTG/ABC/3TC) comes in a purple, biconvex, film-coated tablet form, debossed with the numbers 571 on one side. It contains 50mg dolutegravir, 600mg abacavir, and 300mg lamivudine. Other inactive substances include: magnesium stearate, D-mannitol, microcrystalline cellulose. Povidone K29/32, and sodium starch glycolate. The tablet coating is made of iron oxide black and red, macrogol/PEG. Polyvinyl alcohol (part hydrolyzed) talc, and titanium dioxide.

Antiretroviral drug interactions

There are hundreds of drugs, both generic and brand names, that are known to interact with Triumeq. Drug interactions are dangerous because it can result to significantly lower or higher amount of ART drugs in the blood, which can cause resistance and treatment failure. Some major drug interactions can be fatal. It is important to tell your healthcare provider all the drugs and substances you have used in the past and are currently taking to prevent major interactions with life-threatening effects. Drug interactions affect the absorption, distribution, metabolism, and elimination of antiretroviral agents. Triumeq may be administered with or without food. Absorption of dolutegravir (DTG) is moderately increased based on fat content.

List of drug interactions for Triumeq

ANTIRETROVIRALS

Atazanavir

No dose adjustment is necessary when co-administered with atazanavir or atazanavir + booster

Amprenavir

Abacavir may enhance the effects of amprenavir but may not be an effective combination in people

Darunavir/ritonavir

There are no significant changes observed when used with darunavir/ritonavir or lopinavir/ritonavir

Efavirenz

Dose must be adjusted to 50mg DTG twice a day in treatment-naïve patients or treatment-experienced patients.

Etravirine

Dose adjustments are not required if DTG is concurrently administered with atazanavir/ritonavir, darunavir/ritonavir, or lopinavir/ritonavir

Fosamprenavir/ritonavir

DTG must be adjusted to 50mg twice daily in treatment-naïve patients or treatment-experienced patients.

*Nevirapine

May reduce DTG exposure; co-administration is not recommended because there are not enough data to make dosing recommendations

Tipranavir/ritonavir

Reduces DTG concentration. Adjust dolutegravir to 50mg twice a day. Add a 50mg dose with 12 hours interval from Triumeq

OTHER AGENTS

Antacids

Take Triumeq 2 hours before or 6 hours after an antacid containing magnesium, aluminum, iron, or calcium cations, as well as laxatives, sucralfate, oral iron or calcium supplements, and buffered medications.

Calcium channel blockers (amlodipine, diltiazem, verapamil, nifedipine, etc.)

May not have clinically significant interaction with Triumeq

Carbamazepine

Significantly reduces the concentration of DTG. Patients not previously treated with integrase inhibitors should take DTG 50mg twice daily

Corticosteroids (prednisone, dexamethasone, triamcinolone, etc)

Prednisone slightly increases DTG concentration but results are not clinically significant

H2 blockers (cimetidine,
famotidine, nizatidine, ranitidine, etc.)

No dosing adjustment required

Methadone

No significant effect when administered with Triumeq. Small number of patients may need an increase in methadone dose.

Oral contraceptives

No significant adjustment required. 50mg DTG can be administered once or twice daily

PDE5 inhibitors (sildenafil, avanafil, tadalafil, vardenafil)

No interactions anticipated with these erectile dysfunction drugs

**Phenobarbital

Requires a dose of 50mg DTG twice daily for integrase-naïve patients

**Phenytoin

Requires a dose of 50mg DTG twice daily for integrase-naïve patients

Proton pump inhibitors (esomeprazole, lansoprazole,
omeprazole, pantoprazole)

Safe to be administered together with Triumeq

Rifabutin

No clinically significant interactions in integrase-naïve patients taking Triumeq

**Rifampin

Adjust DTG to 50mg twice daily in treatment-naïve and treatment-experienced patients. Add a 50mg dose with 12 hours interval from Triumeq. Patients with INSTI resistance or suspected resistance must take alternatives to rifampin

**St. John’s Wort

Recommended dose adjustment is 50mg DTG twice daily for integrase-naïve patients.

Warfarin

No significant interactions anticipated

Metformin

Consider reducing metformin dose when co-administered with Triumeq

Ethanol

Increases overall exposure to abacavir. No dosing adjustment required

Mycophenolic acid

May enhance antiviral effectiveness of abacavir but there are no sufficient data to validate the claim


*Contraindicated with Triumeq
**Avoid co-administration if dosing adjustment is not possible

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