TRIUMEQ is a combination formulation of the Integrase Strand Transfer Inhibitor (INSTI) dolutegravir (50mg), the Nucleoside Reverse Transcriptase Inhibitor (NRTI) abacavir (600mg), and the Nucleotide Analogue Reverse Transcriptase Inhibitors (NRTI) lamivudine (300mg). It is used for the treatment of HIV infection.
Dosing & Administration
TRIUMEQ is indicated for the treatment of HIV infection in adults and children weighing 40 Kg or more. TRIUMEQ comes in film-coated tablets, taken with or without food. TRIUMEQ should not be taken within two hours before or six hours after iron or calcium supplements, or certain medications. Dosages and administration instructions are detailed in the product monograph.
TRIUMEQ should not be used in patients with hepatic impairment. TRIUMEQ can be used in patients with a creatinine clearance >=50 mL/min, but is not recommended for use in patients with renal impairment below that level.
TRIUMEQ is contraindicated in patients with hypersensitivity to any components of the drug, or who are taking dofetilide.
TRIUMEQ is associated with serious, even fatal, hypersensitivity reactions, immune reactivation syndrome, osteonecrosis, hepatotoxicity, viral resistance, lactic acidosis, rash, and immune reactivation syndrome. A more complete list of potential adverse effects is provided in the product monograph.
Abacavir (a component of TRIUMEQ) may cause serious, even fatal hypersensitivity reactions, including anaphylaxis. All patients should be tested for HLA-B*5701 prior to initiating treatment with abacavir to reduce the risk. Hypersensitivity to abacavir may also occur in patients who do not test positive for HLA-B*5701.
Abacavir may increase the risk for myocardial infarction, so may not be appropriate for patients with underlying cardiac risk.
Patients with chronic Hepatitis B virus (HBV) or Hepatitis C virus (HCV) infection who take TRIUMEQ are at increased risk for severe, even fatal, adverse liver reactions. TRIUMEQ contains lamivudine, which is active against HBV but should not be used on its own to treat HBV infection. All patients who test positive for an HIV infection should be screened for comorbid HBV and HCV infection. Co-infected patients should be started on an antiretroviral regimen targeting co-infected viruses, regardless of CD4 counts or viral loads. Current HIV treatment guidelines outline drug regimens and prescribing considerations.
TRIUMEQ is associated with a large number of drug-drug and herbal interactions, cautions, and contraindications. These are listed in the product monograph.
Pregnancy & Lactation
Highly active retroviral combination treatment should be used in all pregnant women. TRIUMEQ may be associated with neural tube defects, and should not be used in the first trimester of pregnancy or in women who may become pregnant unless they are using effective birth control. Current guidelines should be consulted when treating women in pregnancy, or women who may become pregnant. Components of TRIUMEQ are excreted in breast milk. The CDC recommends that all HIV positive women, treated or untreated, avoid breastfeeding to prevent vertical transmission of the virus.
TRIUMEQ overdose should be treated with standard supportive care and monitoring. Lamivudine is probably dialyzable, dolutegravir is not, and abacavir is unknown.
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