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Triumeq: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on May 2, 2022.

1. How it works

  • Triumeq is a fixed-dose combination tablet that contains three antivirals: abacavir, dolutegravir, and lamivudine, which may be used to treat human immunodeficiency virus type 1 (HIV-1) infection in adults and children weighing at least 10 kg (22 pounds).
  • Each component of Triumeq works differently. Abacavir is converted by enzymes inside the cell to an active metabolite called carbovir triphosphate (CBV-TP). CBV-TP inhibits the activity of an enzyme (called HIV-1 reverse transcriptase or RT) that is important for the conversion of single-stranded RNA to double-stranded DNA by competing with the natural substrate deoxyguanosine-5′-triphosphate (dGTP) preventing its incorporation into the viral DNA. Abacavir belongs to the class of medicines known as nucleoside analogues.
  • Dolutegravir inhibits HIV integrase (an enzyme that integrates its genetic information into that of the host cell it infects) by binding to the integrase active site and blocking the strand transfer step of retroviral DNA integration which is essential for the HIV replication cycle. Dolutegravir belongs to the class of medicines known as integrase inhibitors.
  • Lamivudine is converted inside the cells to its active metabolite lamivudine triphosphate (3TC-TP). 3TC-TP inhibits RT via DNA chain termination. Lamivudine also belongs to the class of medicines known as nucleoside analogues (like abacavir).
  • Triumeq belongs to the class of medicines known as antiviral combinations.

2. Upsides

  • May be used to treat HIV-1 infection in adults and children who weigh at least 10 kg (22 pounds).
  • The only combination tablet with an abacavir/lamivudine nucleoside backbone.
  • Usually well-tolerated. Fewer side effects and drug interactions have been reported with Triumeq compared with some other antiviral combinations, such as Genvoya because Triumeq doesn't contain a booster such as cobicistat.
  • May be taken with or without food.
  • One tablet is taken once a day.
  • A fixed-dose product that contains 600mg of abacavir, 50mg of dolutegravir, and 300mg of lamivudine.
  • Triumeq PD is the first combination treatment containing dolutegravir that is available as a dispersible tablet for the treatment of pediatric patients weighing 10kgs to < 25 kgs with HIV-1.
  • Considered a first-line treatment by Department of Health and Human Services (HHS) guidelines and equally as effective as some other antiviral combinations, such as Genvoya.
  • Helps people with HIV reach and maintain an undetectable level of virus in their blood (less than 50 copies of HIV-1 RNA per milliliter (mL) of blood).

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Headache, nausea, fatigue, and diarrhea are the most common side effects reported; research has shown these occur in less than 3% of people. Liver toxicity, myocardial infarction, and serious allergic reactions are rare, but serious side effects.
  • Not approved to be used for pre-exposure prophylaxis (PrEP) to prevent HIV-1.
  • Screen for the HLA-B5701 gene before prescribing Triumeq. Do not give to people who test positive for this gene due to a higher risk of allergic reactions.
  • May not be suitable for people with resistance to any of the three drugs found in Triumeq (dolutegravir, abacavir, and lamivudine), or they may need additional HIV medications.
  • Abacavir (an ingredient of Triumeq) has been associated with an increased risk of a heart attack so may not be suitable for people with heart disease or risk factors for heart disease.
  • May not be suitable for some people including those with mild liver disease (contraindicated in moderate-to-severe liver disease) or with kidney disease (contraindicated in those with a CLCR of less than 30mL/minute).
  • Severe exacerbations of hepatitis B have been reported on discontinuation of lamivudine, a component of Triumeq. Monitor liver function for several months in patients with HIV-1 and HBV who discontinue Triumeq. May also cause elevated liver enzymes or hepatitis in people without preexisting liver disease.
  • Rarely, lactic acidosis can occur. Symptoms include fatigue, unexpected muscle pain, difficulty breathing, stomach pain, nausea and vomiting, chills, dizziness, a fast or irregular heartbeat.
  • Dolutegravir, a component of Triumeq, has been reported to cause elevated liver enzymes, hepatitis, and acute liver failure, even in people without existing liver disease.
  • Because of a decrease in dolutegravir concentrations, an additional 50mg dolutegravir tablet, separated 12 hours from Triumeq, should be taken by people who are coadministered efavirenz, fosamprenavir/ritonavir, tipranavir/ritonavir, carbamazepine, or rifampin.
  • May increase your risk of a heart attack. People who smoke, have heart problems, or have risks for heart disease such as high blood pressure, high cholesterol, or diabetes are more at risk.
  • Interacts with some other medications. Dofetilide should not be taken at the same time.
  • Immune reconstitution syndrome has been reported in people treated with combination antiviral regimens, including Triumeq.
  • Perform a pregnancy test in women with childbearing potential before initiating Triumeq because it has been associated with birth defects. Ensure women with child-bearing potential use adequate contraception while taking Triumeq. Register women who inadvertently become pregnant on the Antiretroviral Pregnancy Registry at 1-800-258-4263.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Triumeq is a fixed-dose combination tablet that contains three antivirals: abacavir, dolutegravir, and lamivudine, which may be used to treat HIV-1 infection in adults and children weighing at least 10 kg (22 pounds). It is taken as a single tablet once a day and is usually well-tolerated, with side effects such as fatigue, headache, and nausea reported by less than 3% of people who take it. Triumeq is not suitable for people who test positive for the HLA-B5701 gene.

5. Tips

  • Best taken at the same time each day, either in the morning or at night. Can be taken with or without food.
  • Read the medication guide and warning card that is dispensed with every new prescription and refill of Triumeq. Always carry the warning card with you.
  • if you miss a dose of Triumeq, take it as soon as you remember. If it is almost time for your next dose, do not take the missed dose or double up on the dosage, just go back to your usual dosing schedule.
  • Triumeq can interact with some other medicines. Talk to your doctor or pharmacist before taking any other medications with Triumeq, including supplements and herbals brought from a supermarket or drugstore. Do not take Triumeq at the same time as supplements or antacids that contain aluminum, calcium, magnesium, iron, or zinc. Instead, take Triumeq at least 2 hours before or 6 hours after these medicines.
  • Before taking Triumeq, you will need to take a genetic screening test for the HLA-B5701 gene variation. If you test positive for this gene variation, you won’t be able to take Triumeq, because you will be at higher risk for a serious allergic reaction that can cause death since Triumeq contains abacavir.
  • Stop Triumeq immediately if you experience an allergic reaction. Symptoms may include a fever, rash, nausea, vomiting, diarrhea, abdominal pain, shortness of breath, or a cough. A list of these symptoms is on the Warning Card your pharmacist should have given you with Triumeq. If you have experienced an allergic reaction to Triumeq, you should NEVER restart it. if you stop Triumeq temporarily for any reason (such as supply issues), there is the possibility of an allergic reaction occurring when you restart it again.
  • If you have heart disease, kidney, or liver disease be sure to tell your doctor. Also, let your doctor know if you are pregnant or plan to become pregnant. This medication could harm an unborn baby.
  • Triumeq has been associated with birth defects when taken by pregnant women. Ensure you use adequate contraception while you are taking Triumeq. If you inadvertently become pregnant, tell your doctor immediately and register on the Antiretroviral Pregnancy Registry at 1-800-258-4263. You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. Do not breastfeed if you are taking Triumeq.

6. Response and effectiveness

  • Considered equally as effective as other combination antivirals, such as Genvoya.
  • Usually well-tolerated. The most common side effects (difficulty sleeping, headache, or tiredness) have been reported in less than 3% of people; although in some they can persist long term (more than 3 years).
  • Works quickly to suppress the HIV-1 virus and some show an undetectable viral load within a month of starting Triumeq (corresponds to an HIV‑1 RNA level of fewer than 50 copies/mL). However, results can vary among individuals, and most trials have ranged from 48 weeks duration for treatment-experienced patients to 96 or 144 weeks for treatment-naïve patients. After 48 weeks, 88% of people had achieved HIV‑1 RNA levels of less than 50 copies/mL3 (considered undetectable) and after 144 weeks, 71% of patients taking Triumeq had HIV‑1 RNA levels of less than 50 copies/mL3. 4% of patients stopped taking Triumeq because of side effects. Triumeq increased CD4+ T-cell count by an average of 378 cells/mm3.

7. Interactions

Medicines that interact with Triumeq may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Triumeq. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Triumeq include:

  • aluminum, calcium, or magnesium-containing antacids or other preparations
  • antibiotics, such as clarithromycin, or erythromycin
  • anticonvulsants, such as carbamazepine, fosphenytoin, or phenytoin
  • antifungals, such as fluconazole, itraconazole, or ketoconazole
  • apalutamide
  • aprepitant
  • bexarotene
  • biologics, such as imatinib or nilotinib
  • bosentan
  • cannabidiol
  • cyclosporine
  • dalfampridine
  • dofetilide (avoid)
  • herbals, such as black cohosh or St. John's wort
  • interferon or peginterferon
  • iron preparations
  • kaolin
  • medications for diabetes, such as metformin
  • methadone
  • methotrexate
  • multivitamins
  • other HIV medications such as atazanavir, cobicistat, didanosine, efavirenz, etravirine, indinavir, nevirapine, or ritonavir
  • rifampin
  • riociguat
  • sodium bicarbonate
  • sorbitol
  • sucralfate
  • zinc preparations.

Indigestion remedies (antacids) that contain aluminum carbonate/hydroxide, magnesium hydroxide, or calcium carbonate should be taken at least 2 hours before or 2 hours after Triumeq. Antacids decrease absorption and blood levels of dolutegravir, one of the medicines in Triumeq.

Because of a decrease in dolutegravir concentrations, an additional 50mg dolutegravir tablet, separated 12 hours from Triumeq, should be taken by people who are coadministered efavirenz, fosamprenavir/ritonavir, tipranavir/ritonavir, carbamazepine, or rifampin.

Note that this list is not all-inclusive and includes only common medications that may interact with Triumeq. You should refer to the prescribing information for Triumeq for a complete list of interactions.

References

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Triumeq only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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