HIV-1 infection in adults and pediatrics weighing ≥40kg.
Limitations Of use:
Not recommended alone in patients with resistance-associated integrase substitutions or suspected INSTI resistance due to insufficient dolutegravir dose in Triumeq in these subpopulations.
Adults and Children:
<40kg: not recommended. ≥40kg: 1 tab daily. Concomitant efavirenz, fosamprenavir/ritonavir, tipranavir/ritonavir, carbamazepine, rifampin: give additional dolutegravir 50mg separated by 12hrs from Triumeq.
Presence of HLA-B*5701 allele. Previous hypersensitivity reaction to any of the components. Concomitant dofetilide. Moderate or severe hepatic impairment.
See full labeling re: fatal hypersensitivity reactions with abacavir; discontinue as soon as suspected; do not restart. Evaluate for presence of HLA-B*5701 allele prior to starting therapy or reinitiation; if (+), abacavir is contraindicated; discontinue permanently if hypersensitivity cannot be ruled out even if other diagnoses are possible, regardless of HLA-B*5701 status. If stopped for reasons other than hypersensitivity, restart only if medical care can be readily accessed; monitor. Suspend if lactic acidosis or hepatotoxicity (eg, hepatomegaly and steatosis) occurs. Increased risk for worsening/development of elevated transaminases in patients with hepatitis B or C; monitor LFTs prior to starting, during therapy, and for at least several months after stopping treatment (discontinuing may exacerbate HBV infection). Myocardial infarction: consider CHD risk before starting therapy and minimize modifiable risk factors (eg, HTN, diabetes). Renal impairment (CrCl <50mL/min): not recommended; if lamivudine dose reduction is required, use individual components. Mild hepatic impairment: if abacavir dose reduction is required, use individual components. Elderly. Pregnancy. Nursing mothers: not recommended.
Ethanol may increase abacavir levels. Abacavir may increase clearance of methadone. Dolutegravir may be affected by drugs that induce or inhibit UGT1A1, CYP3A, UGT1A3, UGT1A9, BCRP, and P-gp enzymes or transporters. Avoid concomitant nevirapine, oxcarbazepine, phenytoin, phenobarbital, carbamazepine, St. John’s wort. Potentiates metformin (limit metformin dose to 1g/day); adjust metformin dose when stopping Triumeq; monitor blood glucose. Concomitant etravirine without atazanavir/ritonavir, darunavir/ritonavir, or lopinavir/ritonavir: not recommended. Concomitant efavirenz, fosamprenavir/ritonavir, tipranavir/ritonavir, carbamazepine, rifampin: requires extra dolutegravir dose (see Adults and Children). Concomitant cation-containing antacids or laxatives, sucralfate, buffered drugs, oral calcium/iron supplements, multivitamins; give Triumeq 2hrs before or 6hrs after; alternatively, oral calcium/iron can be used at the same time when taken with food. Monitor for toxicities (eg, hepatic decompensation) with IFN-α ± ribavirin (consider reducing dose or discontinue one or both drugs).