Triumeq

Last updated on RxList: 3/11/2021
Triumeq Side Effects Center

What Is Triumeq?

Triumeq (abacavir, dolutegravir, and lamivudine) is a combination of an integrase strand transfer inhibitor (INSTI) and two nucleoside analogues used to treat human immunodeficiency virus type 1 (HIV1) infection.

What Are Side Effects for Triumeq?

Common side effects of Triumeq include:

Dosage for Triumeq

The adult dose of Triumeq is one tablet daily.

What Drugs, Substances, or Supplements Interact with Triumeq?

Triumeq may interact with dofetilide and other drugs. Tell your doctor all medications and supplements you use.

Triumeq During Pregnancy and Breastfeeding

During pregnancy, Triumeq should be taken only if prescribed. Because breast milk can transmit HIV, do not breastfeed.

Additional Information

Our Triumeq (abacavir, dolutegravir, and lamivudine) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

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Triumeq Consumer Information

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Call your doctor at once if you have symptoms of an allergic reaction from two or more of these specific side effect groups:

  • Group 1 - fever;
  • Group 2 - rash;
  • Group 3 - nausea, vomiting, diarrhea, stomach pain;
  • Group 4 - general ill feeling, extreme tiredness, body aches;
  • Group 5 - shortness of breath, cough, sore throat.

Once you have had an allergic reaction to a medicine that contains abacavir or dolutegravir, you must never use it again. If you stop taking Triumeq for any reason, talk to your doctor before you start taking it again.

Call your doctor at once if you have:

  • other signs of allergic reaction--skin blisters or peeling, eye redness, swelling in your face or throat, trouble breathing;
  • lactic acidosis--unusual muscle pain, trouble breathing, stomach pain, vomiting, irregular heart rate, dizziness, feeling cold, or feeling very weak or tired; or
  • liver problems--swelling around your midsection, right-sided upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Triumeq affects your immune system, which may cause certain side effects (even weeks or months after you've taken this medicine). Tell your doctor if you have:

  • signs of a new infection--fever, night sweats, swollen glands, cold sores, cough, wheezing, diarrhea, weight loss;
  • trouble speaking or swallowing, problems with balance or eye movement, weakness or prickly feeling; or
  • swelling in your neck or throat (enlarged thyroid), menstrual changes, impotence.

Common side effects may include:

  • headache;
  • tiredness; or
  • trouble sleeping.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Triumeq (Abacavir, Dolutegravir, and Lamivudine Film-coated Tablets)

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SIDE EFFECTS

The following adverse reactions are discussed in other sections of the labeling:

  • Serious and sometimes fatal hypersensitivity reaction [see BOXED WARNING, WARNINGS AND PRECAUTIONS].
  • Exacerbations of hepatitis B [see BOXED WARNING, WARNINGS AND PRECAUTIONS].
  • Hepatotoxicity [see WARNINGS AND PRECAUTIONS].
  • Lactic acidosis and severe hepatomegaly with steatosis [see WARNINGS AND PRECAUTIONS].
  • Immune reconstitution syndrome [see WARNINGS AND PRECAUTIONS].
  • Myocardial infarction [see WARNINGS AND PRECAUTIONS].

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

Clinical Trials In Adults

Serious And Fatal Abacavir-Associated Hypersensitivity Reactions

In clinical trials, serious and sometimes fatal hypersensitivity reactions have occurred with abacavir, a component of TRIUMEQ [see BOXED WARNING, WARNINGS AND PRECAUTIONS]. These reactions have been characterized by 2 or more of the following signs or symptoms: (1) fever; (2) rash; (3) gastrointestinal symptoms (including nausea, vomiting, diarrhea, or abdominal pain); (4) constitutional symptoms (including generalized malaise, fatigue, or achiness); (5) respiratory symptoms (including dyspnea, cough, or pharyngitis). Almost all abacavir hypersensitivity reactions include fever and/or rash as part of the syndrome.

Other signs and symptoms have included lethargy, headache, myalgia, edema, arthralgia, and paresthesia. Anaphylaxis, liver failure, renal failure, hypotension, adult respiratory distress syndrome, respiratory failure, myolysis, and death have occurred in association with these hypersensitivity reactions. Physical findings have included lymphadenopathy, mucous membrane lesions (conjunctivitis and mouth ulcerations), and maculopapular or urticarial rash (although some patients had other types of rashes and others did not have a rash). There were reports of erythema multiforme. Laboratory abnormalities included elevated liver chemistries, elevated creatine phosphokinase, elevated creatinine, and lymphopenia and abnormal chest x-ray findings (predominantly infiltrates, which were localized).

Serious Dolutegravir Hypersensitivity Reactions

In clinical trials, hypersensitivity reactions have occurred with dolutegravir, a component of TRIUMEQ [see WARNINGS AND PRECAUTIONS]. These hypersensitivity reactions have been characterized by rash, constitutional findings, and sometimes organ dysfunction, including liver injury.

Additional Treatment-Emergent Adverse Drug Reactions (ADRs) With Use Of TRIUMEQ

The safety assessment of TRIUMEQ is primarily based on the analyses of data from a randomized, international, multicenter, double-blind, active-controlled trial, SINGLE (ING114467) and supported by data in treatment-experienced, INSTI-naive subjects from SAILING (ING111762) and by data from other treatment-naive trials. See full prescribing information for TIVICAY.

Treatment-Naive Subjects

In SINGLE, 833 adult subjects were randomized and received at least one dose of either dolutegravir (TIVICAY) 50 mg with fixed-dose abacavir and lamivudine (EPZICOM) once daily (n = 414) or fixed-dose efavirenz/emtricitabine/tenofovir (ATRIPLA) once daily (n = 419) (study treatment was blinded through Week 96 and open-label from Week 96 through Week 144). Through 144 weeks, the rate of adverse events leading to discontinuation was 4% in subjects receiving TIVICAY + EPZICOM and 14% in subjects receiving ATRIPLA once daily.

Treatment-emergent ADRs of moderate to severe intensity observed in at least 2% of subjects in either treatment arm of SINGLE are provided in Table 2.

Table 2: Treatment-Emergent Adverse Drug Reactions of at Least Moderate Intensity (Grades 2 to 4) and at Least 2% Frequency in Treatment-Naive Subjects in SINGLE (Week 144 Analysis)

Adverse Reaction TIVICAY + EPZICOM Once Daily
(n = 414)
ATRIPLA Once Daily
(n = 419)
Psychiatric
Insomnia 3% 3%
Depression 1% 2%
Abnormal dreams <1% 2%
Nervous System
Dizziness <1% 5%
Headache 2% 2%
Gastrointestinal
Nausea <1% 3%
Diarrhea <1% 2%
General Disorders
Fatigue 2% 2%
Skin and Subcutaneous Tissue
Rasha <1% 6%
Ear and Labyrinth
Vertigo 0 2%
a Includes pooled terms: rash, rash generalized, rash macular, rash maculo-papular, rash pruritic, and drug eruption.

Treatment-Experienced Subjects

SAILING is an international, double-blind trial in INSTI-naive, antiretroviral treatment-experienced adult subjects. Subjects were randomized and received either TIVICAY 50 mg once daily or raltegravir 400 mg twice daily with investigator-selected background regimen consisting of up to 2 agents, including at least one fully active agent. At 48 weeks, the rate of adverse events leading to discontinuation was consistent with that seen in the overall treatment-naive patient population. See full prescribing information for TIVICAY.

The ADRs observed in the subset of subjects who received TIVICAY + EPZICOM were generally consistent with those seen in the overall treatment-naive patient population.

Less Common Adverse Reactions Observed In Clinical Trials

The following adverse reactions occurred in less than 2% of treatment-naive or treatment-experienced subjects in any one trial. These events have been included because of their seriousness and/or assessment of potential causal relationship.

Gastrointestinal Disorders: Abdominal pain, abdominal distention, abdominal discomfort, dyspepsia, flatulence, gastroesophageal reflux disease, upper abdominal pain, vomiting.

General Disorders: Fever, lethargy.

Hepatobiliary Disorders: Hepatitis.

Metabolism and Nutrition Disorders: Anorexia, hypertriglyceridemia.

Musculoskeletal Disorders: Arthralgia, myositis.

Nervous System Disorders: Somnolence.

Psychiatric Disorders: Suicidal ideation, attempt, behavior, or completion. These events were observed primarily in subjects with a pre-existing history of depression or other psychiatric illness. Nightmare and sleep disorder.

Renal and Urinary Disorders: Renal impairment.

Skin and Subcutaneous Tissue Disorders: Pruritus.

Laboratory Abnormalities

Treatment-Naive Subjects

Selected laboratory abnormalities (Grades 2 to 4) with a worsening grade from baseline and representing the worst-grade toxicity in at least 2% of subjects in SINGLE are presented in Table 3. The mean change from baseline observed for selected lipid values is presented in Table 4.

Table 3: Selected Laboratory Abnormalities (Grades 2 to 4) in Treatment-Naive Subjects in SINGLE (Week 144 Analysis)

Laboratory Abnormality TIVICAY + EPZICOM Once Daily
(n = 414)
ATRIPLA Once Daily
(n = 419)
ALT
Grade 2 (>2.5-5.0 x ULN) 3% 5%
Grade 3 to 4 (>5.0 x ULN) 1% <1%
AST
Grade 2 (>2.5-5.0 x ULN) 3% 4%
Grade 3 to 4 (>5.0 x ULN) 1% 3%
Creatine kinase
Grade 2 (6.0-9.9 x ULN) 5% 3%
Grade 3 to 4 (≥10.0 x ULN) 7% 8%
Hyperglycemia
Grade 2 (126-250 mg/dL) 9% 6%
Grade 3 (>250 mg/dL) 2% <1%
Lipase
Grade 2 (>15-3.0 x ULN) 11% 11%
Grade 3 to 4 (>3.0 ULN) 5% 4%
Total neutrophils
Grade 2 (0.75-0.99 x 109) 4% 5%
Grade 3 to 4 (<0.75 x 109) 3% 3%
ULN = Upper limit of normal.

Table 4: Mean Change from Baseline in Fasted Lipid Values in Treatment-Naive Subjects in SINGLE (Week 144 Analysisa)

Lipid TIVICAY + EPZICOM Once Daily
(n = 414)
ATRIPLA Once Daily
(n = 419)
Cholesterol (mg/dL) 24.0 26.7
HDL cholesterol (mg/dL) 5.4 7.2
LDL cholesterol (mg/dL) 16.0 14.6
Triglycerides (mg/dL) 13.6 31.9
a Subjects on lipid-lowering agents at baseline were excluded from these analyses (TIVICAY + EPZICOM: n = 30 and ATRIPLA: n = 27). Seventy-two subjects initiated a lipid-lowering agent post-baseline; their last fasted on-treatment values (prior to starting the agent) were used regardless if they discontinued the agent (TIVICAY + EPZICOM: n = 36 and ATRIPLA: n = 36).

Treatment-Experienced Subjects

Laboratory abnormalities observed in SAILING were generally similar compared with observations seen in the treatment-naive trials.

Hepatitis C Virus Co-infection

In SINGLE, the pivotal Phase 3 trial, subjects with hepatitis C virus co-infection were permitted to enroll provided that baseline liver chemistry tests did not exceed 5 times the upper limit of normal; subjects with hepatitis B co-infection were excluded. Overall, the safety profile in subjects with hepatitis C virus co-infection was similar to that observed in subjects without hepatitis C co-infection, although the rates of AST and ALT abnormalities were higher in the subgroup with hepatitis C virus co-infection for both treatment groups. Grades 2 to 4 ALT abnormalities in hepatitis C co-infected compared with HIV mono-infected subjects receiving TRIUMEQ were observed in 15% and 2% (vs. 24% and 4% of subjects treated with ATRIPLA) (Week 96 analysis), respectively [see WARNINGS AND PRECAUTIONS]. See also full prescribing information for TIVICAY.

Changes In Serum Creatinine

Dolutegravir has been shown to increase serum creatinine due to inhibition of tubular secretion of creatinine without affecting renal glomerular function [see CLINICAL PHARMACOLOGY]. Increases in serum creatinine occurred within the first 4 weeks of treatment and remained stable through 144 weeks. In SINGLE, a mean change from baseline of 0.14 mg per dL (range: -0.25 mg per dL to 0.81 mg per dL) was observed after 144 weeks of treatment. Creatinine increases were similar in treatment-experienced subjects.

Abacavir And Lamivudine

Laboratory abnormalities observed in clinical trials of ZIAGEN (in combination with other antiretroviral treatment) were anemia, neutropenia, liver function test abnormalities, and elevations of CPK, blood glucose, and triglycerides. Additional laboratory abnormalities observed in clinical trials of EPIVIR (in combination with other antiretroviral treatment) were thrombocytopenia and elevated levels of bilirubin, amylase, and lipase.

Clinical Trials Experience In Pediatric Subjects

Abacavir And Lamivudine

The safety of once-daily compared with twice-daily dosing of abacavir and lamivudine, administered as either single products or as EPZICOM, was assessed in the ARROW trial (n = 336). Primary safety assessment in the ARROW (COL105677) trial was based on Grade 3 and Grade 4 adverse events. One event of Grade 4 hepatitis in the once-daily cohort was considered as uncertain causality by the investigator and all other Grade 3 or 4 adverse events were considered not related by the investigator. No additional safety issues were identified in pediatric subjects compared with historical data in adults.

Dolutegravir

IMPAACT P1093 is a 48-week multicenter, open-label, non-comparative trial of approximately 160 HIV-1-infected pediatric subjects aged 4 weeks to less than 18 years, of which, 23 treatment-experienced, INSTI-naive subjects aged 12 to less than 18 years were enrolled [see Use In Specific Populations, Clinical Studies].

The ADR profile was similar to that for adults. Grade 2 ADRs reported by more than one subject were decreased neutrophil count (n = 2). No Grade 3 or 4 ADRs were reported. No ADRs led to discontinuation. The Grade 3 laboratory abnormalities reported in 1 subject each were elevated total bilirubin, elevated lipase, and decreased white blood cell count. There was one Grade 4 decreased neutrophil count. The changes in mean serum creatinine were similar to those observed in adults.

Postmarketing Experience

In addition to adverse reactions reported from clinical trials, the following adverse reactions have been identified during postmarketing use with one or more of the components of TRIUMEQ. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Blood And Lymphatic Systems

Aplastic anemia, anemia (including pure red cell aplasia and severe anemias progressing on therapy), lymphadenopathy, splenomegaly.

Digestive

Stomatitis.

Gastrointestinal

Pancreatitis.

General

Weakness.

Hepatobiliary Disorders

Acute liver failure, liver transplant.

Hypersensitivity

Sensitization reactions (including anaphylaxis), urticaria [see WARNINGS AND PRECAUTIONS, ADVERSE REACTIONS].

Investigations

Weight increased.

Metabolism And Nutrition Disorders

Hyperlactemia.

Musculoskeletal

CPK elevation, muscle weakness, myalgia, rhabdomyolysis.

Nervous

Paresthesia, peripheral neuropathy, seizures.

Psychiatric

Anxiety.

Respiratory

Abnormal breath sounds/wheezing.

Skin

Alopecia, erythema multiforme. Suspected Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported in patients receiving abacavir primarily in combination with medications known to be associated with SJS and TEN, respectively. Because of the overlap of clinical signs and symptoms between hypersensitivity to abacavir and SJS and TEN, and the possibility of multiple drug sensitivities in some patients, abacavir should be discontinued and not restarted in such cases [see ADVERSE REACTIONS].

DRUG INTERACTIONS

Effect Of Dolutegravir On The Pharmacokinetics Of Other Agents

In vitro, dolutegravir inhibited the renal organic cation transporters (OCT)2 (IC50 = 1.93 microM) and multidrug and toxin extrusion transporter (MATE)1 (IC50 = 6.34 microM). In vivo, dolutegravir inhibits tubular secretion of creatinine by inhibiting OCT2 and potentially MATE1. Dolutegravir may increase plasma concentrations of drugs eliminated via OCT2 or MATE1 (dofetilide, dalfampridine, and metformin) [see CONTRAINDICATIONS, DRUG INTERACTIONS].

In vitro, dolutegravir inhibited the basolateral renal transporters, organic anion transporter (OAT) 1 (IC50 = 2.12 microM) and OAT3 (IC50 = 1.97 microM). However, in vivo, dolutegravir did not alter the plasma concentrations of tenofovir or para-amino hippurate, substrates of OAT1 and OAT3.

In vitro, dolutegravir did not inhibit (IC50 greater than 50 microM) the following: cytochrome P450 (CYP)1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A, uridine diphosphate (UDP)-glucuronosyl transferase (UGT)1A1, UGT2B7, P-glycoprotein (P-gp), breast cancer resistance protein (BCRP), bile salt export pump (BSEP), organic anion transporter polypeptide (OATP)1B1, OATP1B3, OCT1, or multidrug resistance protein (MRP)2, or MRP4. In vitro, dolutegravir did not induce CYP1A2, CYP2B6, CYP3A4. Based on these data and the results of drug interaction trials, dolutegravir is not expected to affect the pharmacokinetics of drugs that are substrates of these enzymes or transporters.

In drug interaction trials, dolutegravir did not have a clinically relevant effect on the pharmacokinetics of the following drugs: daclatasvir, tenofovir, methadone, midazolam, rilpivirine, and oral contraceptives containing norgestimate and ethinyl estradiol. Using cross-study comparisons to historical pharmacokinetic data for each interacting drug, dolutegravir did not appear to affect the pharmacokinetics of the following drugs: atazanavir, darunavir, efavirenz, etravirine, fosamprenavir, lopinavir, ritonavir, and boceprevir.

Effect Of Other Agents On The Pharmacokinetics Of Dolutegravir

Dolutegravir is metabolized by UGT1A1 with some contribution from CYP3A. Dolutegravir is also a substrate of UGT1A3, UGT1A9, BCRP, and P-gp in vitro. Drugs that induce those enzymes and transporters may decrease dolutegravir plasma concentrations and reduce the therapeutic effect of dolutegravir.

Coadministration of dolutegravir and other drugs that inhibit these enzymes may increase dolutegravir plasma concentrations.

Etravirine significantly reduced plasma concentrations of dolutegravir, but the effect of etravirine was mitigated by coadministration of lopinavir/ritonavir or darunavir/ritonavir, and is expected to be mitigated by atazanavir/ritonavir (Table 5) [see DRUG INTERACTIONS, CLINICAL PHARMACOLOGY].

In vitro, dolutegravir was not a substrate of OATP1B1 or OATP1B3.

Darunavir/ritonavir, lopinavir/ritonavir, rilpivirine, tenofovir, boceprevir, daclatasvir, prednisone, rifabutin, and omeprazole had no clinically significant effect on the pharmacokinetics of dolutegravir.

Established And Other Potentially Significant Drug Interactions

There were no drug-drug interaction trials conducted with the abacavir, dolutegravir, and lamivudine fixed-dose combination tablets.

Information regarding potential drug interactions with the individual components of TRIUMEQ are provided below. These recommendations are based on either drug interaction trials or predicted interactions due to the expected magnitude of interaction and potential for serious adverse events or loss of efficacy. [See CONTRAINDICATIONS, CLINICAL PHARMACOLOGY]

Table 5: Established and Other Potentially Significant Drug Interactions for Dolutegravir: Alterations in Dose May Be Recommended Based on Drug Interaction Trials or Predicted Interactions

Concomitant Drug Class: Drug Name Effect on Concentration Clinical Comment
HIV-1 Antiviral Agents
Non-nucleoside reverse transcriptase inhibitor: Etravirinea ↓Dolutegravir Use of TRIUMEQ with etravirine without coadministration of atazanavir/ritonavir, darunavir/ritonavir, or lopinavir/ritonavir is not recommended.
Non-nucleoside reverse transcriptase inhibitor: Efavirenza ↓Dolutegravir Adjust dolutegravir dose to 50 mg twice daily. An additional 50-mg dose of dolutegravir should be taken, separated by 12 hours from TRIUMEQ.
Non-nucleoside reverse transcriptase inhibitor: Nevirapine ↓Dolutegravir Avoid coadministration with TRIUMEQ because there are insufficient data to make dosing recommendations.
Protease inhibitor: Fosamprenavir/ritonavira Tipranavir/ritonavira ↓Dolutegravir Adjust dolutegravir dose to 50 mg twice daily. An additional dolutegravir 50-mg dose should be taken, separated by 12 hours from TRIUMEQ.
Other Agents
Antiarrhythmic: Dofetilide ↑Dofetilide Coadministration is contraindicated with TRIUMEQ [see CONTRAINDICATIONS].
Potassium channel blocker: Dalfampridine ↑Dalfampridine Elevated levels of dalfampridine increase the risk of seizures. The potential benefits of taking dalfampridine concurrently with TRIUMEQ should be considered against the risk of seizures in these patients.
Carbamazepinea ↓Dolutegravir Adjust dolutegravir dose to 50 mg twice daily. An additional dolutegravir 50-mg dose should be taken, separated by 12 hours from TRIUMEQ.
Oxcarbazepine Phenytoin Phenobarbital St. John’s wort (Hypericum perforatum) ↓Dolutegravir Avoid coadministration with TRIUMEQ because there are insufficient data to make dosing recommendations.
Medications containing polyvalent cations (e.g., Mg or Al): Cation-containing antacidsa or laxatives
Sucralfate Buffered medications
↓Dolutegravir Administer TRIUMEQ 2 hours before or 6 hours after taking medications containing polyvalent cations.
Oral calcium and iron supplements, including multivitamins containing calcium or irona ↓Dolutegravir When taken with food, TRIUMEQ and supplements or multivitamins containing calcium or iron can be taken at the same time. Under fasting conditions, TRIUMEQ should be taken 2 hours before or 6 hours after taking supplements containing calcium or iron.
Metformina ↑Metformin Refer to the prescribing information for metformin for assessing the benefit and risk of concomitant use of TRIUMEQ and metformin.
Rifampina ↓Dolutegravir Adjust dolutegravir dose to 50 mg twice daily. An additional 50-mg dose of dolutegravir should be taken, separated by 12 hours from TRIUMEQ.
a See CLINICAL PHARMACOLOGY Table 8 or Table 9 for magnitude of interaction.

Methadone

Abacavir

In a trial of 11 HIV-1-infected subjects receiving methadone-maintenance therapy with 600 mg of abacavir twice daily (twice the currently recommended dose), oral methadone clearance increased [see CLINICAL PHARMACOLOGY]. This alteration will not result in a methadone dose modification in the majority of patients; however, an increased methadone dose may be required in a small number of patients.

Sorbitol

Lamivudine

Coadministration of single doses of lamivudine and sorbitol resulted in a sorbitol dose-dependent reduction in lamivudine exposures. When possible, avoid use of sorbitolcontaining medicines with lamivudine-containing medicines [see CLINICAL PHARMACOLOGY].

Riociguat

Abacavir

Coadministration with TRIUMEQ resulted in increased riociguat exposure, which may increase the risk of riociguat adverse reactions [see CLINICAL PHARMACOLOGY]. The riociguat dose may need to be reduced. See full prescribing information for ADEMPAS (riociguat).

Read the entire FDA prescribing information for Triumeq (Abacavir, Dolutegravir, and Lamivudine Film-coated Tablets)

© Triumeq Patient Information is supplied by Cerner Multum, Inc. and Triumeq Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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