Version July 2025
Serious and sometimes fatal hypersensitivity reactions, with multiple organ involvement, have occurred with abacavir. Patients who carry the HLA-B*5701 allele are at a higher risk of a hypersensitivity reaction to abacavir; although, hypersensitivity reactions have occurred in patients who do not carry the HLA-B*5701 allele.
Abacavir/dolutegravir/lamivudine is contraindicated in patients with a prior hypersensitivity reaction to abacavir and in HLA-B*5701-positive patients. All patients should be screened for the HLA-B*5701 allele prior to initiating therapy with abacavir/dolutegravir/lamivudine or reinitiation of therapy with abacavir/dolutegravir/lamivudine unless patients have a previously documented HLA-B*5701 allele assessment. Discontinue abacavir/dolutegravir/lamivudine immediately if a hypersensitivity reaction is suspected, regardless of status and even when other diagnoses are possible.
Following a hypersensitivity reaction to abacavir/dolutegravir/lamivudine, never restart abacavir/dolutegravir/lamivudine or any other abacavir-containing product because more severe symptoms, including death, can occur within hours. Similar severe reactions have also occurred rarely following reintroduction of abacavir-containing products in patients who have no history of abacavir hypersensitivity.
All patients with HIV-1 should be tested for the presence of hepatitis B virus (HBV) prior to or when initiating abacavir/dolutegravir/lamivudine. Emergence of lamivudine-resistant HBV variants associated with lamivudine-containing antiretroviral regimens has been reported. If abacavir/dolutegravir/lamivudine is used in patients coinfected with HIV-1 and HBV, additional treatment should be considered for appropriate treatment of chronic HBV; otherwise, consider an alternative regimen.
Severe acute exacerbations of hepatitis B have been reported in patients who are coinfected with HBV and HIV-1 and have discontinued lamivudine, a component of abacavir/dolutegravir/lamivudine. Closely monitor hepatic function in these patients and, if appropriate, initiate anti-HBV treatment.
Note: Tablets (Triumeq) and tablets for oral suspension (Triumeq PD) are not interchangeable on a mg-per-mg basis due to different pharmacokinetic profiles of the dolutegravir component. Triumeq PD (tablets for oral suspension) should not be used in patients ≥25 kg; suboptimal dosing may occur.
HIV-1 infection, treatment: Note: Evaluate gene mutation and antiretroviral resistance patterns (refer to https://www.iasusa.org and https://hivdb.stanford.edu for more information).
Infants ≥3 months and Children, weighing 6 to <25 kg: Triumeq PD tablets for oral suspension (abacavir 60 mg/dolutegravir 5 mg/lamivudine 30 mg per tablet):
6 to <10 kg: Oral: 3 tablets once daily.
10 to <14 kg: Oral: 4 tablets once daily.
14 to <20 kg: Oral: 5 tablets once daily.
20 to <25 kg: Oral: 6 tablets once daily.
Children and Adolescents weighing ≥25 kg: Triumeq tablets (abacavir 600 mg/dolutegravir 50 mg/lamivudine 300 mg per tablet): Oral: One tablet once daily.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Infants ≥3 months, Children, and Adolescents, weighing ≥6 kg:
CrCl ≥30 mL/minute: No dosage adjustment necessary. Patients with CrCl consistently between 30 and <50 mL/minute should be monitored for lamivudine-associated hematologic toxicities. If new or worsening neutropenia or anemia develops, requiring dose adjustment of lamivudine, then use individual components of abacavir, dolutegravir, and lamivudine with dose adjustments as appropriate.
CrCl <30 mL/minute: Use is not recommended.
Infants ≥3 months, Children, and Adolescents, weighing ≥6 kg:
Mild impairment: Use of fixed-dose combination is not recommended; see individual agents.
Moderate to severe impairment: Use is contraindicated; safety, efficacy, and pharmacokinetic properties have not been established.
(For additional information see "Dolutegravir, abacavir, and lamivudine: Drug information")
HIV-1 infection, treatment: Oral: One tablet (abacavir 600 mg/dolutegravir 50 mg/lamivudine 300 mg) once daily. Note: Do not use in the setting of hepatitis B virus (HBV) coinfection or unknown HBV status (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
CrCl ≥30 mL/minute: No dosage adjustment necessary. Patients with CrCl consistently between 30 and <50 mL/minute should be monitored for lamivudine-associated hematologic toxicities. If new or worsening neutropenia or anemia develop, requiring dose adjustment of lamivudine, then use dose-adjusted individual components of abacavir, dolutegravir, and lamivudine.
CrCl <30 mL/minute: Use is not recommended (use dose-adjusted individual component drugs).
Mild impairment (Child-Pugh class A): Use is not recommended (use dose-adjusted individual component drugs).
Moderate to severe impairment (Child-Pugh class B or C): Use is contraindicated.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reaction incidences reported in adults. Also see individual agents.
>10%: Gastrointestinal: Increased serum lipase (grade 2: 11%; grades 3/4: 5%)
1% to 10%:
Dermatologic: Pruritus (<2%)
Endocrine & metabolic: Hyperglycemia (grade 2: 9%; grade 3: 2%), hypertriglyceridemia (<2%)
Gastrointestinal: Abdominal distention (<2%), abdominal distress (<2%), abdominal pain (<2%), anorexia (<2%), dyspepsia (<2%), flatulence (<2%), gastroesophageal reflux disease (<2%), upper abdominal pain (<2%), vomiting (<2%)
Hematologic & oncologic: Decreased neutrophils (grade 2: 4%; grades 3/4: 3%)
Hepatic: Hepatitis (<2%), increased serum alanine aminotransferase (grade 2: 3%; grades 3/4: 1%), increased serum aspartate aminotransferase (grade 2: 3%; grades 3/4: 1%)
Nervous system: Depression (1%), drowsiness (<2%), fatigue (2%), headache (2%), insomnia (3%), lethargy (<2%), nightmares (<2%), sleep disorder (<2%), suicidal ideation (<2%), suicidal tendencies (<2%)
Neuromuscular & skeletal: Arthralgia (<2%), increased creatine phosphokinase in blood specimen (grade 2: 5%; grades 3/4: 7%), myositis (<2%)
Renal: Renal insufficiency (<2%)
Miscellaneous: Fever (<2%)
<1%:
Dermatologic: Skin rash
Gastrointestinal: Diarrhea, nausea
Nervous system: Abnormal dreams, dizziness
Frequency not defined:
Hepatic: Exacerbation of hepatitis B
Hypersensitivity: Hypersensitivity reaction (including severe hypersensitivity reaction)
Postmarketing: Immunologic: Immune reconstitution syndrome
Hypersensitivity to abacavir, dolutegravir, lamivudine, or any component of the formulation; patients with HLA-B*5701 allele; concomitant dofetilide; moderate or severe hepatic impairment.
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Canadian labeling: Additional contraindications (not in US labeling): Concurrent use with organic cation transporter 2 substrates with narrow therapeutic windows (eg, fampridine).
Concerns related to adverse effects:
• Hepatotoxicity: Hepatic adverse events, including elevated transaminases, hepatitis, and acute liver failure (sometimes requiring liver transplant), have been reported with regimens containing dolutegravir. Risk may be increased in patients with significant transaminase elevations or hepatitis B or C prior to treatment; however, hepatotoxicity has been reported in patients with no preexisting hepatic disease or other risk factors. In some patients receiving dolutegravir-containing regimens, elevations in transaminases may be concurrent with development of immune reconstitution syndrome or hepatitis B reactivation (especially if antihepatitis therapy has been discontinued).
• Hypersensitivity reactions: Hypersensitivity reactions have been reported with use of abacavir or dolutegravir. Serious, sometimes fatal, hypersensitivity reactions, including multiorgan failure and anaphylaxis, have occurred with abacavir. Reactions usually occur within 6 weeks of starting abacavir (median time to onset: 9 days), although these reactions may occur at any time during therapy. Patients who carry the HLA-B*5701 allele are at higher risk for abacavir hypersensitivity reactions, although patients without the allele have also developed hypersensitivity reactions. Hypersensitivity reactions reported with dolutegravir include rash, constitutional findings (eg, fatigue, fever, malaise, muscle/joint aches), and organ dysfunction (eg, liver injury). Monitor clinical status, including LFTs, and initiate supportive therapy as appropriate. If hypersensitivity occurs or is suspected, immediately discontinue therapy and do not reinitiate. Because it is not possible to clinically determine whether a hypersensitivity reaction is caused by abacavir or dolutegravir, do not restart therapy or any other abacavir- or dolutegravir-containing product in patients who have stopped therapy due to a hypersensitivity reaction; life-threatening hypotension and death have occurred within hours of restarting abacavir. If a hypersensitivity reaction is ruled out, may restart therapy. Rarely, patients who have stopped abacavir for reasons other than hypersensitivity have also reported life-threatening reactions within hours of reinitiating. Reintroduction of therapy or any other abacavir-containing product is only recommended if medical care is readily accessible.
• Immune reconstitution syndrome: Patients may develop immune reconstitution syndrome resulting in the occurrence of an inflammatory response to an indolent or residual opportunistic infection during initial HIV treatment or activation of autoimmune disorders (eg, Graves disease, polymyositis, Guillain-Barré syndrome) later in therapy; further evaluation and treatment may be required.
• Lactic acidosis/hepatomegaly: Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with nucleoside analogues, including abacavir and lamivudine. Female gender and obesity may increase the risk for development. Suspend treatment in any patient who develops clinical or laboratory findings suggestive of lactic acidosis or hepatotoxicity (transaminase elevation may/may not accompany hepatomegaly and steatosis).
• Pancreatitis: Pancreatitis has been observed with lamivudine and abacavir. Discontinue use if pancreatitis is suspected and resume only after pancreatitis has been ruled out.
Disease-related concerns:
• Coronary heart disease: Use has been associated with an increased risk of MI in some cohort studies (Elion 2018; HHS [ARV adult] 2023). Consider using with caution in patients with risks for coronary heart disease and minimizing modifiable risk factors (eg, hypertension, hyperlipidemia, diabetes mellitus, smoking) prior to use.
• Emergence of lamivudine-resistant hepatitis B: HIV/HBV coinfected patients receiving lamivudine-containing antiretroviral regimens have developed lamivudine resistant HBV variants.
• Hepatic impairment: Abacavir/dolutegravir/lamivudine, as a fixed-dose combination tablet, should not be used in patients with mild hepatic impairment; use is contraindicated in moderate to severe hepatic impairment.
• Renal impairment: Abacavir/dolutegravir/lamivudine, as a fixed-dose combination tablet, should not be used in patients with CrCl <30 mL/minute.
Dosage form specific warnings:
• Interchangeability: Tablets and tablets for oral suspension are not interchangeable on a milligram-per-milligram basis; differing pharmacokinetic profiles for the dolutegravir component exist.
• Tablets for oral suspension: Tablets for oral suspension are only recommended for use in pediatric patients weighing 6 to <25 kg; suboptimal dosing may occur if used in patients ≥25 kg.
Other warnings/precautions:
• Changes in serum creatinine: Dolutegravir may increase serum creatinine due to inhibition of tubular secretion of creatinine without affecting renal glomerular function or effective renal plasma flow (Gutierrez 2014). Increased serum creatinine occurred within the first 4 weeks of treatment with dolutegravir and remained stable through 144 weeks of treatment.
The major clinical toxicity of lamivudine in pediatric patients is pancreatitis, which was reported in 14% of patients in one open-label, dose-escalation trial; discontinue lamivudine therapy if clinical signs, symptoms, or laboratory abnormalities suggestive of pancreatitis occur. Use with extreme caution and only if there is no satisfactory alternative therapy in pediatric patients with a history of pancreatitis or other significant risk factors for the development of pancreatitis (Epivir prescribing information).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral:
Triumeq: Abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg
Tablet Soluble, Oral:
Triumeq PD: Abacavir 60 mg, dolutegravir 5 mg, and lamivudine 30 mg
Triumeq PD: Abacavir 60 mg, dolutegravir 5 mg, and lamivudine 30 mg [strawberry cream flavor]
May be product dependent
Tablets (Triumeq Oral)
600-50-300 mg (per each): $155.90
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Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral:
Triumeq: Abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg
Oral: Administer with or without food. Do not chew, cut, or crush. Administer 2 hours before or 6 hours after cation-containing antacids or laxatives, sucralfate, oral supplements containing iron or calcium, or buffered medications. Alternatively, may be administered with supplements containing calcium or iron at the same time if administered together with food.
Tablet for oral suspension (Triumeq PD): Volume used to prepare dose depends on number of tablets. If dose is 3 tablets, use 15 mL of clean drinking water; if dose is 4 to 6 tablets, use 20 mL. Pour appropriate volume of clean drinking water into the provided dosing cup. Add the appropriate number of tablets to achieve dose to the water; swirl cup gently for 1 to 2 minutes to disperse tablets; swirl until no lumps remain. Administer mixture within 30 minutes of preparation using cup or an oral dosing syringe; following administration, add another 15 mL of drinking water to the cup, swirl, and administer. If any remnants of the dose remain in the dosing cup or syringe, repeat the addition of 15 mL of drinking water and administer. If a spill occurs during preparation, or if >30 minutes pass between preparation and administration, discard and prepare a new dose. Only use water to prepare oral suspension; do not use other liquids. Clean cup with water following use.
Oral:
Tablet: Administer with or without food. If patient is on concomitant therapy with efavirenz, fosamprenavir/ritonavir, tipranavir/ritonavir, carbamazepine, or rifampin an additional daily single-component dolutegravir tablet should be administered 12 hours after Triumeq. Administer 2 hours before or 6 hours after cation-containing antacids or laxatives, sucralfate, oral supplements containing iron or calcium, or buffered medications. Alternatively, may be administered with supplements containing calcium or iron at the same time if administered together with food.
Tablet for oral suspension: Do not use in adults.
Abacavir is a hazardous agent (NIOSH 2024 [table 2]).
Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2023; NIOSH 2024; USP-NF 2020).
Note: Facilities may perform risk assessment of some hazardous drugs to determine if appropriate for alternative handling and containment strategies (USP-NF 2020). Refer to institution-specific handling policies/procedures.
Store at 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F). Dispense in original container; protect from moisture.
An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:
Triumeq: https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/205551s31,215413s02lbl.pdf
Treatment of HIV-1 infection (FDA approved in ages ≥3 months weighing ≥6 kg and adults).
Note: Not recommended for use in patients with resistance-associated integrase substitutions or clinically suspected integrase strand transfer inhibitor resistance because the dose of dolutegravir is insufficient in these subpopulations.
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Aluminum Hydroxide: May decrease serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral aluminum hydroxide. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral aluminum hydroxide. Risk D: Consider Therapy Modification
Antidiabetic Agents: Hyperglycemia-Associated Agents may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor
Arimoclomol: May increase serum concentration of OCT2 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor
Atazanavir: May increase serum concentration of UGT1A1 Substrates. Management: Do not use UGT1A1 substrates for which small increases in exposure can cause serious adverse effects together with atazanavir, and use caution with any UGT1A1 substrate, even when small changes in exposure are less likely to cause serious adverse effects. Risk D: Consider Therapy Modification
Atidarsagene Autotemcel: Antiretroviral Agents may decrease therapeutic effects of Atidarsagene Autotemcel. Risk X: Avoid
Belumosudil: May increase serum concentration of UGT1A1 Substrates. Management: Avoid coadministration of belumosudil with substrates of UGT1A1 for which minimal concentration increases can cause serious adverse effects. If coadministration is required, dose reductions of the UGT1A1 substrate may be required. Risk D: Consider Therapy Modification
Betibeglogene Autotemcel: Antiretroviral Agents may decrease therapeutic effects of Betibeglogene Autotemcel. Risk X: Avoid
Cabozantinib: MRP2 Inhibitors may increase serum concentration of Cabozantinib. Risk C: Monitor
Calcium Salts: May decrease serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral calcium. Administer dolutegravir/rilpivirine at least 4 hours before or 6 hours after oral calcium salts. Alternatively, dolutegravir and oral calcium can be taken together with food. Risk D: Consider Therapy Modification
CarBAMazepine: May decrease serum concentration of Dolutegravir. Management: Increase dolutegravir to 50 mg twice/day in adults. Increase weight-based dose to twice daily in pediatric patients. Specific recommendations vary for combination products; see interaction monograph for details. Risk D: Consider Therapy Modification
Cladribine: Agents that Undergo Intracellular Phosphorylation may decrease therapeutic effects of Cladribine. Risk X: Avoid
Clofarabine: OCT2 Inhibitors may increase serum concentration of Clofarabine. Risk C: Monitor
Dalfampridine: OCT2 Inhibitors may increase serum concentration of Dalfampridine. Management: Consider alternatives to this combination. Carefully weigh the risk of seizures against the benefit of combining OCT2 inhibitors with dalfampridine. Risk D: Consider Therapy Modification
Dofetilide: Dolutegravir may increase serum concentration of Dofetilide. Risk X: Avoid
Efavirenz: May decrease serum concentration of Dolutegravir. Management: Increase dolutegravir to 50 mg twice/day in adults. Increase weight-based dose to twice daily in pediatric patients. Recommendations vary for combo products; see interaction monograph for details. Not recommended with Dovato or Juluca brand combos. Risk D: Consider Therapy Modification
Elivaldogene Autotemcel: Antiretroviral Agents may decrease therapeutic effects of Elivaldogene Autotemcel. Management: Avoid use of antiretroviral medications for at least one month, or for the amount of time required for elimination of the retroviral medication, prior to stem cell mobilization and until the all apheresis cycles are finished Risk X: Avoid
Etravirine: May decrease serum concentration of Dolutegravir. Management: Avoid etravirine with dolutegravir unless with atazanavir/ritonavir, darunavir/ritonavir or lopinavir/ritonavir; avoid use with Dovato brand combination. Canada recommends using dolutegravir 50 mg twice daily when with etravirine. Risk D: Consider Therapy Modification
Fedratinib: May increase serum concentration of MATE1/2-K Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor
Fedratinib: May increase serum concentration of OCT2 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor
Fexinidazole: May increase serum concentration of MATE1/2-K Substrates (Clinically Relevant with Inhibitors). Management: Avoid use of fexinidazole with MATE1/2-K substrates when possible. If combined, monitor for increased MATE1/2-K substrate toxicities. Risk D: Consider Therapy Modification
Fexinidazole: May increase serum concentration of OCT2 Substrates (Clinically Relevant with Inhibitors). Management: Avoid use of fexinidazole with OCT2 substrates when possible. If combined, monitor for increased OCT2 substrate toxicities. Risk D: Consider Therapy Modification
Fosamprenavir: May decrease serum concentration of Dolutegravir. Specifically, Fosamprenavir/Ritonavir may decrease the serum concentration of Dolutegravir. The individual contributions of Fosamprenavir and Ritonavir to this effect are unknown. Management: Increase dolutegravir to 50 mg twice/day in adults. Increase weight-based dose to twice daily in pediatric patients. Recommendations vary for combo products; see interaction monograph for details. Not recommended with Dovato or Juluca brand combos. Risk D: Consider Therapy Modification
Foslevodopa: May increase serum concentration of MATE1/2-K Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor
Fosphenytoin-Phenytoin: May decrease serum concentration of Dolutegravir. Risk X: Avoid
Gilteritinib: May increase serum concentration of OCT1 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor
Givinostat: May increase serum concentration of OCT2 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor
Iron Preparations: May decrease serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral iron. Administer dolutegravir/rilpivirine at least 4 hours before or 6 hours after oral iron. Alternatively, dolutegravir and oral iron can be taken together with food. Risk D: Consider Therapy Modification
Isoniazid: Dolutegravir may increase adverse/toxic effects of Isoniazid. Dolutegravir may increase serum concentration of Isoniazid. Risk C: Monitor
Levomethadone: May decrease therapeutic effects of Abacavir. Abacavir may decrease serum concentration of Levomethadone. Risk C: Monitor
Lovotibeglogene Autotemcel: Antiretroviral Agents may decrease therapeutic effects of Lovotibeglogene Autotemcel. Risk X: Avoid
Magnesium Salts: May decrease serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral magnesium salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral magnesium salts. Risk D: Consider Therapy Modification
MetFORMIN: Dolutegravir may increase serum concentration of MetFORMIN. Management: Consider alternatives to this combination or use of lower metformin doses. Carefully weigh the risk of metformin toxicities (including lactic acidosis) against the benefit of combining dolutegravir with metformin. Risk D: Consider Therapy Modification
Methadone: May decrease therapeutic effects of Abacavir. Abacavir may decrease serum concentration of Methadone. Risk C: Monitor
Mitapivat: May decrease serum concentration of UGT1A1 Substrates. Risk C: Monitor
Multivitamins/Minerals (with ADEK, Folate, Iron): May decrease serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after multivitamins. Administer the dolutegravir/rilpivirine product at least 4 hours before or 6 hours multivitamins. Alternatively, dolutegravir and multivitamins can be taken together with food Risk D: Consider Therapy Modification
Multivitamins/Minerals (with AE, No Iron): May decrease serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after multivitamins. Administer the dolutegravir/rilpivirine product at least 4 hours before or 6 hours multivitamins. Alternatively, dolutegravir and multivitamins can be taken together with food Risk D: Consider Therapy Modification
Nevirapine: May decrease serum concentration of Dolutegravir. Management: Prescribing information suggests avoiding the concomitant use of dolutegravir and nevirapine. HIV treatment guidelines suggest these drugs can be combined without dose adjustment. Monitor for reduced dolutegravir concentrations/effects if combined. Risk D: Consider Therapy Modification
Orlistat: May decrease serum concentration of Antiretroviral Agents. Risk C: Monitor
OXcarbazepine: May decrease serum concentration of Dolutegravir. Risk X: Avoid
PHENobarbital: May decrease serum concentration of Dolutegravir. Risk X: Avoid
Pilsicainide: Dolutegravir may increase serum concentration of Pilsicainide. Management: Consider alternatives to this combination if possible. Risk D: Consider Therapy Modification
Primidone: May decrease serum concentration of Dolutegravir. Specifically, the Primidone metabolite phenobarbital may decrease Dolutegravir serum concentrations. Risk X: Avoid
Rifabutin: May decrease serum concentration of Dolutegravir. Risk C: Monitor
RifAMPin: May decrease serum concentration of Dolutegravir. Management: Increase dolutegravir to 50 mg twice/day in adults. Increase weight-based dose to twice daily in pediatric patients. Specific recommendations vary for combination products; see interaction monograph for details. Risk D: Consider Therapy Modification
Rifapentine: Dolutegravir may increase adverse/toxic effects of Rifapentine. Rifapentine may decrease serum concentration of Dolutegravir. Risk C: Monitor
Riociguat: Abacavir may increase serum concentration of Riociguat. Risk C: Monitor
Risdiplam: May increase serum concentration of MATE1/2-K Substrates (Clinically Relevant with Inhibitors). Management: Avoid use of risdiplam with MATE substrates if possible. If the combination cannot be avoided, monitor closely for adverse effects. Consider a reduced dose of the MATE substrate according to that substrate's labeling if appropriate. Risk D: Consider Therapy Modification
Selenium: May decrease serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral selenium. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral selenium. Risk D: Consider Therapy Modification
Sorbitol: May decrease serum concentration of LamiVUDine. Management: When possible, avoid chronic coadministration of sorbitol-containing solutions with lamivudine, but if this combination cannot be avoided, monitor patients more closely for possible therapeutic failure associated with decreased lamivudine exposure. Risk D: Consider Therapy Modification
St John's Wort: May decrease serum concentration of Dolutegravir. Risk X: Avoid
Sucralfate: May decrease serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after sucralfate. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after sucralfate. Risk D: Consider Therapy Modification
Tafenoquine: May increase serum concentration of MATE1/2-K Substrates (Clinically Relevant with Inhibitors). Management: Avoid use of MATE substrates with tafenoquine, and if the combination cannot be avoided, monitor closely for evidence of toxicity of the MATE substrate and consider a reduced dose of the MATE substrate according to that substrate's labeling. Risk D: Consider Therapy Modification
Tafenoquine: May increase serum concentration of OCT2 Substrates (Clinically Relevant with Inhibitors). Management: Avoid use of OCT2 substrates with tafenoquine, and if the combination cannot be avoided, monitor closely for evidence of toxicity of the OCT2 substrate and consider a reduced dose of the OCT2 substrate according to that substrate's labeling. Risk D: Consider Therapy Modification
Tipranavir: May decrease serum concentration of Dolutegravir. Specifically, Tipranavir/Ritonavir may decrease the serum concentration of Dolutegravir. The individual contributions of Tipranavir and Ritonavir to this effect are unknown. Management: Increase dolutegravir to 50 mg twice/day in adults. Increase weight-based dose to twice daily in pediatric patients. Recommendations vary for combo products; see interaction monograph for details. Not recommended with Dovato or Juluca brand combos. Risk D: Consider Therapy Modification
Trimethoprim: May increase serum concentration of LamiVUDine. Risk C: Monitor
Valproic Acid and Derivatives: May decrease serum concentration of Dolutegravir. Risk C: Monitor
Vimseltinib: May increase serum concentration of OCT2 Substrates (Clinically Relevant with Inhibitors). Management: Avoid concomitant use of vimseltinib and OCT2 substrates when possible. If combined, monitor for increased effects and toxicities of the OCT2 substrate and consider dose adjustments. Risk D: Consider Therapy Modification
Zinc Salts: May decrease serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral zinc salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral zinc salts. Risk D: Consider Therapy Modification
This fixed-dose combination of abacavir, dolutegravir, and lamivudine is a preferred regimen for patients with HIV who are not yet pregnant but are trying to conceive (HHS [perinatal] 2024).
Refer to individual monographs for additional information.
This fixed-dose combination of abacavir, dolutegravir, and lamivudine is a preferred regimen in pregnant patients with HIV who are antiretroviral naive, who have had antiretroviral therapy (ART) in the past but are restarting, and who require a new ART regimen (due to poor tolerance or poor virologic response of current regimen). Patients who become pregnant while taking this regimen may continue if viral suppression is effective and the regimen is well tolerated (HHS [perinatal] 2024).
Refer to individual monographs for additional information.
HIV: General recommendations: Management of HIV infection requires extensive monitoring; refer to current guidelines (https://clinicalinfo.hiv.gov/en/guidelines) for additional guidance. Antiretroviral (ARV) drug-resistance testing is recommended before initiation of therapy in treatment-naive patients. After initiation of or change in ARV therapy regimen, pediatric patients should be evaluated for clinical adverse effects and treatment adherence at 1 to 2 weeks, and laboratory testing for drug toxicity should occur at 2 to 4 weeks; monitor for therapy adherence, effectiveness, and toxicities every 3 to 4 months.
Drug-specific monitoring: Frequency may vary based on several factors including age, concomitant therapy, and clinical response; refer to current guidelines for additional information.
HLA-B*5701 genotype status prior to initiating therapy or resuming therapy in patients of unknown HLA-B*5701 status (including patients previously tolerating therapy); signs and symptoms of hypersensitivity reaction (in all patients, but especially in those untested for the HLA-B*5701 allele).
Screen for hepatitis B prior to starting therapy (in patients who previously demonstrated no immunity to hepatitis B). For patients with hepatitis B coinfection, monitor hepatic function and hepatitis B viral load for several months after therapy with lamivudine is stopped.
Pregnancy test in patients who could become pregnant (baseline). Serum electrolytes (including anion gap), SCr, lipid profiles, hepatic function tests, and weight (baseline and periodically with therapy or if clinical presentation indicates need); serum lactate (if clinical presentation indicates need), serum amylase (if clinical presentation indicates need).
Note: Dolutegravir may increase SCr via inhibition of tubular secretion while not affecting glomerular filtration. Increases occurred within the first 4 weeks of therapy.
Dolutegravir inhibits HIV integrase by binding to the integrase active site and blocking the strand transfer step of retroviral DNA integration. Abacavir is converted by cellular enzymes to the active metabolite, carbovir triphosphate (CBV-TP), an analogue of deoxyguanosine-5′-triphosphate (dGTP). CBV-TP inhibits the activity of HIV-1 reverse transcriptase (RT) both by competing with the natural substrate dGTP and by its incorporation into viral DNA. Intracellularly, lamivudine is phosphorylated to its active 5′-triphosphate metabolite, lamivudine triphosphate (3TC-TP). The principal mode of action of 3TC-TP is inhibition of reverse transcriptase via DNA chain termination after incorporation of the nucleotide analogue.
Pharmacokinetic studies of Triumeq show no difference in values when compared to dolutegravir as a single agent given with abacavir and lamivudine as a combination product. Tablets and tablets for oral suspension are bioequivalent for the abacavir and lamivudine components, but not the dolutegravir component. The relative dolutegravir bioavailability of the tablet formulation is ~1.7-fold higher than the tablet for oral suspension; therefore, the 2 dosage forms are not interchangeable. See individual agents.
Altered kidney function: Patients taking abacavir/dolutegravir/lamivudine with CrCl between 30 and 49 mL/minute may experience a 1.6- to 3.3-fold higher lamivudine AUC compared to patients with CrCl ≥50 mL/minute.
