TRIUMEQ

Clinical safety rating: caution

Comprehensive clinical and safety monograph for TRIUMEQ (TRIUMEQ).

How it works

TRIUMEQ is a fixed-dose combination of dolutegravir, an HIV integrase strand transfer inhibitor (INSTI) that blocks HIV replication by inhibiting integration of viral DNA into host cell DNA, and abacavir/lamivudine, nucleoside reverse transcriptase inhibitors (NRTIs) that inhibit HIV reverse transcriptase.

What the body does with it

Metabolism	Dolutegravir: Primarily metabolized by UGT1A1 with minor contribution from CYP3A. Abacavir: Metabolized by alcohol dehydrogenase and glucuronosyl transferases. Lamivudine: Eliminated unchanged renally and undergoes limited hepatic metabolism.
Excretion	Abacavir: 83% renal (unchanged and metabolites), 16% fecal. Dolutegravir: 64% fecal (unchanged), 31% renal (metabolites, <1% unchanged). Lamivudine: ~70% renal (unchanged).
Half-life	Abacavir: 1.5 h (intracellular carbovir-TP 20 h). Dolutegravir: 14 h (inhibits its own metabolism). Lamivudine: 13-19 h (intracellular lamivudine-TP 16-19 h). Clinical context: Once-daily dosing due to long intracellular half-lives.
Protein binding	Abacavir: ~50% (albumin). Dolutegravir: >99% (albumin and α-1-acid glycoprotein). Lamivudine: <36% (albumin).
Volume of Distribution	Abacavir: 0.86 L/kg (extensive extravascular distribution). Dolutegravir: 17.4 L (0.25 L/kg) (high tissue penetration). Lamivudine: 1.3 L/kg (wide distribution, including CSF).
Bioavailability	Abacavir: 83% (oral). Dolutegravir: ~72% (oral, fasted); 86% with moderate-fat meal. Lamivudine: 86% (oral).
Onset of Action	Oral: Antiviral activity begins within hours; maximal viral suppression observed by 8-12 weeks.
Duration of Action	Duration of antiviral effect persists 24 h with once-daily dosing; requires continuous daily dosing to maintain viral suppression.

Classification & Brands

Dosing & administration

One tablet (abacavir 600 mg, dolutegravir 50 mg, lamivudine 300 mg) orally once daily.

Dosage form	TABLET
Renal impairment	Contraindicated if CrCl < 30 mL/min. No dose adjustment for CrCl ≥ 30 mL/min.
Liver impairment	Contraindicated in Child-Pugh Class B or C hepatic impairment. If Child-Pugh Class A, use only if benefit outweighs risk; monitor closely. No dose adjustment available.
Pediatric use	For children ≥40 kg: one tablet once daily. For children <40 kg or age <12 years: not recommended due to fixed-dose combination strength.
Geriatric use	No specific dose adjustment based on age alone; use with caution due to age-related renal and hepatic function decline. Monitor renal function.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for TRIUMEQ (TRIUMEQ).

Breastfeeding	Breastfeeding is not recommended for HIV-infected mothers in developed countries. Abacavir and lamivudine are excreted in human milk; dolutegravir likely. M/P ratio not well established. Infant may risk developing HIV resistance and potential adverse effects.
Teratogenic Risk	TRIUMEQ (abacavir/dolutegravir/lamivudine) is contraindicated in pregnancy. Dolutegravir has a known risk of neural tube defects when taken at conception and during first trimester. Risk: neural tube defects (0.9% vs 0.1% background), plus potential for mitochondrial toxicity from NRTIs. Second and third trimester risks include preterm delivery and low birth weight.

Warnings & precautions

■ FDA Black Box Warning

WARNING: HYPERSENSITIVITY REACTIONS AND LACTIC ACIDOSIS/SEVERE HEPATOMEGALY WITH STEATOSIS. See full prescribing information for complete boxed warning. Abacavir: Serious and sometimes fatal hypersensitivity reactions have occurred, usually within the first 6 weeks of treatment. Discontinue immediately if hypersensitivity is suspected. Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogues.

Side Effect Profile

Serious Effects

Absolute Contraindications

Presence of HLA-B*5701 allele (abacavir hypersensitivity). Previous hypersensitivity reaction to abacavir or any component. Moderate to severe hepatic impairment. Co-administration with dofetilide (due to dolutegravir).

Clinical Precautions

Precautions

Hypersensitivity reactions (abacavir): Screen for HLA-B*5701 allele prior to initiation. Lactic acidosis/hepatomegaly. Hepatotoxicity in patients with hepatitis B or C co-infection. Immune reconstitution syndrome. Fat redistribution. Myocardial infarction risk with abacavir (controversial).

Clinical Tips & Counseling

Drug interactions

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TRIUMEQ

Clinical safety rating: caution

Comprehensive clinical and safety monograph for TRIUMEQ (TRIUMEQ).

How it works

What the body does with it

Metabolism	Dolutegravir: Primarily metabolized by UGT1A1 with minor contribution from CYP3A. Abacavir: Metabolized by alcohol dehydrogenase and glucuronosyl transferases. Lamivudine: Eliminated unchanged renally and undergoes limited hepatic metabolism.
Excretion	Abacavir: 83% renal (unchanged and metabolites), 16% fecal. Dolutegravir: 64% fecal (unchanged), 31% renal (metabolites, <1% unchanged). Lamivudine: ~70% renal (unchanged).
Half-life	Abacavir: 1.5 h (intracellular carbovir-TP 20 h). Dolutegravir: 14 h (inhibits its own metabolism). Lamivudine: 13-19 h (intracellular lamivudine-TP 16-19 h). Clinical context: Once-daily dosing due to long intracellular half-lives.
Protein binding	Abacavir: ~50% (albumin). Dolutegravir: >99% (albumin and α-1-acid glycoprotein). Lamivudine: <36% (albumin).
Volume of Distribution	Abacavir: 0.86 L/kg (extensive extravascular distribution). Dolutegravir: 17.4 L (0.25 L/kg) (high tissue penetration). Lamivudine: 1.3 L/kg (wide distribution, including CSF).
Bioavailability	Abacavir: 83% (oral). Dolutegravir: ~72% (oral, fasted); 86% with moderate-fat meal. Lamivudine: 86% (oral).
Onset of Action	Oral: Antiviral activity begins within hours; maximal viral suppression observed by 8-12 weeks.
Duration of Action	Duration of antiviral effect persists 24 h with once-daily dosing; requires continuous daily dosing to maintain viral suppression.

Classification & Brands

Dosing & administration

One tablet (abacavir 600 mg, dolutegravir 50 mg, lamivudine 300 mg) orally once daily.

Dosage form	TABLET
Renal impairment	Contraindicated if CrCl < 30 mL/min. No dose adjustment for CrCl ≥ 30 mL/min.
Liver impairment	Contraindicated in Child-Pugh Class B or C hepatic impairment. If Child-Pugh Class A, use only if benefit outweighs risk; monitor closely. No dose adjustment available.
Pediatric use	For children ≥40 kg: one tablet once daily. For children <40 kg or age <12 years: not recommended due to fixed-dose combination strength.
Geriatric use	No specific dose adjustment based on age alone; use with caution due to age-related renal and hepatic function decline. Monitor renal function.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for TRIUMEQ (TRIUMEQ).

Breastfeeding	Breastfeeding is not recommended for HIV-infected mothers in developed countries. Abacavir and lamivudine are excreted in human milk; dolutegravir likely. M/P ratio not well established. Infant may risk developing HIV resistance and potential adverse effects.
Teratogenic Risk	TRIUMEQ (abacavir/dolutegravir/lamivudine) is contraindicated in pregnancy. Dolutegravir has a known risk of neural tube defects when taken at conception and during first trimester. Risk: neural tube defects (0.9% vs 0.1% background), plus potential for mitochondrial toxicity from NRTIs. Second and third trimester risks include preterm delivery and low birth weight.