Abacavir, Dolutegravir, and Lamivudine

pronounced as (a bak' a vir) (doe" loo teg' ra vir) (la miv' ue deen)

Brand Name(s): Triumeq®, Triumeq PD®

Why is this medicine prescribed?

The combination of abacavir, dolutegravir, and lamivudine is used alone or along with other medications to treat HIV infection in certain adults and children 3 months or older who weigh at least 13 lb (6 kg). Abacavir and lamivudine are in a class of medications called nucleoside analogue reverse transcriptase inhibitors (NRTIs) and dolutegravir is in a class of medications called integrase strand transfer inhibitors (INSTIs). They work by decreasing the amount of HIV in your blood and increasing the number of immune cells that help fight infections in your body. Although abacavir, dolutegravir, and lamivudine will not cure HIV, these medications may decrease your chance of developing acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer. Taking these medications along with practicing safer sex and making other lifestyle changes may decrease the risk of getting or transmitting the HIV virus to other people.

Are there other uses for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

The combination of abacavir, dolutegravir, and lamivudine comes as a tablet to take by mouth or tablets to be dissolved into a suspension (liquid) to be taken by mouth. The tablet is usually prescribed for adults and children weighing more than 55 lb (25 kg) and taken once daily with or without food. The tablets for suspension are prescribed for children weighing less than 55 lb (25 kg) and are taken once daily with or without food. Take abacavir, dolutegravir, and lamivudine at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take abacavir, dolutegravir, and lamivudine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If giving the tablets for suspension to a child, the tablets should be placed in the provided cup with 15-20 mL of drinking water (3 tablets can be placed in 15 mL but more than 3 tablets should be placed in 20 mL) and then swirl contents until tablets are completely dissolved and no lumps remain. After tablets are completely dissolved, the contents of the cup should be completely swallowed within 30 minutes. For children too young to drink from a cup, the contents of the cup may be drawn into a syringe and the medication given this way.

Abacavir, dolutegravir, and lamivudine help to control HIV infection but do not cure it. Continue to take abacavir, dolutegravir, and lamivudine even if you feel well. Do not stop taking abacavir, dolutegravir, and lamivudine without talking to your doctor.

What special precautions should I follow?

Before taking abacavir, dolutegravir, and lamivudine,

  • tell your doctor and pharmacist if you are allergic to abacavir, dolutegravir, and lamivudine, any other medications, or any of the ingredients in abacavir, dolutegravir, and lamivudine tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
  • tell your doctor if you are taking dofetilide (Tikosyn). Your doctor will probably tell you not to take abacavir, dolutegravir, and lamivudine if you are taking this medication.
  • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, you are taking or plan to take. Be sure to mention any of the following: carbamazepine (Carbatrol, Equetro, Tegretol, others); dalfampridine (Ampyra); other medications for HIV including abacavir (in Epzicom, in Trizivir, Ziagen), dolutegravir (Tivicay), efavirenz (Sustiva, in Atripla), emtricitabine (Emtriva, in Atripla, in Complera, in Truvada, others), etravirine (Intelence), fosamprenavir (Lexiva) taken with ritonavir (Norvir), lamivudine (Epivir, in Combivir, in Epzicom, in Trizivir, others), nevirapine (Viramune), and tipranavir (Aptivus) taken with ritonavir (Norvir); metformin (Glumetza, Glucophage, Riomet); methadone (Dolophine, Methadose); oxcarbazepine (Oxtellar XR, Trileptal); phenobarbital; phenytoin (Dilantin, Phenytek); rifampin (Rifadin, Rimactane, in Rifamate, in Rifater); and sorbitol or medications that contain sorbitol. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • if you are taking antacids, laxatives, or multivitamins that contain aluminum, magnesium, or calcium; calcium supplements; iron supplements; sucralfate (Carafate); or buffered medications such as buffered aspirin, take abacavir, dolutegravir, and lamivudine at least 2 hours before or 6 hours after you take these medications.
  • tell your doctor what herbal products you are taking, especially St. John's wort. You should not take St. John's wort while you are taking abacavir, dolutegravir, and lamivudine.
  • tell your doctor if you have or have ever had liver disease. Your doctor will probably tell you not to take abacavir, dolutegravir, and lamivudine.
  • tell your doctor if you smoke or drink alcohol, or if you have or have ever had high blood pressure, high cholesterol, diabetes, or heart or kidney disease.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. You will need to take a pregnancy test before you start treatment. You should not become pregnant while you are taking abacavir, dolutegravir, and lamivudine. Talk to your doctor about effective birth control methods that you can use during your treatment. If you become pregnant while taking abacavir, dolutegravir, and lamivudine, call your doctor immediately. Dolutegravir may harm the fetus.
  • tell your doctor if you are breastfeeding. You should not breastfeed if you are infected with HIV or if you are taking abacavir, dolutegravir, and lamivudine.
  • you should know that while you are taking medications to treat HIV infection, your immune system may get stronger and begin to fight other infections that were already in your body. This may cause you to develop symptoms of those infections. If you have new or worsening symptoms at any time during your treatment with abacavir, dolutegravir, and lamivudine, be sure to tell your doctor.
  • ask your doctor about the safe use of alcoholic beverages and medications that contain alcohol while you are taking abacavir, dolutegravir, and lamivudine.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What should I do in case of overdose?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help . If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

What side effects can this medicine cause?

Some side effects can be serious. If you experience any of the following symptoms, or those mentioned in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

  • excessive tiredness; weakness, dizziness, or lightheadedness; fast or irregular heartbeat; muscle pain; stomach pain with nausea and vomiting; shortness of breath or difficulty breathing; flu-like symptoms such as fever, chills, or cough; or feeling cold, especially in the arms or legs
  • light-colored bowel movements; yellowing of the skin or eyes; loss of appetite; unusual bleeding or bruising; dark yellow or brown urine; or pain in the upper right part of stomach

Abacavir, dolutegravir, and lamivudine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( http://www.fda.gov/Safety/MedWatch ) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not remove the desiccant (small packet included with medication to absorb moisture) from your bottle.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website ( http://goo.gl/c4Rm4p ) for more information if you do not have access to a take-back program.

What other information should I know?

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Keep a supply of abacavir, dolutegravir, and lamivudine on hand. Do not wait until you run out of medication to refill your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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