WARNING

Abacavir, Dolutegravir, and Lamivudine are medications used in combination to treat HIV. Here’s a brief overview of the risks associated with each:

• • Hypersensitivity Reaction: This can be severe and potentially life-threatening. Symptoms may include fever, rash, gastrointestinal symptoms, and respiratory issues. Testing for the HLA-B*5701 allele before starting Abacavir helps identify those at higher risk.
  • Lactic Acidosis: A rare but serious condition where lactic acid builds up in the blood, leading to symptoms like nausea, weakness, and rapid breathing.
  • Neuropsychiatric Effects: Some people may experience mood changes, insomnia, or suicidal thoughts.
  • Weight Gain: This has been observed in some patients, potentially leading to metabolic complications.
  • Elevated Liver Enzymes: Monitoring liver function is important, especially in individuals with pre-existing liver conditions.
  • Lactic Acidosis: Similar to Abacavir, though less common, it can occur and present with symptoms like muscle pain or difficulty breathing.
  • Hepatitis B Rebound: If Lamivudine is stopped suddenly, there may be a rebound in hepatitis B activity if the patient has both HIV and hepatitis B.

Regular monitoring and adherence to prescribed guidelines help manage these risks effectively.

Why is this medication prescribed?

Abacavir, Dolutegravir, and Lamivudine are prescribed together as a combination therapy to treat HIV-1 infection. This combination is often referred to by the brand name Triumeq when all three drugs are combined into a single tablet.

• Effective HIV Management: These three drugs work together to inhibit the replication of the HIV virus in the body, which helps to reduce the viral load (the amount of HIV in the blood) to undetectable levels. This prevents the progression of HIV to AIDS and helps maintain immune function.
• Combination Therapy: Dolutegravir is an integrase inhibitor that prevents the integration of viral DNA into the host cell genome. Abacavir and Lamivudine are nucleoside reverse transcriptase inhibitors (NRTIs) that block the reverse transcription process, which is essential for HIV replication. Using these drugs together is more effective than using them individually, as they target different stages of the HIV life cycle.
• Convenience: When these three medications are combined into a single tablet (such as in Triumeq), it simplifies the treatment regimen, which can improve adherence to therapy. Adherence is crucial in preventing the development of drug resistance.
• First-Line Treatment: This combination is often used as a first-line treatment for HIV due to its efficacy, safety profile, and the convenience of once-daily dosing.

By suppressing the virus effectively, this combination helps individuals with HIV maintain a higher quality of life, reduce the risk of HIV transmission, and prevent the progression of the disease.

How should this medicine be used?

The combination of abacavir, dolutegravir, and lamivudine is used alone or along with other medications for the treatment of HIV. Here’s how they should be used:

• Standard Dosage: The typical dose is one tablet taken once daily, with or without food.
• Missed Dose: If you miss a dose, take it as soon as you remember. If it’s close to the time of your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose to make up for a missed one.
• Consistent Use: It’s important to take the medication at the same time each day to maintain a consistent level of the drug in your body. Consistency helps prevent the virus from replicating and reduces the risk of developing drug resistance.
• Genetic Testing for Abacavir: Before starting this medication, a genetic test for HLA-B*5701 is typically recommended to assess the risk of a hypersensitivity reaction to Abacavir. If you test positive, this combination may not be suitable for you.
• Pregnancy: Women who are pregnant or planning to become pregnant should discuss the risks and benefits with their healthcare provider, particularly regarding the use of Dolutegravir.
• Monitoring: Regular monitoring by your healthcare provider is necessary to check the effectiveness of the treatment and to monitor for potential side effects. This may include blood tests to monitor your liver function, kidney function, and overall health.
• Drug Interactions: Be sure to inform your healthcare provider about all other medications, supplements, or herbal products you are taking, as these can interact with this combination therapy.
• Food Interactions: There are no specific food restrictions, but taking the medication with or without food as directed is important.
• Importance of Adherence: Adherence to this regimen is crucial. Skipping doses or not taking the medication as prescribed can lead to the development of drug-resistant strains of HIV, making the treatment less effective.

Always follow your healthcare provider’s instructions closely and report any side effects or concerns you may have while taking these medications.

Other uses for this medicine

• Prevention of HIV Transmission: In some cases, these medications might be used as part of post-exposure prophylaxis (PEP) to prevent HIV infection after potential exposure.
• Off-Label Uses: Although less common, doctors might prescribe these drugs for other off-label uses related to HIV treatment and prevention, but this should only be done under close medical supervision.

What special precautions should I follow?

Before Taking the Medication:

• Hypersensitivity to Abacavir: Before starting therapy, you must undergo genetic testing for the HLA-B*5701 allele. If you test positive, you should not take Abacavir due to the risk of a severe hypersensitivity reaction.
• Pregnancy and Breastfeeding: Discuss with your doctor if you are pregnant, planning to become pregnant, or breastfeeding. Dolutegravir may cause neural tube defects if taken during the first trimester.
• Medical History: Inform your healthcare provider about any history of liver disease, heart disease, mental health conditions, or kidney problems.
• Drug Interactions: Abacavir, Dolutegravir, and Lamivudine can interact with other medications, including certain antacids, multivitamins, and supplements. Always inform your healthcare provider of all the medications and supplements you are taking.
• Avoid Alcohol: Alcohol can increase the risk of liver problems and can exacerbate side effects, so it’s best to limit or avoid alcohol while on this medication.
• Monitoring: Regular blood tests are essential to monitor liver and kidney function, as well as to ensure that the medication is effectively controlling the HIV infection.
• Seek Immediate Medical Help: if you develop symptoms such as fever, rash, gastrointestinal issues, respiratory symptoms, or general malaise, as these may indicate a hypersensitivity reaction, particularly to Abacavir.
• Dolutegravir: May cause depression, anxiety, or other mental health issues in some people. Report any mood changes, thoughts of self-harm, or unusual behavior to your healthcare provider immediately.

By adhering to these precautions and working closely with your healthcare provider, you can effectively manage HIV while minimizing the risks associated with this medication regimen.

What special dietary instructions should I follow?

• Food and Timing: Abacavir, Dolutegravir, and Lamivudine can be taken with or without food. There are no specific dietary restrictions, but taking them with food may help reduce stomach upset in some individuals.
• Balanced Diet: Maintain a healthy, balanced diet to support your overall health and immune function, which is important when managing HIV.
• Hydration: Stay well-hydrated unless your healthcare provider advises otherwise.

What should I do if I forget a dose?

• Take It As Soon As You Remember: If you forget to take a dose, take it as soon as you remember, unless it’s almost time for your next dose.
• Skip If Close to Next Dose: If it’s close to the time of your next dose, skip the missed dose and continue with your regular dosing schedule.
• Do Not Double the Dose: Never take a double dose to make up for a missed one. Doubling up can increase the risk of side effects.

What side effects can this medication cause?

Abacavir, Dolutegravir, and Lamivudine, commonly used together as part of antiretroviral therapy (ART) for HIV, can cause a range of side effects. These can vary in severity and may affect different individuals in different ways. Here are the potential side effects:

Common Side Effects:

• Nausea
• Diarrhea
• Headache
• Fatigue
• Trouble sleeping (insomnia)
• Dizziness
• Loss of appetite

Serious Side Effects:

• Allergic Reaction (Hypersensitivity Reaction): Symptoms may include fever, rash, nausea, vomiting, abdominal pain, fatigue, and shortness of breath. Hypersensitivity reactions can be life-threatening and typically occur with Abacavir. It’s important to seek immediate medical attention if these symptoms occur.
• Lactic Acidosis: This is a rare but serious condition that can occur due to a buildup of lactic acid in the blood. Symptoms include unusual muscle pain, trouble breathing, stomach pain with nausea, vomiting, fast or irregular heart rate, and feeling cold (especially in the arms and legs).
• Liver Problems: Symptoms include yellowing of the skin or eyes (jaundice), dark urine, pale stools, severe stomach pain, and loss of appetite. Liver issues may be more likely in patients with pre-existing liver conditions or those who drink alcohol regularly.
• Changes in Immune System (Immune Reconstitution Inflammatory Syndrome – IRIS): As the immune system begins to recover, it may start fighting infections that were hidden, leading to inflammation and worsening of symptoms.
• Mental Health Changes: Dolutegravir can sometimes cause mood changes, including depression, anxiety, and suicidal thoughts, particularly in people with a history of these conditions.
• Pancreatitis: Inflammation of the pancreas is a rare but serious side effect, with symptoms like severe abdominal pain, nausea, and vomiting.
• Fat Redistribution (Lipodystrophy): Changes in body fat distribution can occur, leading to fat loss in the face, arms, and legs, or fat accumulation in the abdomen, chest, and neck.

Less Common Side Effects:

• Joint pain
• Muscle pain
• Cough
• Fever

Important Considerations:

• Monitoring: Regular monitoring by your healthcare provider is important to catch any potential side effects early, especially serious ones like hypersensitivity or liver issues.
• Managing Side Effects: If you experience side effects, it’s important to communicate with your healthcare provider. Some side effects may be manageable with additional treatments, while others may require adjusting your medication regimen.
• Allergy Testing: Before starting treatment with Abacavir, genetic testing may be recommended to determine if you’re at a higher risk for hypersensitivity reactions (HLA-B*5701 testing).

If you experience any severe or concerning side effects, contact your healthcare provider immediately. Never stop taking your medication without consulting your doctor, as this can lead to drug resistance and worsen your condition.

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

Storage and Disposal of Abacavir, Dolutegravir, and Lamivudine:

Storage:

• Keep in Original Container: Store the medication in its original container with the lid tightly closed.
• Room Temperature: Keep the medication at room temperature (68°F to 77°F or 20°C to 25°C). Avoid storing it in areas with excessive heat, moisture, or direct sunlight, such as bathrooms or near windows.
• Out of Reach of Children and Pets: Store the medication out of reach and sight of children and pets to prevent accidental ingestion.

Disposal:

• Do Not Flush: Do not flush unused medication down the toilet or pour it into a drain unless instructed to do so.
• Proper Disposal: If the medication is expired or no longer needed, dispose of it through a medication take-back program if available. If no take-back program is available, you can mix the medication with an undesirable substance (like used coffee grounds or cat litter) in a sealed plastic bag and dispose of it in the household trash.
• Environmental Safety: Proper disposal helps prevent harm to others and the environment.

In case of emergency/overdose

Overdose Symptoms: Symptoms of overdose might include severe nausea, vomiting, dizziness, or drowsiness. In extreme cases, it may cause confusion, breathing difficulties, or unconsciousness.

Immediate Actions:

• Seek Immediate Help: Call emergency services or go to the nearest emergency room immediately if you suspect an overdose.
• Poison Control: Contact the Poison Control Center at 1-800-222-1222 for additional guidance.
• Information to Provide: Be ready to provide the name of the medication, the amount taken, and the time of ingestion.

What other information should I know?

• Adherence: Take the medication exactly as prescribed. Do not skip doses, as this can lead to resistance and treatment failure.
• Drug Interactions: Inform your healthcare provider about all other medications, supplements, and herbs you are taking, as these can interact with Abacavir, Dolutegravir, and Lamivudine.
• Alcohol Use: Limit or avoid alcohol, as it can increase the risk of liver problems and worsen side effects.
• Allergic Reactions: Be aware of signs of a serious allergic reaction, such as rash, fever, fatigue, or difficulty breathing. If these occur, seek medical attention immediately.
• Regular Monitoring: Regular blood tests may be required to monitor your liver function, kidney function, and overall health while on this medication.
• Missed Dose: If you miss a dose, take it as soon as you remember unless it’s almost time for the next dose. Do not double up to make up for the missed dose.

This combination is essential in managing HIV, so it’s important to follow your healthcare provider’s instructions closely.