Abacavir with dolutegravir and lamivudine

eMC §4.2 (Triumeq 50 mg/600 mg/300 mg film-coated tablets). Therapy should be prescribed by a physician experienced in the management of HIV infection. The recommended dose is one tablet once daily for adults, adolescents and children weighing at least 25 kg. Film-coated tablets must NOT be given to anyone weighing less than 25 kg because it is a fixed-dose tablet that cannot be dose reduced; dispersible tablets are available for children of at least 3 months of age weighing at least 6 kg to less than 25 kg, and the bioavailability of dolutegravir from film-coated and dispersible tablets is NOT comparable so they must not be used as direct replacements (the fetched SPC text does not give the dispersible-tablet dosing table - obtain it from the full SPC and a children's formulary). HLA-B*5701 (SPC §4.4): HLA-B*5701 status must always be documented before starting; never initiate in a patient with positive HLA-B*5701 status, nor in a patient with negative status who had a suspected abacavir hypersensitivity reaction on a previous abacavir-containing regimen. Stop without delay if a hypersensitivity reaction is suspected, even in the absence of the allele, and never re-initiate this or any other abacavir- or dolutegravir-containing product afterwards - restarting can cause a prompt, more severe reaction within hours including life-threatening hypotension and death. MISSED DOSE: take as soon as possible provided the next dose is not due within 4 hours; if the next dose is due within 4 hours, skip the missed dose and resume the usual schedule. DOSE ADJUSTMENT: separate preparations of dolutegravir, abacavir or lamivudine are available where discontinuation or dose adjustment of one component is indicated; an additional separate dose of dolutegravir is needed where a dose adjustment is required for drug-drug interactions, e.g. rifampicin, carbamazepine, oxcarbazepine, phenytoin, phenobarbital, St John's wort, etravirine (without boosted protease inhibitors), efavirenz, nevirapine or tipranavir/ritonavir. ELDERLY: limited data in patients 65 years and over; no evidence a different dose is needed, but special care is advised because of age-related decline in renal function and altered haematological parameters. HEPATIC IMPAIRMENT: abacavir is primarily metabolised by the liver; no clinical data in moderate or severe hepatic impairment, so use is not recommended unless judged necessary. In mild hepatic impairment (Child-Pugh 5-6) close monitoring is required, including abacavir plasma levels if feasible. PAEDIATRIC: safety and efficacy in children under 3 months of age or weighing less than 6 kg have not been established and no posology recommendation can be made - verify any under-18 use against a children's formulary.