Triumeq Drug Interactions: What to Avoid and What to Tell Your Doctor

Triumeq (abacavir/dolutegravir/lamivudine) can interact with many other medications, supplements, and foods. Some interactions are dangerous or even life-threatening. Others are manageable with careful timing or dose adjustments. Before starting Triumeq, tell your provider and pharmacist about every prescription medication, over-the-counter drug, vitamin, mineral supplement, and herbal product you take.

Absolute Contraindication: Dofetilide (Tikosyn)

If you take dofetilide (brand name Tikosyn) for a heart rhythm disorder (arrhythmia), you cannot take Triumeq. Dolutegravir inhibits the renal organic cation transporter OCT2, which reduces the kidney's ability to clear dofetilide from the body. This causes dangerous build-up of dofetilide, which can lead to life-threatening heart rhythm abnormalities. This is listed as a contraindication — meaning the combination must never be used.

Drugs That Reduce Triumeq Effectiveness (Inducers)

Some medications speed up the breakdown of dolutegravir, lowering its blood levels and reducing Triumeq's effectiveness. If you take any of these, your doctor may need to add a separate dolutegravir dose:

Rifampin (used for tuberculosis) — significantly reduces dolutegravir levels. Requires an additional 50 mg dolutegravir dose, taken 12 hours after Triumeq.

Carbamazepine (Tegretol) — anti-seizure drug that lowers dolutegravir levels. Requires additional dolutegravir.

Efavirenz — another antiretroviral; if taken with Triumeq, requires additional dolutegravir.

Fosamprenavir/ritonavir and tipranavir/ritonavir — protease inhibitor combinations that lower dolutegravir levels.

St. John's Wort (Herbal Supplement)

St. John's Wort (Hypericum perforatum), a popular herbal supplement used for depression and anxiety, is a potent inducer of drug-metabolizing enzymes. It significantly reduces dolutegravir levels in the blood, which could allow HIV viral load to rebound and increase the risk of resistance. Do not take St. John's Wort while on Triumeq.

Antacids, Minerals, and Supplements

Dolutegravir can bind to polyvalent metal cations (magnesium, aluminum, calcium, iron), which reduces its absorption. This affects many common over-the-counter products:

Antacids containing aluminum or magnesium (e.g., Maalox, Mylanta, Tums)

Calcium supplements

Iron supplements

Multivitamins containing minerals

Under fasting conditions, take Triumeq at least 2 hours before or 6 hours after these products. When taken with food, Triumeq and calcium or iron supplements can be taken at the same time. Ask your pharmacist to help you work out the best timing schedule.

Metformin (Diabetes Medication)

Dolutegravir inhibits the transporters OCT2, MATE1, and MATE2-K, which are responsible for clearing metformin (used for type 2 diabetes) through the kidneys. This can cause metformin to build up in the body, increasing the risk of side effects including lactic acidosis. Your doctor may need to limit your metformin dose (typically to 1,000 mg/day or less) while you are on Triumeq.

Alcohol

Alcohol can slow the breakdown of abacavir, causing it to accumulate in the body and increasing the risk of side effects like nausea, headache, and insomnia. If you drink alcohol, discuss safe limits with your provider. Limiting or avoiding alcohol while on Triumeq is recommended.

Other Antiretrovirals

Triumeq is a complete antiretroviral regimen. Do not take additional medications that contain abacavir (Ziagen, Epzicom) or lamivudine (Epivir, 3TC) while on Triumeq — this would result in duplicate doses. Do not use Triumeq with other complete regimens such as Biktarvy, Genvoya, or Stribild.

Dalfampridine (Ampyra) — Multiple Sclerosis Medication

Dolutegravir inhibits OCT2, which affects how dalfampridine (used for walking difficulties in multiple sclerosis) is cleared. This can increase dalfampridine levels and may raise the risk of seizures. Tell your provider if you take dalfampridine.

What to Tell Your Doctor and Pharmacist

Before starting Triumeq, provide your full medication list including all prescription drugs, OTC medications, vitamins, minerals, and herbal supplements. When in doubt, ask. See our full guide on Triumeq side effects and what to expect for more safety information.