Triumeq is a single-tablet regimen for patients with HIV infection comprising dolutegravir, abacavir and lamivudine. Overdoses with Triumeq have not been reported previously. We present a case of a 26-year-old man who presented to our hospital after intentionally ingesting 30 tablets of Triumeq. An intoxication with Triumeq can lead to several side effects. An overdose of abacavir and lamivudine can cause mitochondrial toxicity and lactic acidosis. An intoxication with dolutegravir appears to be relatively harmless. As Triumeq will be used on a regular basis as treatment for patients with HIV-1 infection, these intoxications are expected to be encountered more often.
References
1.
LeeM., EyerF., FelgenhauerN., KlinkerH.F., SpinnerC.D.Overdose of dolutegravir in combination with tenofovir disoproxil fumarate/emtricitabine in suicide attempt in a 21-year old patient.AIDS Res Ther2015; 12: 18.
2.
HavenithT., BurgerD., VisschersM.J., SchippersJ., Oude LashofA.Acute kidney injury after efavirenz/tenofovir disoproxil fumarate/emtricitabine (Atripla) overdose.Ther Drug Monit2017; 39: 91–92.
3.
MargolisA.M., HeverlingH., PhamP.A., StolbachA.A review of the toxicity of HIV medications.J Med Toxicol2014; 10: 26–39.
4.
SmithR.L., TanJ.M.E., JonkerM.J.Beyond the polymerase-y theory: production of ROS as a mode of NRTI-induced mitochondrial toxicity.PLoS One2017; 12: e0187424.
5.
ClaessensY.E., ChicheJ.D., MiraJ.P.Bench-to-bedside review: severe lactic acidosis in HIV patients treated with nucleoside analogue reverse transcriptase inhibitors.Crit Care2003; 7: 226–232.
6.
ElziL., ErbS., FurrerH.Adverse events of raltegravir and dolutegravir.AIDS2017; 31: 1853–1858.
JullienV., TréluyerJ.M., ChappuyH.Weight related differences in the pharmacokinetics of abacavir in HIV-infected patients.Br J Clin Pharmacol2005; 59: 183–188.
10.
MooreK.H.P., YuenG.J., HusseyE.K., PakesG.E., EronJ.J., BartlettJ.A.Population pharmacokinetics of lamivudine in adult human immunodeficiency virus-infected patients enrolled in two Phase III clinical trials.Antimicrob Agents Chemother1999; 43: 3025–3029.
11.
ZhangJ., HayesS., SadlerB.M.Population pharmacokinetics of dolutegravir in HIV-infected treatment-naive patients.Br J Clin Pharmacol2015; 80: 502–514.
