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What causes tremors, cold hands and feet after switching from Atripla to Triumeq?

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Posted on Fri, 27 Nov 2015
Question: I switched from Atripla (which I was on for 10 years) to Triumeq several weeks ago.

within one week, I began getting cold hands and legs and a little shaky. I also got a cold which has turned into a sinus infection. Just in the last week or two I have been very tired and my body feels week. I am eating properly and exercising 2-3 times/week. I am able to make it through my workouts without undue fatigue (even though I'm fighting off a cold) but in general, I feel like took muscle relaxer in my mind and in my body. I get home from work and get straight in bed.

I know that some of these symptoms are warning signs for lactic acidosis with Triumeq, but I'm guessing that is an acute situation and not something that would slowly progress over weeks? I'm still concerned, though. I took a provigil around noon and the "muscle relaxer" feeling came back by 7pm.

Another thing to consider: I increased my citalopram Saturday from 5 to 15 mgs. It's never made me feel weak or tired before (especially at a low dose). I also take 150mgs Lamictal (for mood) and .25mgs klonopin.

I know the Sustiva component of Atripla has a tendency to interfere with some psych meds and vice versa. I wonder if switching to Triumeq is making the psych meds behave differently.

Is this weakness a warning sign and/or should it go away with time?
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Answered by Dr. S. Murugan (22 hours later)
Brief Answer:
Triumeq is a good drug.Consider drug interaction with Provigil,anti-depress

Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.

Triumeq is the recommended combination for first line therapy by CDC, XXXXXXX as per their latest guidelines. That means it is most effective, less side effect and accepted by many. Lactic acidosis and mitochondrial toxicities are very very rare with Abacavir and Lamivudine as well with Doultigravir. But individual variations can be possible. If it is possible try to stop Provigil as some type of drug interaction could be the possibility for your present problem. You are already on many drugs interfering with your mental performance. Once again drug interaction could be the possibility for your problem.
Serum lactate test would likely to rule out the least possibility of lactic acidosis. Drug interactions of Abacavir, Lamivudine and Doultigravir with anti-depressant drugs are insignificant as per literature, but individual variations can occur with anyone.
Your treating physician is the right person to judge all these thins. More over our experience with the combination with Ttriumeq is nil in this part of world and the knowledge gained only through literature and conferences.
Get well soon.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. S. Murugan

HIV AIDS Specialist

Practicing since :1974

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What causes tremors, cold hands and feet after switching from Atripla to Triumeq?

Brief Answer: Triumeq is a good drug.Consider drug interaction with Provigil,anti-depress Detailed Answer: Hi, Welcome to HCM. Thanks for posting your query. Triumeq is the recommended combination for first line therapy by CDC, XXXXXXX as per their latest guidelines. That means it is most effective, less side effect and accepted by many. Lactic acidosis and mitochondrial toxicities are very very rare with Abacavir and Lamivudine as well with Doultigravir. But individual variations can be possible. If it is possible try to stop Provigil as some type of drug interaction could be the possibility for your present problem. You are already on many drugs interfering with your mental performance. Once again drug interaction could be the possibility for your problem. Serum lactate test would likely to rule out the least possibility of lactic acidosis. Drug interactions of Abacavir, Lamivudine and Doultigravir with anti-depressant drugs are insignificant as per literature, but individual variations can occur with anyone. Your treating physician is the right person to judge all these thins. More over our experience with the combination with Ttriumeq is nil in this part of world and the knowledge gained only through literature and conferences. Get well soon. Dr S.Murugan