🏷️ Parameter	🔍 Details
🧬 Active Ingredients	Stavudine 40mg + Lamivudine 150mg + Nevirapine 200mg
💊 Indication	HIV-1 Infection (First-line ART for patients >60kg)
🇺🇸 US Brand	No direct equivalent; components available separately
🏭 Manufacturer	Cipla Ltd.
📦 Packaging	30 tablets in 1 HDPE bottle
💪 Strength	40mg/150mg/200mg per tablet
🚚 Delivery Time	7–14 days (Worldwide)

🧬 Introduction to Triomune 40mg/150mg/200mg

Triomune by Cipla is a high-dose fixed-dose combination for HIV-1 treatment, containing:

⚡ Stavudine 40mg (NRTI: higher dose for patients >60kg)
🔒 Lamivudine 150mg (NRTI: prevents viral replication)
🔥 Nevirapine 200mg (NNRTI: targets reverse transcriptase)

Designed for adult patients >60kg, this 30-tablet bottle provides a 15-day maintenance supply after the lead-in phase. Key considerations:

⚠️ 30% higher risk of peripheral neuropathy vs. 30mg formulation
✅ Cost-effective for resource-limited settings
❗ Phased out in high-income countries due to toxicity concerns

💊 Dosage & Indications

💉 Indication	🧪 Dosage	⏱️ Frequency	💡 Notes
Adults >60kg (Maintenance)	1 tablet BID	Twice daily	After 14-day Nevirapine lead-in (200mg/day)
Adults <60kg	Contraindicated	–	Use Triomune 30mg formulation
Lead-in Phase	Nevirapine 200mg/day alone	Once daily	14 days (monitor rash)
Renal Impairment (CrCl <50)	Avoid	Contraindicated	Lamivudine accumulation risk

⚠️ Side Effects, Storage & Warnings

❗ Common Side Effects:
- Numbness/tingling (42% at 40mg dose)
- Hyperlactatemia (elevated lactate)
- Rash (25% during lead-in)
🚫 Serious Effects:
- Lactic acidosis (fatal in 0.8% of cases)
- Severe hepatotoxicity
- Pancreatic inflammation
❄️ Storage: 15–30°C; keep bottle tightly closed (desiccant included).
⚠️ Critical Warnings:
- Contraindicated if baseline lactate >2 mmol/L
- Monthly monitoring: Liver enzymes + lactate levels
- Permanent discontinuation for lipoatrophy (face/limb fat loss)

🌍 Global Availability & Shipping

🌎 Region	📦 Shipping	💵 Price (30-tablet bottle)	📜 Prescription
🇺🇸 USA	✅ Restricted	$65–$100	Required
🇬🇧 UK	✅ Yes	£50–£80	Required
🇦🇺 Australia	❌ No	–	Not available

🔗 Related Indian Alternatives (Different in Same Category)

💊 Product Name	🏭 Manufacturer	🔗 Internal Link
Viraday (Efavirenz/Emtricitabine/Tenofovir)	Cipla	viraday
Dolutranz (Dolutegravir/Tenofovir)	Mylan	dolutranz
Tenof-EM (Tenofovir/Emtricitabine)	Hetero	tenof-em
Abacavir-L (Abacavir/Lamivudine)	Cipla	abacavir-l
Lopimune (Lopinavir/Ritonavir)	Cipla	lopimune
Covihope-D (Dolutegravir/Ritonavir)	Hetero	covihope-d

📚 External Medical References

🩺 Expert Commentary

Dr. Sanjay Verma, HIV Pharmacologist:
*”The 40mg Stavudine in Triomune significantly increases neuropathy risk compared to 30mg. For patients >60kg, I recommend transitioning to [tenof-em] (Tenofovir-based regimen) within 6 months. Always conduct monthly lactate checks – Cipla’s bottle includes desiccant to maintain stability in tropical climates.”*

📌 Disclaimer

*This information is not medical advice. Use under physician supervision. Cipla’s Triomune 40mg carries black-box warnings for fatal lactic acidosis and hepatotoxicity.*

💡 Clinical Protocol:

Toxicity Monitoring Schedule:

Test Frequency Action Threshold

Lactate Monthly >2 mmol/L (symptomatic)

ALT/AST Baseline, Month 1,3 >5× ULN

Peripheral Sensation Quarterly New numbness/tingling
Bottle Specifications:
- White HDPE bottle with child-resistant cap
- “TR40” embossed on tablets
- Desiccant canister (do not eat)
Discontinuation Criteria:
- Confirmed lipoatrophy
- Persistent lactate >4 mmol/L
- Rash with mucosal involvement
Drug Interactions:
- ↓ Concentrations of methadone
- ↑ Risk of neuropathy with INH/zidovudine