II. Indications
- HIV Infection (part of combination therapy)
III. Contraindications
- Severe hepatic Impairment (Child-Pugh Class C)
IV. Mechanism
V. Medications
- Dolutegravir (Tivicay) tablets: 10, 25 and 50 mg
- Combinations
- Dolutegravir and Lamivudine (Dovato)
- Dolutegravir 50 mg AND Rilpivirine 25 mg (Juluca)
- Indicated in stable disease with HIV RNA <50 copies/ml for >=6 months (no resistance or treatment failures)
- Dose one tablet orally daily
- (2018) Presc Lett, New Drug: Juluca, Resource #340209
VI. Dosing: Adult
VII. Dosing: Child
VIII. Adverse Effects
-
Serum Creatinine increase
- Mild increases of Serum Creatinine without affecting GFR
- Hepatotoxicity
- Increased serum transaminases
- Higher risk in comorbid Hepatitis B or Hepatitis CVirus Infection
IX. Safety
- Avoid in Lactation
- Pregnancy
- Preferred Integrase Strand Transfer Inhibitor in pregnancy (as of 2022, includes first trimester, which had been category X)
- Pregnancy registry exists
- Initial data with risk of Neural Tube Defects (and had been avoided at conception and first trimester)
- However further study demonstrates no increased risk compared with other ART
- Patel (2022) N Engl J Med 387(9):799-809 +PMID: 36053505 [PubMed]
X. Drug Interactions
- CYP3A4 Inducer or UGT1A Inducer
- Metformin
- Medications that interfere with absorption (take Dolutegravir 2 hours before or 6 hours after these agents)
- Aluminum Hydroxide and Magnesium Hydroxide Antacid
- Sucralfate
- Oral Calcium supplement (may be taken with Dolutegravir if during mealtime)
- Oral iron supplement (may be taken with Dolutegravir if during mealtime)
- Buffered medications
- Medications contraindicated with Dolutegravir
- Dofetilide
- Oxcarbazepine
- Phenytoin
- Phenobarbital
- St Johns Wort
XI. Pharmacokinetics
- Excretion via Glucuronidation
- No dose adjustment in renal disease, but severe renal disease is associated with decreased serum levels of Dolutegravir
XII. Resources
- Dolutegravir (DailyMed)
Images: Related links to external sites (from Bing)
Related Studies
| tivicay (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| TIVICAY 50 MG TABLET | $65.17 each | |
| dovato (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| DOVATO 50-300 MG TABLET | $85.60 each | |
| juluca (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| JULUCA 50-25 MG TABLET | $100.94 each | |