Dolutegravir Overview & Drug Interactions
Class of ARV Benefits Formulations Standard Dose DTG dose with concomitant rifampicin-containing TB treatment Side Effects Drug Interactions with Dolutegravir Class of ARV: Integrase Inhibitor (InSTI) Benefits: DTG is a potent antiretroviral that provides rapid viral suppression, has a high genetic barrier to resistance, and has minimal side effects and drug interactions. It is well t
DTG dose with concomitant rifampicin-containing TB treatment
Drug Interactions with Dolutegravir
Class of ARV:
Integrase Inhibitor (InSTI)
Benefits:
DTG is a potent antiretroviral that provides rapid viral suppression, has a high genetic barrier to resistance, and has minimal side effects and drug interactions. It is well tolerated by clients and contributes positively to adherence and retention on ART.
Formulations:
- Fixed-dose combination: tenofovir (TDF) 300 mg + lamivudine (3TC) 300 mg + DTG 50 mg (TLD). TLD can be prescribed for clients ≥ 30 kg and ≥ 10 years of age
- Abacavir (ABC) 600 mg + lamivudine (3TC) 300 mg + DTG 50 mg (ALD). ALD can be prescribed for clients ≥ 25 kg
- DTG 50 mg tablet
- DTG 10 mg dispersible tablet
- Please note that the adult film coated 50 mg tablet and the paediatric dispersible 10 mg tablet are not bioequivalent. The 50mg film coated tablet is the equivalent of 30mg of the dispersible tablets.
Standard Dose:
- Children ≥ 20 kg; adolescents and adults: DTG 50 mg daily
- Children > 4 weeks of age and 3-19 kg: As per Drug Dosing Chart
DTG dose with concomitant rifampicin-containing TB treatment:
- Increase DTG dose to 50 mg 12-hourly.
- If on TLD or ALD FDC, add DTG 50 mg 12 hours after TLD or ALD dose.
- If on paediatric DTG, follow Drug Dosing Chart for DTG and concomitant rifampicin-containing TB treatment.
Side-effects:
- Usually mild and self-limiting.
- Side-effects include insomnia, headache, central nervous system (CNS) effects, and gastrointestinal effects.
- DTG can be taken in the evening or the morning as per the client’s preference. However, if the client develops insomnia, TLD should be taken in the morning.
Contrary to initial speculation that the integrase inhibitor class may be causing weight gain, the association now appears not to be causal. Instead, the association may be the result of comparatively less metabolic toxicity than alternative older ART regimens (that mitigate weight gain through toxicity) combined with an initial return-to-health phenomenon, and an obesogenic environment. Dolutegravir-based ART regimens have numerous advantages over comparators and are still recommended first-line agents for people living with HIV. There is no role for switching from dolutegravir-containing regimens in patients gaining weight.
For further detail on switching existing stable clients on ART between regimens, see Switching existing clients to DTG-containing regimens
Drug Interactions with Dolutegravir
Drug interactions can result in suboptimal drug concentrations which can cause
• an elevated HIV viral load
• drug resistance, due to replicating virus in the presence of subtherapeutic drug concentrations
• For interactions with paediatric regimens see Drug Interactions with DTG and Rifampicin-containing TB Treatment
Click here to open the PDF on the Overview of Dolutegravir
Click here to open the PDF on Drug Interactions
Click here for the abbreviations list
Click here for www.hiv-druginteractions.org/checker
2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates
June 2023 Version 4
Upload date: 28/07/2023