DOLUTEGRAVIR INTERACTIONS
INFORMATION SHEET
POTENTIAL INTERACTIONS WITH DOLUTEGRAVIR (DTG)
Drug interactions can result in suboptimal drug concentrations which can cause
• an elevated viral load
• drug resistance, due to replicating virus in the presence of subtherapeutic drug concentrations
Interacting Effect of co-
Recommendation
drug administration
Double DTG dose to 50 mg 12-hourly. If on TLD FDC, add DTG 50 mg 12 hours
Rifampicin ↓ DTG
after TLD dose
Avoid coadministration if possible. Alternative agents that do not interact with
Anticonvulsants:
DTG include valproate, lamotrigine, levetiracetam, and topiramate. Remember
Carbamazepine
↓ DTG that valproate is contra-indicated during pregnancy. Double DTG dose to 50 mg
Phenobarbital
12-hourly for carbamazepine, phenytoin, or phenobarbital if an alternative
Phenytoin
anticonvulsant cannot be used
Metformin ↑ Metformin DTG increases metformin levels. Maximum metformin dose 500 mg 12-hourly*
Many over the counter (OTC) medications contain
Polyvalent cations (Mg2+, Fe2+, Ca2+, Al3+, Zn2+) polyvalent cations. Healthcare workers should
e.g. antacids, sucralfate, multivitamin and nutritional supplements regularly ask clients about OTC medication use and
advise about possible interactions
Interaction occurs if taken together on empty stomach. To prevent this, take at
the same time, with food. Without food, take the calcium supplement a
Calcium ↓ DTG
minimum of 2 hours after or 6 hours before DTG. It is safe to dissolve the DTG
dispersible tablets in breast milk
Interaction occurs if taken together on empty stomach. To prevent this, take at
the same time, with food. Without food, take the iron supplement a minimum of
Iron ↓ DTG
2 hours after or 6 hours before DTG.
Remember: Take calcium and iron at least 4 hours apart
Magnesium/
We do not know if food intake eliminates this interaction. Antacids should be
aluminium con- ↓ DTG
taken a minimum of 2 hours after or 6 hours before DTG
taining antacids
We do not know if food intake eliminates this interaction. Sucralfate/zinc should
Sucralfate/Zinc ↓ DTG
be taken a minimum of 2 hours after or 6 hours before DTG
*
If your patient's blood sugar is not controlled on this dose contact the hotline (0800 212 506) for assistance
This publication was supported under funding provided by the Global Fund to Fight AIDS,
Tuberculosis and Malaria through the National Department of Health of South Africa and the NDoH
Pharmacovigilance Centre for Public Health Programmes. Its contents are solely the responsibility of
the authors and do not necessarily represent the official views of the Global Fund or the
National Department of Health of South Africa
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Published May 2023, Version 3
IF YOU TAKE DOLUTEGRAVIR (e.g. TLD) AND NEED TO TAKE CALCIUM AND
IRON SUPPLEMENTATION (e.g. DURING PREGNANCY) DO IT LIKE THIS:
WITH FOOD WITHOUT FOOD
08:00 TLD + Calcium + FOOD 06:00 TLD
08:00 Calcium
13:00 Iron supplement 13:00 Iron supplement
20:00 Calcium 20:00 Calcium
Antacid can be taken after 10h00 and before 02h00, but Antacid can be taken after 8h00 and before 24h00, but not
not at the same time as iron. Try to separate the dosing of at the same time as iron. Try to separate the dosing of iron
iron and antacids as much as possible and antacids as much as possible
