dolutegravir sodium + rilpivirine hydrochloride: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
dolutegravir sodium + rilpivirine hydrochloride: clinical details
Prescribing considerations
- Initiation and follow-up should be overseen by clinicians experienced in HIV management.
- Confirm sustained virological suppression, suitable treatment history and absence of known or suspected NNRTI or integrase-inhibitor resistance before switching.
- Use caution in moderate hepatic impairment; it is not recommended in severe hepatic impairment.
- Pregnancy requires prompt specialist review because component exposure falls and the fixed combination is not recommended.
Contraindications and cautions
- Hypersensitivity to either active substance or an excipient
- Fampridine
- Carbamazepine, oxcarbazepine, phenobarbital or phenytoin
- Rifampicin or rifapentine
- Proton-pump inhibitors
- Systemic dexamethasone except as a single treatment
- St John’s wort
Monitoring
- HIV viral load, adherence and clinical response
- Liver function, particularly with hepatitis B or C co-infection
- Weight, blood lipids and glucose as clinically appropriate
- Renal function and glycaemic control with metformin
- New rash or systemic hypersensitivity features
- Mood changes, suicidal ideation and immune-reconstitution symptoms
- QT-risk medicines and other clinically significant interactions
Clinical pharmacology
Dolutegravir inhibits HIV integrase strand transfer. Rilpivirine is an HIV-1 NNRTI metabolised mainly through CYP3A, so gastric pH and enzyme induction can materially affect exposure. Dolutegravir inhibits renal tubular creatinine transport, potentially causing a small early creatinine rise without reducing glomerular filtration.
Formulation and product differences
- The selected product is an oral fixed-combination film-coated tablet that should be swallowed whole with a meal.
- It contains lactose and may be unsuitable in specified rare hereditary disorders of galactose metabolism.
- Separate single-ingredient preparations are available when component-specific management is required.
- Keep in the original tightly closed bottle with the desiccant to protect it from moisture.
dolutegravir sodium + rilpivirine hydrochloride preparations and strengths
Tablet
Route: Oral
Strengths: 50 mg + 25 mg
dolutegravir sodium + rilpivirine hydrochloride interactions
The HIV clinic or pharmacist should check all medicines, supplements and herbal products. Important examples include:
Proton-pump inhibitors, including omeprazole, lansoprazole and pantoprazole
Contraindicated because they can substantially reduce rilpivirine absorption and risk loss of HIV control.
H2-receptor antagonists, including famotidine
Must be separated because they can reduce rilpivirine absorption; follow specialist timing instructions.
Antacids containing aluminium, magnesium or calcium
Can reduce absorption and must be separated as directed by the HIV clinic or pharmacist.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.