dolutegravir sodium: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
dolutegravir sodium: clinical details
Prescribing considerations
- Use under an HIV-experienced prescriber as part of appropriate combination treatment.
- Review integrase-resistance history and concomitant enzyme inducers.
- Coordinate pregnancy and infant-feeding decisions with specialist HIV services.
- Review psychiatric history and counsel about mood deterioration or suicidal thoughts.
Contraindications and cautions
- Hypersensitivity to dolutegravir or a formulation excipient.
- Concomitant fampridine or another narrow-therapeutic-index OCT2 substrate covered by the product contraindication.
- Use caution in severe hepatic impairment because clinical data are unavailable.
Monitoring
- HIV viral load, adherence and treatment response; investigate virological failure and resistance where appropriate.
- Liver biochemistry, particularly with hepatitis B or C coinfection or symptoms of hypersensitivity or hepatic injury.
- Renal function and glycaemic control with metformin.
- Weight and clinically appropriate metabolic parameters.
- OCT2/MATE1 inhibition may cause a small creatinine rise without reducing glomerular filtration.
Clinical pharmacology
Dolutegravir inhibits HIV integrase-mediated strand transfer. It is mainly metabolised by UGT1A1, with a minor CYP3A contribution, and inhibits renal OCT2 and MATE1 transporters.
Formulation and product differences
- Dispersible tablets are suitable for younger or lower-weight children and people for whom film-coated tablets are inappropriate.
- Dispersible tablets can be dispersed in water or swallowed whole but must not be chewed, cut or crushed.
- Dispersible and film-coated tablets have different bioavailability and are not interchangeable milligram for milligram.
dolutegravir sodium preparations and strengths
Dispersible tablet
Route: Oral
Strengths: 5 mg
Tablet
Route: Oral
Strengths: 50 mg
dolutegravir sodium interactions
Ask the HIV team or pharmacist to check all prescribed, over-the-counter and herbal products before starting or stopping them.
Fampridine (dalfampridine)
Contraindicated because dolutegravir may increase fampridine exposure and seizure risk.
Magnesium- or aluminium-containing antacids
Can substantially reduce dolutegravir absorption and must be separated from it.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.