a method [40:<40 kg receiving certain UGT1A or CYP3A inducers (i.e., efavirenz, ritonavir-boosted fosamprenavir, ritonavir-boosted tipranavir, carbamazepine, rifampin): 35 mg twice daily (one 25-mg tablet and one 10-mg tablet twice daily). 1 Dolutegravir in children and adolescents weighing 40 kg: 50 mg once daily. 1 Dolutegravir in children and adolescents weighing 40 kg receiving certain UGT1A or CYP3A inducers (i.e., efavirenz, ritonavir-boosted fosamprenavir, ritonavir-boosted tipranavir, carbamazepine, rifampin): 50 mg twice daily. 1 Antiretroviral-experienced Pediatric Patients Oral Dolutegravir (Tivicay ) in children and adolescents weighing 30 to> <40 kg: 35 mg once daily (one 25-mg tablet and one 10-mg tablet once daily). 1 Dolutegravir in children and adolescents weighing 30 to> <40 kg receiving certain UGT1A or CYP3A inducers (i.e., efavirenz, ritonavir-boosted fosamprenavir, ritonavir-boosted tipranavir, carbamazepine, rifampin): 35 mg twice daily (one 25-mg tablet and one 10-mg tablet twice daily). 1 Dolutegravir in children and adolescents weighing 40 kg who are antiretroviral-experienced, INSTI-naive: 50 mg once daily. 1 Dolutegravir in children and adolescents 40 kg who are antiretroviral-experienced, INSTI-naive, and receiving certain UGT1A or CYP3A inducers (i.e., efavirenz, ritonavir-boosted fosamprenavir, ritonavir-boosted tipranavir, carbamazepine, rifampin): 50 mg twice daily. 1 Dolutegravir: Safety and efficacy not established in INSTI-experienced pediatric patients with documented or clinically suspected resistance to other INSTIs (e.g., elvitegravir, raltegravir). 1 Abacavir/dolutegravir/lamivudine (Triumeq ): Safety and efficacy not established in pediatric patients. 240 Adults Treatment of HIV Infection Antiretroviral-naive Adults Oral Dolutegravir (Tivicay ): 50 mg once daily. 1 Dolutegravir in adults receiving certain UGT1A or CYP3A inducers (i.e., efavirenz, ritonavir-boosted fosamprenavir, ritonavir-boosted tipranavir, carbamazepine, rifampin): 50 mg twice daily. 1 Abacavir/dolutegravir/lamivudine (Triumeq ): 1 tablet (abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg) once daily. 240 Abacavir/dolutegravir/lamivudine in adults receiving certain drugs (i.e., efavirenz, ritonavir-boosted fosamprenavir, ritonavir-boosted tipranavir, carbamazepine, rifampin): 1 tablet (abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg) once daily and a 50-mg tablet of single-entity dolutegravir once daily given 12 hours after the daily dose of the fixed combination. 240 Antiretroviral-experienced Adults Oral Dolutegravir (Tivicay ) in antiretroviral-experienced, INSTI-naive adults: 50 mg once daily. 1 Dolutegravir in antiretroviral-experienced adults, INSTI-experienced adults with certain INSTI-associated resistance substitutions or clinically suspected INSTI resistance: 50 mg twice daily. 1 Dolutegravir in antiretroviral-experienced adults receiving certain UGT1A or CYP3A inducers (i.e., efavirenz, ritonavir-boosted fosamprenavir, ritonavir-boosted tipranavir, carbamazepine, rifampin): 50 mg twice daily. 1 Abacavir/dolutegravir/lamivudine (Triumeq ) in antiretroviral-experienced adults: 1 tablet (600 mg of abacavir, 50 mg of dolutegravir, and 300 mg of lamivudine) once daily. 240 Do not use alone in those with clinically suspected or confirmed INSTI-resistance substitutions. 240 Abacavir/dolutegravir/lamivudine in antiretroviral-experienced adults receiving certain drugs (efavirenz, ritonavir-boosted fosamprenavir, ritonavir-boosted tipranavir, carbamazepine, rifampin): 1 tablet (abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg) once daily and a 50-mg tablet of single-entity dolutegravir once daily given 12 hours after the daily dose of the fixed combination. 240 Postexposure Prophylaxis following Nonoccupational Exposure to HIV (nPEP) Oral Dolutegravir 50 mg once daily. 198 Use in conjunction with 2 NRTIs (see Postexposure Prophylaxis following Nonoccupational Exposure to HIV [nPEP] under Uses). 198 Initiate nPEP as soon as possible (within 72 hours) following nonoccupational exposure that represents a substantial risk for HIV transmission and continue for 28 days. 198 nPEP not recommended if exposed individual seeks care> 72 hours after exposure. 198 Special Populations Hepatic Impairment Dolutegravir (Tivicay ): Dosage adjustments not needed in patients with mild or moderate hepatic impairment (Child-Pugh class A or B); 1 do not use in those with severe hepatic impairment (Child-Pugh class C). 1 (See Hepatic Impairment under Cautions.) Abacavir/dolutegravir/lamivudine (Triumeq ): Do not use in patients with mild hepatic impairment (Child-Pugh class A) since reduction in abacavir dosage needed in such patients; 240 contraindicated in those with moderate or severe hepatic impairment (Child-Pugh class B or C). 240 (See Hepatic Impairment under Cautions.) Renal Impairment Dolutegravir (Tivicay ): Dosage adjustments not needed in antiretroviral-naive or antiretroviral-experienced, INSTI-naive patients with mild, moderate, or severe renal impairment; 1 dosage adjustments not needed in antiretroviral-experienced, INSTI-experienced patients with mild or moderate renal impairment. 1 Use with caution in patients with severe renal impairment who are INSTI-experienced and have certain INSTI-associated resistance substitutions or clinically suspected INSTI resistance. 1 10 (See Renal Impairment under Cautions.) Abacavir/dolutegravir/lamivudine (Triumeq ): Do not use in patients with Cl cr <50 mL/minute since reduction in lamivudine dosage needed in such patients. 240 (See Renal Impairment under Cautions.) Geriatric Patients No specific dosage recommendations; 1 use with caution because of age-related decreases in hepatic, renal, and/or cardiac function and potential for concomitant disease and drug therapy. 1 (See Geriatric Use under Cautions.) Cautions for Dolutegravir Sodium Contraindications Dolutegravir (Tivicay ): Previous hypersensitivity reaction to dolutegravir; 1 concomitant use with dofetilide. 1 (See Specific Drugs under Interactions.) Abacavir/dolutegravir/lamivudine (Triumeq ): HLA-B*5701-positive or previous hypersensitivity reaction to abacavir (regardless of HLA-B*5701 status); 240 previous hypersensitivity reaction to dolutegravir or lamivudine; 240 concomitant use with dofetilide; 240 moderate or severe hepatic impairment. 240 Consider contraindications associated with each drug in the fixed combination. 240 (See Precautions Related to Use of Fixed Combinations under Cautions.) Warnings/Precautions Sensitivity Reactions Hypersensitivity Reactions Hypersensitivity reactions reported. 1 Reactions include rash and constitutional findings and, occasionally, organ dysfunction including liver toxicity. 1 Immediately discontinue dolutegravir, abacavir/dolutegravir/lamivudine, and any other suspect agents if signs or symptoms of hypersensitivity occur, including (but not limited to) severe rash or rash accompanied by fever, general malaise, fatigue, muscle or joint aches, blisters or peeling skin, oral blisters or lesions, conjunctivitis, facial edema, hepatitis, eosinophilia, angioedema, or difficulty breathing. 1 240 Monitor clinical status, including liver aminotransferases, and initiate appropriate therapy. 1 240 Life-threatening reactions could occur if discontinuance of dolutegravir, abacavir/dolutegravir/lamivudine, and any other suspect agents is delayed after onset of hypersensitivity reaction. 1 240 Individuals with HBV or HCV Infection Increased risk of development or worsening of serum aminotransferase elevations in HIV-infected patients with HBV or HCV coinfection. 1 In some cases, elevations in serum aminotransferase concentrations may be consistent with immune reconstitution syndrome or HBV reactivation, particularly in the setting where HBV therapy had been discontinued. 1 In patients with underlying hepatic disease such as HBV or HCV infection, perform laboratory monitoring for hepatotoxicity prior to and routinely during dolutegravir or abacavir/dolutegravir/lamivudine treatment. 1 240 (See Hepatic Impairment under Cautions.) If abacavir/dolutegravir/lamivudine used in HIV-infected patients coinfected with HBV or HCV, consider that additional precautions apply to these coinfected patients. 240 (See Precautions Related to Use of Fixed Combinations under Cautions.) Precautions Related to Use of Fixed Combinations Abacavir/dolutegravir/lamivudine: Consider cautions, precautions, contraindications, and drug interactions associated with each drug in the fixed combination. 240 Consider cautionary information applicable to specific populations (e.g., pregnant or nursing women, individuals with hepatic or renal impairment, geriatric patients) for each drug. 240 Do not use abacavir/dolutegravir/lamivudine concomitantly with single-entity dolutegravir, unless needed for adjustment of dolutegravir dosage (e.g., when fixed combination used concomitantly with efavirenz, ritonavir-boosted fosamprenavir, ritonavir-boosted tipranavir, or rifampin). 240 (See Interactions.) Because antiretrovirals contained in abacavir/dolutegravir/lamivudine may also be available in single-entity or other fixed-combination preparations, take care to ensure that therapy is not duplicated if the fixed combination is used in conjunction with other antiretrovirals. 240 Do not use abacavir/dolutegravir/lamivudine concomitantly with any preparation containing abacavir or lamivudine. 240 If abacavir/dolutegravir/lamivudine used, consider that abacavir associated with serious and sometimes fatal hypersensitivity reactions, including multiorgan failure and anaphylaxis. 240 Individuals with the HLA-B*5701 allele are at higher risk for hypersensitivity reactions to abacavir, although such reactions reported in patients without the HLA-B*5701 allele. 240 Review medical history for prior exposure to any abacavir-containing preparation. 240 Screen all patients for the HLA-B*5701 allele prior to initiating or reinitiating abacavir/dolutegravir/lamivudine, unless patient has documentation of prior HLA-B*5701 allele assessment. 240 Immediately discontinue abacavir/dolutegravir/lamivudine if a hypersensitivity reaction is suspected, regardless of patient's HLA-B*5701 status and even when other diagnoses are possible. 240 Never restart abacavir/dolutegravir/lamivudine or any other abacavir-containing preparation in a patient who experienced a hypersensitivity reaction to an abacavir-containing preparation since more severe reactions can occur within hours and may include life-threatening hypotension and death. 240 If hypersensitivity ruled out, manufacturer of abacavir/dolutegravir/lamivudine states that the drug may be reinitiated, but only if medical care is readily accessible. 240 Since it is not possible to determine whether hypersensitivity reaction in patient receiving abacavir/dolutegravir/lamivudine is caused by abacavir or dolutegravir, 240 never reinitiate abacavir-containing or dolutegravir-containing preparations in patients who stopped therapy with abacavir/dolutegravir/lamivudine due to a hypersensitivity reaction. 240 If abacavir/dolutegravir/lamivudine used, consider that lactic acidosis and severe hepatomegaly with steatosis, including fatalities, reported in patients receiving HIV NRTIs alone or in conjunction with other antiretrovirals. 240 Discontinue abacavir/dolutegravir/lamivudine if clinical or laboratory findings indicate lactic acidosis or pronounced hepatotoxicity, which may include hepatomegaly and steatosis even in the absence of marked increases in serum aminotransferase concentrations. 240 If abacavir/dolutegravir/lamivudine used in patients coinfected with HIV and HBV, consider that severe, acute exacerbations of HBV infection reported following discontinuance of lamivudine in coinfected patients. 240 Closely monitor hepatic function (using both clinical and laboratory follow-up) for at least several months after abacavir/dolutegravir/lamivudine discontinued. 240 If appropriate, initiation of HBV treatment may be warranted. 240 Safety and efficacy of abacavir/dolutegravir/lamivudine not established for treatment of chronic HBV infection. 240 Adipogenic Effects Redistribution or accumulation of body fat, including central obesity, dorsocervical fat enlargement ( buffalo hump ), peripheral wasting, facial wasting, breast enlargement, and general cushingoid appearance reported in patients receiving antiretroviral therapy. 1 240 Mechanisms and long-term consequences unknown; 1 240 causal relationship not established. 1 240 Immune Reconstitution Syndrome During initial treatment, HIV-infected patients who respond to antiretroviral therapy may develop an inflammatory response to indolent or residual opportunistic infections (e.g., Mycobacterium avium , M. tuberculosis , cytomegalovirus [CMV], Pneumocystis jirovecii [formerly P. carinii ], varicella-zoster virus [VZV]); 1 240 this may necessitate further evaluation and treatment. 1 240 Autoimmune disorders (e.g., Graves' disease, polymyositis, Guillain-Barré syndrome) also reported to occur in the setting of immune reconstitution; 1 240 time to onset is more variable and can occur many months after initiation of antiretroviral therapy. 1 240 Specific Populations Pregnancy Antiretroviral Pregnancy Registry at 800-258-4263 or . 1 202 240 Insufficient human data to assess risk of birth defects and miscarriage if dolutegravir used in pregnant women. 1 No adequate and well-controlled studies of abacavir/dolutegravir/lamivudine in pregnant women; 240 manufacturer states use during pregnancy only if clearly needed or if potential benefits to the woman outweigh risks to fetus. 240 Experts state that only limited data available regarding use of dolutegravir during pregnancy and the drug is not recommended for initial treatment in antiretroviral-naive pregnant women. 202 Lactation Distributed into milk in rats. 1 202 Not known whether distributed into human milk, 1 202 affects milk production, or affects breast-fed infant. 1 Instruct HIV-infected women not to breast-feed because of risk of HIV transmission and risk of adverse effects in the infant. 1 202 Pediatric Use Dolutegravir (Tivicay ): Safety and efficacy not established in pediatric patients weighing> <30 kg; 1 safety and efficacy not established in INSTI-experienced pediatric patients who have documented or suspected resistance to other INSTIs (e.g., elvitegravir, raltegravir). 1 Safety profile in children and adolescents 6 to> <18 years of age similar to that in adults. 1 Abacavir/dolutegravir/lamivudine (Triumeq ): Safety and efficacy not established in pediatric patients. 240 Geriatric Use Insufficient experience in patients 65 years of age to determine whether they respond differently to dolutegravir (Tivicay ) or abacavir/dolutegravir/lamivudine (Triumeq ) than younger adults. 1 240 Use with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy. 1 240 Hepatic Impairment Dolutegravir (Tivicay ): Not recommended in patients with severe hepatic impairment (Child-Pugh class C); 1 pharmacokinetics not evaluated in such patients. 1 Pharmacokinetics in patients with moderate hepatic impairment similar to those in healthy individuals; dosage adjustments not needed in those with mild or moderate hepatic insufficiency (Child-Pugh class A or B). 1 Risk for further elevations in hepatic enzyme concentrations in patients with HBV or HCV coinfection. 1 Abacavir/dolutegravir/lamivudine (Triumeq ): Do not use in patients with mild hepatic impairment (Child-Pugh class A). 240 Because decreased abacavir dosage is recommend in those with mild hepatic impairment, 200 switch to the single-entity components to allow adjustment of abacavir dosage in such patients. 240 Contraindicated in those with moderate or severe hepatic impairment (Child-Pugh class B or C). 240 Renal Impairment Dolutegravir (Tivicay ): Use with caution in patients with severe renal impairment who are INSTI-experienced and have documented or suspected INSTI resistance; 1 10 dolutegravir plasma concentrations decreased in such patients and may result in loss of therapeutic effects and development of resistance to the drug or other antiretrovirals. 1 Dolutegravir: May be used in patients with mild or moderate renal impairment; no clinically important effect on dolutegravir pharmacokinetics. 1 10 Dosage adjustments not needed in antiretroviral-naive or antiretroviral-experienced, INSTI-naive patients with mild, moderate, or severe renal impairment. 1 10 Dosage adjustments not needed in INSTI-experienced patients with mild or moderate renal impairment. 1 Not evaluated in dialysis patients; 1 unlikely that renal replacement therapy would have clinically important effect on dolutegravir pharmacokinetics. 10 (See Renal Impairment under Dosage and Administration.) Dolutegravir increases S cr by inhibiting tubular secretion of creatinine; 1 does not cause clinically important change in GFR or renal plasma flow. 1 Abacavir/dolutegravir/lamivudine (Triumeq ): Do not use if Cl cr> <50 mL/minute. 240 Because lamivudine substantially eliminated by kidneys and decreased lamivudine dosage recommended in those with Cl cr> <50 mL/minute, switch to the single-entity components to allow adjustment of lamivudine dosage in such patients. 240 Common Adverse Effects Insomnia; headache; fatigue; diarrhea; hyperglycemia; decreased neutrophils; increased serum aminotransferases, total bilirubin, creatine kinase, lipase, and cholesterol. 1 Interactions for Dolutegravir Sodium CYP3A plays minor role in dolutegravir metabolism. 1 8 9 The drug does not inhibit CYP isoenzymes 1A2, 2A6, 2B6, 2C8, 2C9, 2C19, 2D6, or 3A and does not induce CYP1A2, 2B6, or 3A4. 1 Dolutegravir is a substrate of P-glycoprotein (P-gp); 1 does not inhibit P-gp-mediated transport. 1 Substrate of breast cancer resistance protein (BCRP); 1 does not inhibit BCRP. 1 Inhibits multidrug and toxin extrusion transporter (MATE) 1; 1 may increase concentrations of drugs eliminated by MATE1. 1 Inhibits the renal organic cation transporter (OCT) 2; 1 may increase concentrations of drugs eliminated by OCT2. 1 Does not inhibit OCT1. 1 Inhibits organic anion transporter (OAT) 1 and OAT3; 1 no in vivo evidence of increased concentrations of OAT1 or OAT3 substrates. 1 Does not inhibit bile salt export pump (BSEP), multidrug resistance protein (MRP) 2 or MRP4, or organic anion transporter polypeptide (OATP) 1B1 or OATP1B3; 1 not expected to affect pharmacokinetics of drugs that are substrates of these transporters. 1 Metabolized by UGT1A1 and is a substrate for UGT1A3 and UGT1A9. 1 Does not inhibit UGT1A1 or UGT2B7. 1 The following drug interactions are based on studies using dolutegravir. 1 Drug interaction studies not performed using abacavir/dolutegravir/lamivudine. 240 When abacavir/dolutegravir/lamivudine is used, consider interactions associated with each drug in the fixed combination. 240 Drugs Affecting or Metabolized by Hepatic Microsomal Enzymes CYP3A inducers: Possible decreased dolutegravir concentrations and decreased therapeutic effects. 1 CYP3A inhibitors: Possible increased dolutegravir concentrations. 1 Drugs Affecting or Metabolized by Uridine Diphosphate-glucuronosyltransferases UGT1A1 inducers: Possible decreased dolutegravir concentrations and decreased therapeutic effects. 1 UGT1A1 inhibitors: Possible increased dolutegravir concentrations. 1 Drugs Affecting P-glycoprotein Transport P-gp inducers: Possible decreased dolutegravir concentrations. 1 P-gp inhibitors: Possible increased dolutegravir concentrations. 1 Drugs Affecting Breast Cancer Resistance Protein BCRP inducers: Possible decreased dolutegravir concentrations. 1 BCRP inhibitors: Possible increased dolutegravir concentrations. 1 Specific Drugs Drug Interaction Comments Abacavir No in vitro evidence of antagonistic antiretroviral effects 1 Adefovir No in vitro evidence of antagonistic antiviral effects 1 Antacids, aluminum-, calcium-, or magnesium-containing Decreased dolutegravir concentrations and AUC 1 19 200 240 Administer dolutegravir or abacavir/dolutegravir/lamivudine at least 2 hours before or 6 hours after aluminum-, calcium-, or magnesium-containing antacids 1 200 240 Antiarrhythmic agents (dofetilide) Dofetilide: Increased dofetilide concentrations and increased risk of serious and/or life-threatening adverse effects 1 240 Dofetilide: Concomitant use with dolutegravir or abacavir/dolutegravir/lamivudine contraindicated 1 240 Anticonvulsants (carbamazepine, oxcarbazepine, phenobarbital, phenytoin) Carbamazepine: Decreased dolutegravir concentrations and AUC 1 30 Oxcarbazepine, phenobarbital, phenytoin: Decreased dolutegravir concentrations 1 Carbamazepine (adults): In antiretroviral-naive or antiretroviral-experienced, INSTI-naive adults, use dolutegravir 50 mg twice daily; 1 consider alternative anticonvulsant in INSTI-experienced adults with documented or suspected INSTI resistance; 1 if abacavir/dolutegravir/lamivudine used, give 1 fixed-combination tablet (abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg) once daily and a 50-mg tablet of single-entity dolutegravir once daily 12 hours after the fixed-combination dose 240 Carbamazepine (pediatric patients): In antiretroviral-naive or antiretroviral-experienced, INSTI-naive pediatric patients weighing 30 to> <40 kg, use dolutegravir 35 mg twice daily; 1 in those weighing 40 kg, use dolutegravir 50 mg twice daily; 1 consider alternative anticonvulsant in INSTI-experienced patients with documented or suspected INSTI resistance 1 Oxcarbazepine, phenobarbital, phenytoin: Avoid concomitant use with dolutegravir or abacavir/dolutegravir/lamivudine since data insufficient to make dosage recommendations; 1 240 consider alternative anticonvulsant 200 Antidiabetic agents (metformin) Metformin: Increased metformin concentrations and AUC 1 31 200 Metformin: Monitor blood glucose concentrations when dolutegravir or abacavir/dolutegravir/lamivudine is initiated or discontinued in patient receiving metformin 1 31 200 240 and do not exceed metformin hydrochloride dosage of 1 g daily during concomitant therapy; 1 200 240 experts state use low metformin dosage if initiated in patient receiving dolutegravir and titrate dosage to achieve glycemic control and minimize adverse GI effects 200 Antimycobacterial agents (rifabutin, rifampin, rifapentine) Rifabutin: No clinically important effects on dolutegravir pharmacokinetics 1 200 Rifampin: Decreased dolutegravir concentrations and AUC 1 200 Rifapentine: Decreased dolutegravir concentrations expected 200 Rifabutin: Dosage adjustments not needed 200 Rifampin (adults): In antiretroviral-naive or antiretroviral-experienced, INSTI-naive adults, use dolutegravir 50 mg twice daily; 1 200 consider alternative to rifampin (e.g., rifabutin) in INSTI-experienced adults with documented or suspected INSTI resistance; 1 200 if abacavir/dolutegravir/lamivudine used, give 1 fixed-combination tablet (abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg) once daily and give a 50-mg tablet of single-entity dolutegravir once daily 12 hours after the fixed-combination dose 240 Rifampin (pediatric patients): In antiretroviral-naive or antiretroviral-experienced, INSTI-naive pediatric patients weighing 30 to> <40 kg, use dolutegravir 35 mg twice daily; 1 in those weighing 40 kg, use dolutegravir 50 mg twice daily; 1 consider alternative to rifampin (e.g., rifabutin) in INSTI-experienced patients with documented or suspected INSTI resistance 1 Rifapentine: Experts state do not use concomitantly with dolutegravir 200 Atazanavir Ritonavir-boosted atazanavir or unboosted atazanavir: Increased dolutegravir concentrations and AUC; no effects on atazanavir pharmacokinetics 1 200 Cobicistat-boosted atazanavir: Data not available 200 Ritonavir-boosted , cobicistat-boosted , or unboosted atazanavir: Dosage adjustments not needed 200 Buffered preparations Buffered preparations containing polyvalent cations: Possible decreased dolutegravir concentrations 1 Buffered preparations containing polyvalent cations: Administer dolutegravir or abacavir/dolutegravir/lamivudine at least 2 hours before or 6 hours after such preparations; 1 200 240 Calcium supplements Possible decreased dolutegravir concentrations when used concomitantly in the fasted state 1 28 Administer dolutegravir or abacavir/dolutegravir/lamivudine at least 2 hours before or 6 hours after oral calcium supplements; 1 28 200 240 alternatively, may be used concomitantly if taken with food 1 28 200 240 Corticosteroids Prednisone: No clinically important effects on dolutegravir pharmacokinetics 1 8 Daclatasvir No clinically important pharmacokinetic interactions 1 Darunavir Ritonavir-boosted darunavir: Decreased dolutegravir concentrations and AUC; no effects on darunavir pharmacokinetics 1 200 Cobicistat-boosted darunavir: No clinically important interactions with dolutegravir expected 237 Ritonavir-boosted or cobicistat-boosted darunavir: Dosage adjustments not needed 200 Efavirenz Decreased dolutegravir concentrations and AUC; 1 26 200 effect on efavirenz pharmacokinetics unlikely 1 No in vitro evidence of antagonistic antiretroviral effects 1 Dolutegravir (adults): In antiretroviral-naive or antiretroviral-experienced, INSTI-naive, use dolutegravir 50 mg twice daily; 1 200 in INSTI-experienced adults with documented or suspected INSTI resistance, consider alternative to efavirenz whenever possible 1 200 Dolutegravir (pediatric patients): In antiretroviral-naive or antiretroviral-experienced, INSTI-naive pediatric patients weighing 30 to> <40 kg, use dolutegravir 35 mg twice daily; 1 in those weighing 40 kg, use dolutegravir 50 mg twice daily; 1 in INSTI-experienced patients with documented or suspected INSTI resistance, consider alternative to efavirenz whenever possible 1 Abacavir/dolutegravir/lamivudine (adults): Give 1 fixed-combination tablet (abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg) once daily and give a 50-mg tablet of single-entity dolutegravir once daily 12 hours after the fixed-combination dose 240 Elbasvir and grazoprevir Fixed combination of elbasvir and grazoprevir (elbasvir/grazoprevir): No clinically important effects on pharmacokinetics of elbasvir, grazoprevir, or dolutegravir 177 Dosage adjustments not needed 177 Enfuvirtide No in vitro evidence of antagonistic antiretroviral effects 1 Etravirine Substantially decreased dolutegravir concentrations and AUC; 1 200 no apparent effects on etravirine pharmacokinetics 1 Effect on dolutegravir pharmacokinetics is mitigated if etravirine and dolutegravir used concomitantly with lopinavir/ritonavir or ritonavir-boosted darunavir; 1 200 effect expected to be mitigated if etravirine and dolutegravir used concomitantly with ritonavir-boosted atazanavir 1 200 Do not use etravirine and dolutegravir or abacavir/dolutegravir/lamivudine concomitantly unless ritonavir-boosted atazanavir, ritonavir-boosted darunavir, or lopinavir/ritonavir also included in the regimen 1 200 240 In antiretroviral-naive or antiretroviral-experienced, INSTI-naive patients without INSTI resistance: Use dolutegravir 50 mg once daily with etravirine and with ritonavir-boosted atazanavir, ritonavir-boosted darunavir, or lopinavir/ritonavir 200 INSTI-experienced with documented or suspected INSTI resistance: Use dolutegravir 50 mg twice daily with etravirine and with ritonavir-boosted atazanavir, ritonavir-boosted darunavir, or lopinavir/ritonavir 200 Estrogens/progestins Oral contraceptives containing ethinyl estradiol and norgestimate: No effect on pharmacokinetics of ethinyl estradiol or norgestimate 1 29 Oral contraceptives containing ethinyl estradiol and norgestimate: Dosage adjustments not needed 200 Fosamprenavir Ritonavir-boosted fosamprenavir: Decreased dolutegravir concentrations and AUC; 1 27 200 effect on fosamprenavir pharmacokinetics unlikely 1 27 No in vitro evidence of antagonistic antiretroviral effects with amprenavir (active metabolite of fosamprenavir) 1 Ritonavir-boosted fosamprenavir (adults): In antiretroviral-naive or antiretroviral-experienced, INSTI-naive adults, use dolutegravir 50 mg twice daily; 1 200 in INSTI-experienced adults with documented or suspected INSTI resistance, consider alternative to ritonavir-boosted fosamprenavir whenever possible; 1 200 if abacavir/dolutegravir/lamivudine used, give 1 fixed-combination tablet (abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg) once daily and give a 50-mg tablet of single-entity dolutegravir once daily 12 hours after the fixed-combination dose 240 Ritonavir-boosted fosamprenavir (pediatric patients): In antiretroviral-naive or antiretroviral-experienced, INSTI-naive pediatric patients weighing 30 to> <40 kg, use dolutegravir 35 mg twice daily; 1 in those weighing 40 kg, use dolutegravir 50 mg twice daily; 1 in INSTI-experienced patients with documented or suspected INSTI resistance, consider alternative to ritonavir-boosted fosamprenavir whenever possible 1 Iron preparations Possible decreased dolutegravir concentrations when used concomitantly in the fasted state 1 28 Administer dolutegravir or abacavir/dolutegravir/lamivudine at least 2 hours before or 6 hours after oral iron; 1 28 200 240 alternatively, may be used concomitantly if taken with food 1 28 200 240 Laxatives containing polyvalent cations Possible decreased dolutegravir concentrations 1 Administer dolutegravir or abacavir/dolutegravir/lamivudine at least 2 hours before or 6 hours after laxatives containing polyvalent cations 1 200 240 Ledipasvir and sofosbuvir Fixed combination of ledipasvir and sofosbuvir (ledipasvir/sofosbuvir): No clinically important pharmacokinetic interactions expected if used with dolutegravir 181 Some experts state ledipasvir/sofosbuvir may be used concomitantly with dolutegravir 200 Lopinavir/ritonavir No clinically important effects on dolutegravir or lopinavir pharmacokinetics 1 200 No in vitro evidence of antagonistic antiretroviral effects 1 Once-daily or twice-daily lopinavir/ritonavir: Dosage adjustments not needed 200 Maraviroc No in vitro evidence of antagonistic antiretroviral effects 1 Methadone No clinically important effect on methadone pharmacokinetics 1 200 Dosage adjustments not needed 200 Midazolam No clinically important effect on midazolam pharmacokinetics 1 18 200 Dosage adjustments not needed 200 Multivitamins Decreased dolutegravir concentrations 1 Administer dolutegravir or abacavir/dolutegravir/lamivudine at least 2 hours before or 6 hours after multivitamins containing calcium or iron; 1 200 240 alternatively, may be used concomitantly if taken with food 1 240 Nevirapine Decreased dolutegravir concentrations 1 200 No in vitro evidence of antagonistic antiretroviral effects 1 Do not use concomitantly with dolutegravir or abacavir/dolutegravir/lamivudine; 1 200 240 data insufficient to make dosage recommendations 1 240 Proton-pump inhibitors Omeprazole: No clinically important effect on dolutegravir pharmacokinetics 1 19 Proton-pump inhibitors: Dosage adjustments not needed 200 Raltegravir No in vitro evidence of antagonistic antiretroviral effects 1 Ribavirin No in vitro evidence of antagonistic antiviral effects 1 Rilpivirine No clinically important effect on rilpivirine or dolutegravir pharmacokinetics 1 200 Dosage adjustments not needed 200 Ritonavir Effect on ritonavir pharmacokinetics unlikely 1 St. John's wort Decreased dolutegravir concentrations 1 Avoid concomitant use with dolutegravir or abacavir/dolutegravir/lamivudine 1 240 Saquinavir Ritonavir-boosted saquinavir: Experts state dosage adjustments not necessary 200 Simeprevir Clinically important interactions with dolutegravir not expected 187 Some experts state may be used concomitantly with dolutegravir 200 Sofosbuvir Clinically important interactions with dolutegravir unlikely 200 Dosage adjustments not needed 200 Sofosbuvir and velpatasvir Fixed combination of sofosbuvir and velpatasvir (sofosbuvir/velpatasvir): No clinically important pharmacokinetic interactions with dolutegravir 176 Stavudine No in vitro evidence of antagonistic antiretroviral effects 1 Sucralfate Decreased dolutegravir concentrations 1 Administer dolutegravir or abacavir/dolutegravir/lamivudine at least 2 hours before or 6 hours after sucralfate 1 200 240 Tenofovir No clinically important effect on tenofovir or dolutegravir pharmacokinetics 1 Dosage adjustments not needed 200 Tipranavir Ritonavir-boosted tipranavir: De a petrol
because of this Dolutegravir Sodium instance
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