University of California, San Francisco Logo

University of California, San Francisco | About UCSF | Search UCSF | UCSF Medical Center

Home > Treatment > Interactions
Database of Antiretroviral Drug Interactions

All Interactions with Dolutegravir (Tivicay)

Coadministered DrugDose of DrugDose of DolutegravirEffect on Drug LevelsEffect on Dolutegravir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Antacids641
(Maalox, Mylanta, Riopan, Milk of Magnesia, others)
Maalox given 2 hours after dolutegravir50 mg x 1-Dolutegravir AUC: decreased 26%; Cmin: decreased 30% Potentially decreased dolutegravir effectiveness -

Administer dolutegravir 2 hours before or 6 hours after antacids.

Antacids641
(Maalox, Mylanta, Riopan, Milk of Magnesia, others)
Maalox given simultaneously as dolutegravir50 mg x 1-Dolutegravir AUC: decreased 74%; Cmin: decreased 74%--

Do not coadminister simultaneously. Administer dolutegravir 2 hours before or 6 hours after antacids.

Atazanavir641
(ATV)(Reyataz)
300 mg QD with ritonavir 100 mg QD30 mg QD-Dolutegravir AUC increased 62%; Cmin: increased 121%--

No dose adjustment necessary

Atazanavir641
(ATV)(Reyataz)
400 mg QD30 mg QD-Dolutegravir AUC: increased 91%; Cmin: increased 180% --

No dose adjustment necessary

Boceprevir641
(Victrelis)
800 mg Q8H50 mg QD-No significant change--

No dose adjustment necessary

Coadministered DrugDose of DrugDose of DolutegravirEffect on Drug LevelsEffect on Dolutegravir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Calcium carbonate685, 641
1200 mg50 mg x 1-Dolutegravir AUC decreased ~39% if taken together, fasting conditions. No significant change in dolutegravir AUC if taken 2 hours before calcium carbonate or if taken simultaneously with food.Potential decreased dolutegravir effectiveness if taken in fasted state-

Administer dolutegravir 2 hours before or 6 hours after calcium-containing supplements. Alternatively, administer dolutegravir simulatenously with calcium supplements and with food.

Carbamazepine691
(others)(Tegretol)
300 mg BID50 mg daily-Dolutegravir AUC decreased 49%; Cmin decreased 73%Decreased dolutegravir effectiveness-

Avoid combination if possible. If using, dose dolutegravir 50 mg twice daily in INSTI-naïve adult patients. If known or clinically suspected InSTI resistance use alternative agent.

Alternative Agents:
Gabapentin, Lamotrigine, Levitiracetam, Tiagabine Topiramate

Daclatasvir747
(Daklinza)
60 mg daily50 mg daily No significant changeDolutegravir Cmax increased 29%; AUC increased 33%; Cmin increased 45%--

No dose adjustment necessary

Darunavir641
(DRV)(Prezista)
600 mg BID with ritonavir 100 mg BID30 mg QD-Dolutegravir AUC: decreased 22%; Cmin: decreased 38% --

No dose adjustment necessary

Dofetilide691
(Tikosyn)
--Not studied; may increase dofetilide levels-Potential increased dofetilide toxicityDTG may increase plasma concentrations of drugs eliminated by OCT2 or MATE1

Contraindicated - do not coadminister

Efavirenz641
(EFV)(Sustiva)
600 mg QD50 mg QD-Dolutegravir AUC: decreased 57%; Cmin: decreased 75% Potentially reduced dolutegravir effectiveness-

If no INSTI resistance, increase dolutegravir dosage to 50 mg BID. If known or clinically suspected INSTI resistance, use alternative combination

Coadministered DrugDose of DrugDose of DolutegravirEffect on Drug LevelsEffect on Dolutegravir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Elbasvir/grazoprevir641
(Zepatier)
elbasvir 50 mg + grazoprevir 200 mg once daily50 mg x 1No significant change in elbasvir. Grazoprevir Cmax decreased 36%; AUC decreased 19%; Cmin decreased 14%Dolutegravir Cmax increased 22%; AUC increased 16%--

No dose adjustment necessary

Ethinyl estradiol/norgestimate641
(others)(Ortho Tri-Cyclen, Ortho Tri-Cyclen)
0.035 mg ethinyl estradiol50 mg BIDNo significant change---

No dose adjustment necessary

Etravirine641
(ETR)(Intelence)
200 mg BID50 mg QD-Dolutegravir AUC: decreased 71%; Cmin: decreased 88%Potentially reduced dolutegravir effectiveness-

Do not coadminister etravirine with dolutegravir unless boosted atazanavir, darunavir or lopinavir are also being used concomitantly.

Etravirine641
(ETR)(Intelence)
200 mg BID with darunavir/ritonavir 600/100 mg BID50 mg QD-Dolutegravir AUC: decreased 25%; Cmin: decreased 37% Potentially reduced dolutegravir effectiveness-

If no INSTI resistance, no dose adjustment necessary. If known or clinically suspected INSTI resistance, increase dolutegravir dosage to 50 mg BID

Etravirine641
(ETR)(Intelence)
200 mg BID with lopinavir/ritonavir 400/100 mg BID50 mg QD-Dolutegravir AUC increased 11%; Cmin: increased 28%--

If no INSTI resistance, no dose adjustment necessary. If known or clinically suspected INSTI resistance, increase dolutegravir dosage to 50 mg BID

Ferrous fumarate687
(Iron)
324 mg50 mg-Dolutegravir AUC decreased 54% when administered simultaneously with ferrous fumarate, fasting conditions. No significant change in dolutegravir AUC if given simultaneously with ferrous fumarate, with food or if given 2 hours after ferrous fumarate.Potentially decreased dolutegravir effectiveness if given with iron.Chelation of dolutegravir by divalent cations

Administer dolutegravir 2 hours before or 6 hours after medicines with divalent cations (Ca++, Fe++). Alternatively, dolutegravir can be taken simultaneously with iron supplements, with food.

Coadministered DrugDose of DrugDose of DolutegravirEffect on Drug LevelsEffect on Dolutegravir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Fosamprenavir641
(FPV)(Lexiva)
700 mg BID with ritonavir 100 mg BID50 mg QD-Dolutegravir AUC: decreased 35%; Cmin: decreased 49% Potentially reduced dolutegravir effectiveness-

If no INSTI resistance, increase dolutegravir dosage to 50 mg BID. If known or clinically suspected INSTI resistance, use alternative combination

Isoniazid753
(INH, others)(Tubizid)
15 mg/kg + rifapentine 900 mg once weekly50 mg once dailyINH AUC increased 67-92% in 2/4 subjects. Rifapentine no significant change.DTG AUC decreased 46%; Cmin decreased 74%Potential adverse effects of isoniazid (flu-like symptoms, nausea, vomiting, and fever)-

Do not coadminister

Lopinavir/ritonavir641
(LPV/r)(Kaletra)
400/100 mg BID30 mg QD-No significant change --

No dose adjustment necessary

Metformin
(Glucophage)
500 mg BID50 mgMetformin AUC increased 79%; Cmax increase 66%, Cmin increase 9% when given with dolutegravir once daily. If given with dolutegravir 50 mg BID, then metformin AUC increase 2.4 fold; Cmax increase 2 fold and Cmin increase 14%. -Potential increased adverse effects from metformin (e.g. GI side effects).-

In patients taking dolutegravir who are starting metformin, begin with low metformin dose and titrate up carefully. Recommended dose limit of metformin 1000 mg daily. If patient is already on metformin and initiating dolutegravir, monitor glucose, hemoglobin a1c, and metformin adverse effects and adjust dose as necessary.

Methadone641
(Dolophine)(Dolophine)
16-150 mg50 mg BIDNo significant change ---

No dose adjustment necessary

Midazolam641
(Versed)(Versed)
3 mg25 mg QDNo significant change ---

No dose adjustment necessary

Coadministered DrugDose of DrugDose of DolutegravirEffect on Drug LevelsEffect on Dolutegravir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Multiple vitamin641
One-A-Day given simultaneously with dolutegravir50 mg x 1-Dolutegravir AUC: decreased 33%; Cmin: decreased 32%Potentially decreased dolutegravir effectiveness-

Administer dolutegravir 2 hours before or 6 hours after multivitamins.

Nevirapine691
(NVP)(Viramune)
200 mg QD; 200 mg BID; 400 mg QD (XR formulation)50 mg QD-Dolutegravir AUC: decreased 19%; Cmin: decreased 34%--

No dose adjustment necessary

Norelgestromin641
0.25 mg50 mg BIDNo significant change---

No dose adjustment necessary

Omeprazole641
(Prilosec)(Prilosec)
40 mg QD50 mg x 1-No significant change --

No dose adjustment necessary

Oxcarbazepine691
(Oxtellar, Trileptal)
---Not studied; may decrease dolutegravir levels Potentially decreased dolutegravir effectiveness-

Contraindicated - consider alternative anticonvulsants

Alternative Agents:
Gabapentin, Lamotrigine, Levitiracetam, Tiagabine Topiramate

Phenobarbital
(Luminal, others)(Luminal)
---Not studied; may decrease dolutegravir levelsPotentially decreased dolutegravir effectiveness-

Contraindicated - consider alternative anticonvulsants

Alternative Agents:
Gabapentin, Lamotrigine, Levitiracetam, Tiagabine Topiramate

Coadministered DrugDose of DrugDose of DolutegravirEffect on Drug LevelsEffect on Dolutegravir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Phenytoin691
(Dilantin)(Dilantin)
---Not studied; may decrease dolutegravir levelsPotentially decreased dolutegravir effectiveness-

Contraindicated; consider alternative anticonvulsants

Alternative Agents:
Gabapentin, Lamotrigine, Levitiracetam, Tiagabine Topiramate

Prednisolone641
(others)
60 mg QD with taper50 mg QD-Dolutegravir Cmin: increased 17% --

No dose adjustment necessary

Rifabutin641
(Mycobutin)(Mycobutin)
300 mg QD50 mg QD-Dolutegravir Cmin: decreased 30% --

No dose adjustment necessary

Rifampin641
(Rifampicin)(Rifadin)
600 mg QD50 mg BID-Dolutegravir AUC: decreased 54%; Cmin: decreased 72% (when compared to dolutegravir 50 mg BID without rifampin)Decreased dolutegravir effectiveness-

If no InSTI resistance, increase dolutegravir dosage to 50 mg BID. If known or clinically suspected INSTI resistance, use alternative or consider rifabutin

Rifampin641
(Rifampicin)(Rifadin)
600 mg QD50 mg BID-Dolutegravir AUC: increased 33%; Cmin: increased 22% (when compared to dolutegravir 50 mg QD)--

If no INSTI resistance, increase dolutegravir dosage to 50 mg BID. If known or clinically suspected INSTI resistance, use alternative or consider rifabutin

Rifapentine691
(Priftin)
---Not studied; may decrease dolutegravir levelsPotentially decreased dolutegravir effectiveness-

Contraindicated - do not coadminister

Coadministered DrugDose of DrugDose of DolutegravirEffect on Drug LevelsEffect on Dolutegravir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Rilpivirine641
(RPV)(Edurant)
25 mg QD50 mg QD Rilpivirine Cmin increased 21%Dolutegravir Cmin: increased 22%--

No dose adjustment necessary

Sofosbuvir/velpatasvir691
(Epclusa)
400/100 mg daily50 mg dailySofosbuvir Cmax decreased 12%; AUC decreased 8%. No significant change in sofosbuvir metabolite GS-331007. Velpatasvir Cmax decreased 6%; AUC decreased 9%; Cmin decreased 12%. Not studied--

Administer standard doses

St. John's Wort691
(Hypericum perforatum)
---Not studied; may decrease dolutegravir levelsPotentially decreased dolutegravir effectiveness Induction of CYP450 3A4 by St. John's Wort

Contraindicated - do not coadminister

Sucralfate689
(Carafate)
---Not studied - may result in decreased dolutegravir concentrationsPotentially decreased dolutegravir effectiveness -

Administer dolutegravir 2 hours before or 6 hours after sucralfate.

Telaprevir641
(Incivek)
750 mg Q8H50 mg QD-Dolutegravir AUC: increased 25%; Cmin: increased 40%--

No dose adjustment necessary

Tenofovir alafenamide
10 mg QD 50 mg QDNo significant changeNo significant change--

No dose adjustment necessary

Tenofovir disoproxil fumarate641
(TDF)(Viread)
300 mg QD50 mg QD TDF AUC: increased 12%; Cmin: increased 19%No significant change--

No dose adjustment necessary

Tipranavir641
(TPV)(Aptivus)
500 mg BID with ritonavir 200 mg BID50 mg QD-Dolutegravir AUC: decreased 59%; Cmin: decreased 76%Potentially reduced dolutegravir effectiveness-

If no INSTI resistance, increase dolutegravir dosage to 50 mg BID. If known or clinically suspected INSTI resistance, use alternative combination

"-" indicates that there are no data available
 641:Tivicay [package insert]. Research Triangle Park, NC: Viiv Healthcare; Sept 2013.
 685:Song I, Borland J, Arya N, Wynne B, Piscitelli S. The effect of calcium and iron supplements on the pharmacokinetics of Dolutegravir in healthy subjects. 15th International Workshop on Clinical Pharmacology of HIV and Hepatitis Therapy. May 19-21, 2014. Washington, DC. Abstract P_13.
 687:Song, I., Borland, J., Arya, N., Wynne, B. and Piscitelli, S. (2015), Pharmacokinetics of dolutegravir when administered with mineral supplements in healthy adult subjects. Journal of Clinical Pharma, 55: 490–496
 689:Tivicay [package insert]. Research Triangle Park, NC: Viiv Healthcare; August 2015
 691:Tivicay [package insert]. Research Triangle Park, NC: Viiv Healthcare; August 2015
 747:Daklinza [package insert]. Princeton, NJ: Bristol-Myers Squibb Company, 2016
 753:Brooks KM, Pau AK, George JM, Kellogg A, McLaughlin M, McManus M, Hadigan C, Kovacs JA, Kumar P. Early termination of a PK study between dolutegravir and weekly isoniazid/rifapentine. Conference on Retroviruses and Opportunistic Infections 2017. February 13–16, 2017. Seattle, Washington. Abstract 409a.