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Database of Antiretroviral Drug Interactions

Interactions with Metformin and Antiretrovirals

Antiretroviral (ARV)Dose of ARVDose of MetforminEffect on ARV LevelsEffect on Metformin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Bictegravir759
(Biktarvy)
50 mg daily500 mg twice dailyNot studied Cmax inccreased 28%; AUC increased 39%; Cmin increased 36%.Potential increase in metformin adverse effects (gastrointestinal) -

No dose adjustment necessary; monitor for gastrointestinal adverse effects

Dolutegravir
(Tivicay)
50 mg500 mg BID-Metformin 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.

"-" indicates that there are no data available
 759:Biktarvy [package insert]. Foster City, CA: Gilead Sciences, 2018