Dolutegravir

St. John's Wort

Dosage adjustment is recommended.

No pharmaceutical opinion available for this interaction.

Mechanism

St. John's Wort may induce the metabolism (UGT 1A1 and CYP3A) and decrease the plasma concentration of Dolutegravir.

Dolutegravir

Pharmacodynamic effects

Possible decrease of clinical efficacy.

Recommendations

Tivicay : An increased dose of dolutegravir to 50 mg BID is recommended.

Triumeq or Dovato : Administer an additional dose of 50 mg dolutegravir 12 hours after Triumeq or Dovato.

Monitor for clinical efficacy.

Avoid combination in patients with resistance to integrase inhibitors.

Juluca : Concomitant administration contraindicated.

Alternative solution(s)

St. John's Wort

Pharmacodynamic effects

Recommendations

Alternative solution(s)

Monitor

Tests

CD4+

Viral load HIV

Pharmacokinetic parameters

Comment

Co-administration has not been studied. However, St. John's Wort is a potent inducer of CYP3A4 such as carbamazepine, so we can expect similar reductions as seen in the interaction between carbamazepine and dolutegravir. See dolutegravir and carbamazepine.

Reference
  • 2868
    Dolutegravir (Tivicay), ViiV Healthcare, Quebec, Canada, 31 janv. 2020.
  • 3120
    Dolutégravir/abacavir/lamivudine (Triumeq), ViiV Healthcare, Québec, Canada, 31 janv. 2020.
  • 3441
    Dolutegravir/Rilpivirine (Juluca), ViiV Healthcare ULC, Quebec, Canada, 5 fév. 2020.
  • 3497
    Dolutegravir/Lamivudine (Dovato), ViiV Soins de santé ULC, Québec, Canada, 29 septembre 2020.
  • 3054
    Song I, Weller S, Patel J, Borland J, Wynne B et al. Effect of carbamazepine on dolutegravir pharmacokinetics and dosing recommendation. Eur J Clin Pharmacol 2016; 72: 665-670.