Dolutegravir

Iron (supplements)

A spacing between the drugs is required if dolutegravir is taken fasting.

No pharmaceutical opinion available for this interaction.

Mechanism

Cations by chelation may reduce the absorption of Dolutegravir.

Dolutegravir

Pharmacodynamic effects

Possible decrease of clinical efficacy.

Recommendations

Tivicay, Triumeq or Dovato : If taken with food: it may be taken with iron without spacing dose. If taken fasting: it must be taken 2 hours before or 6 hours after taking iron.

Tivicay, Triumeq or Dovato : If dolutegravir is prescribed at 50 mg BID and dolutegravir resistance is demonstrated, avoid combination with calcium or iron supplement.

If combination can not be avoided taking dolutegravir with food should be preferred, perform dolutegravir plasma level monitoring and closely monitor clinical effectiveness.

Juluca : If taken with food: it may be taken with iron without spacing dose. If taken fasting: it must be taken 4 hours before or 6 hours after taking iron.

Monitor for clinical efficacy.

Alternative solution(s)

Iron (supplements)

Pharmacodynamic effects

Recommendations

Alternative solution(s)

Monitor

Tests

CD4+

Viral load HIV

Dolutegravir plasma level

Pharmacokinetic parameters
Parameters
Reference number
# patients
HIV
Dose
Frequency
AUC
Cmax
Cmin
Dolutegravir
2981 2981 2981
11 11 10
- - -
50 mg 50 mg 50 mg
x 1 * x 1 † x 1 °
- 54% - 2% - 5%
- 57% ± 0% - 8%
- 56% + 3% - 1%
Iron (supplements)
2981 2981 2981
11 11 10
- - -
324 mg 324 mg 324 mg
x 1 * x 1 † x 1 °
     
     
     
Comment

Ref #2981 : * Administered simultaneously fasten; † Administered simultaneously with food; ° Iron administered 2 hours after dolutegravir.
Co-administration of dolutegravir with calcium or iron under fed condition, or dosing dolutegravir 2 hours prior to the administration of these supplements yielded dolutegravir exposures similar to those when dolutegravir was given alone under fasted conditions.

However, taking vitamins (containing 162 mg of calcium, 100 mg of magnesium, iron, zinc and copper) had no clinically significant impact on the concentration of dolutegravir. See multivitamins + dolutegravir.

Reference
  • 2868
    Dolutegravir (Tivicay), ViiV Healthcare, Quebec, Canada, 27 août 2018.
  • 2858
    Dolutegravir (Tivicay), US Prescribing Information, ViiV Healthcare, August 2013.
  • 3120
    Dolutégravir/abacavir/lamivudine (Triumeq), ViiV Healthcare, Québec, Canada, 27 août 2018.
  • 2981
    Song I, Borland J, Arya N, Wynne B et Piscitelli S. Pharmacokinetics of Dolutegravir When Administered With Mineral Supplements in Healthy Adult Subjects. J Clin Pharmacol. 2015 May; 55(5): 490–496.
  • 3441
    Dolutegravir/Rilpivirine (Juluca), ViiV Healthcare ULC, Quebec, Canada, 27 août 2018.
  • 3497
    Dolutegravir/Lamivudine (Dovato), ViiV Soins de santé ULC, Québec, Canada, 22 août 2019.