Dolutegravir

Aluminium / Magnesium hydroxide

A spacing between the drugs is required.

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 : administer 2 hours before or 6 hours after the antacid.

Juluca : administer 4 hours before or 6 hours after the antacid.

Monitor for clinical efficacy.

Alternative solution(s)

Aluminium / Magnesium hydroxide

Pharmacodynamic effects

Recommendations

Avoid association, if possible.

Alternative solution(s)

For Tivicay, Triumeq or Dovato : H2 receptor antagonists or proton pump inhibitors. For Juluca : H2 receptor antagonists administered 4 hours or 12 hours after Juluca. Proton Pump Inhibitors contraindicated.

Monitor

Tests

CD4+

Viral load HIV

Dolutegravir plasma level

Pharmacokinetic parameters
Parameters
Reference number
# patients
HIV
Dose
Frequency
AUC
Cmax
Cmin
Dolutegravir
2824 2824
16 16
- -
50 mg * 50 mg †
x 1 x 1
- 74% - 26%
- 72% - 18%
- 74% - 30%
Aluminium / Magnesium hydroxide
2824 2824
16 16
- -
20 ml 20 ml
   
   
   
   
Comment

Ref #2824 : * Dolutegravir administered
simultaneously with the antacid.
† Dolutegravir administered2 hours before the antacid.
Dolutegravir should not be taken together with Maalox or any antacids containing significant amounts of metal cations. Administration of antacid 2 hours after dolutegravir attenuated the impact of antacid. The mean C24h of 0.56μg/mL with a 2 hour separation of antacid represents a value of 5.6-fold above the PA-IC90. It is recommended that dolutegravir should be administered 2 hours before or 6 hours after antacids.

Reference
  • 2824
    Patel P, Song I, Borland J, et al. Pharmacokinetics of the HIV integrase inhibitor S/GSK1349572 co-administered with acid-reducing agents and multivitamins in healthy volunteers. J Antimicrob Chemother 2011; 66 (7):1567-72.
  • 2868
    Dolutegravir (Tivicay), ViiV Healthcare, Quebec, Canada, 31 janv. 2020.
  • 2858
    Dolutegravir (Tivicay), US Prescribing Information, ViiV Healthcare, August 2013.
  • 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.