What is dolutegravir?
Dolutegravir is a medication used to treat HIV, marketed under the brand name Tivicay. It is taken in combination with other antiretroviral drugs.
The usual adult dose of dolutegravir is one 50mg tablet once a day. If you are taking certain other medications, you may be prescribed a dose of one 50mg tablet twice a day.
Dolutegravir is also available in combination pills with lamivudine and abacavir (marketed as Triumeq), with lamivudine (marketed as Dovato) and with rilpivirine (marketed as Juluca).
How does dolutegravir work?
Dolutegravir is from a class of drugs known as integrase inhibitors. Your doctor will prescribe dolutegravir as part of your HIV treatment, along with antiretrovirals from another class of drugs. It is important to take all the drugs as prescribed, every day. Each drug class works against HIV in a different way.
The aim of HIV treatment is to reduce the level of HIV in your body (viral load). Ideally, your viral load should become so low that it is undetectable – usually less than 50 copies of virus per ml of blood. Taking HIV treatment and having an undetectable viral load protects your immune system and stops HIV being passed on to someone else during sex.
How do I take dolutegravir?
You can usually take dolutegravir with or without food. If you are prescribed dolutegravir to be taken twice a day, your doctor will advise you to take it with food.
HIV treatment works best if you take it every day. When would be a good time for you to plan to take your treatment? Think about your daily routine and when you will find it easiest to take your treatment.
If you forget to take a dose of dolutegravir, take it as soon as you remember. If your next dose is due within four hours, then don’t take a double dose, just skip the dose you’ve forgotten and carry on.
If you regularly forget to take your treatment, or you aren’t taking it for another reason, it’s important to talk to your doctor about this.
What are the possible side effects of dolutegravir?
All drugs have possible side effects. It’s a good idea to talk to your doctor about possible side effects before you start taking a drug. If you experience something that might be a side effect, talk to your doctor about what can be done. A full list of side effects, including less common side effects, should be included in the leaflet that comes in the packaging with dolutegravir.
We generally divide side effects into two types:
Common – a side effect that occurs in at least one in a hundred people (more than 1%) who take this drug.
Rare – a side effect that occurs in fewer than one in a hundred people (less than 1%) who take this drug.
Common side effects of dolutegravir include (most common in bold):
- headache; insomnia (difficulty sleeping); dizziness; abnormal dreams; depression; lack of energy (fatigue).
- diarrhoea; feeling sick (nausea); being sick (vomiting); abdominal pain or discomfort; wind (flatulence).
- rash; itching.
- increase in the level of liver enzymes; increase in the level of enzymes produced in the muscles (creatine phosphokinase).
Rarely, dolutegravir can cause a hypersensitivity (allergic) reaction. If you develop a rash with other symptoms, such as a fever, seek medical advice.
People with HIV may gain weight after starting antiretroviral treatment. Clinical trials of new HIV drugs introduced since 2003 show that people taking dolutegravir are at higher risk of substantial weight gain than people taking other antiretroviral drugs.
Does dolutegravir interact with other drugs?
You should always tell your doctor and pharmacist about any other drugs or medication you are taking. That includes anything prescribed by another doctor, medicines you have bought from a high-street chemist, herbal and alternative treatments, and recreational or party drugs (‘chems’).
Some medicines or drugs are not safe if taken together – the interaction could cause increased, dangerous levels, or it could stop one or both of the drugs from working. Other drug interactions are less dangerous but still need to be taken seriously. If levels of one drug are affected, you may need to change the dose you take. This must only be done on the advice of your HIV doctor.
A list of drugs, known to have interactions with dolutegravir, should be included in the leaflet that comes in the packaging with dolutegravir. Tell your doctor if you are taking any of these drugs, and other drugs that are not on the list.
If you are taking dolutegravir, it is particularly important to check with your HIV doctor or pharmacist before taking any of the following medicines:
- carbamazepine
- oxcarbazepine
- metformin
- phenobarbital
- phenytoin
- rifampicin
- St John’s Wort
Taking calcium, iron, magnesium or aluminium can stop you from absorbing dolutegravir properly – all multivitamins, mineral supplements and antacids (used to treat heartburn or indigestion) must be taken at least six hours before or two hours after dolutegravir.
Can I take dolutegravir in pregnancy?
If you are considering having a baby, or think you might be pregnant, talk to your doctor as soon as possible about which combination of anti-HIV medications would be right for you. It is important to take antiretroviral treatment during pregnancy to prevent passing HIV from mother to baby.
Initial studies found that dolutegravir was associated with a slight increase in neural tube defects. Neural tube defects affect the development of your baby’s brain and spine. It’s important to know that this increase was small and that more recent studies suggest that there is no increased risk.
Whether you continue to take dolutegravir or switch medication is your decision.
The World Health Organization has recommended that all adults and adolescents with HIV, including pregnant people, should start treatment with a dolutegravir-containing regimen.
The British HIV Association currently lists dolutegravir (in combination with other medications) as an option that may be considered if you begin HIV treatment later on in pregnancy, depending on your individual circumstances.
Can children take dolutegravir?
A dispersible tablet is approved for use by infants and children. Tablets of 10mg, 25mg or 50mg can be used by children aged 6 years and over.
Talking to your doctor
If you have any concerns about your treatment or other aspects of your health, it’s important to talk to your doctor about them.
For example, if you have a symptom or side effect or if you are having problems taking your treatment every day, it’s important that your doctor knows about this. If you are taking any other medication or recreational drugs, or if you have another medical condition, this is also important for your doctor to know about.
Building a relationship with a doctor may take time. You may feel very comfortable talking to your doctor, but some people find it more difficult, particularly when talking about sex, mental health, or symptoms they find embarrassing. It’s also easy to forget things you wanted to talk about.
Preparing for an appointment can be very helpful. Take some time to think about what you are going to say. You might find it helpful to talk to someone else first, or to make some notes and bring them to your appointment.
For detailed information on this drug, visit the dolutegravir page in the A-Z of antretroviral medications.