Immunodeficiency Clinic > Drug Interaction Guide
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Dolutegravir & Calcium [class:yellow]
Summary/Recommendation:
Dolutegravir (Tivicay, Triumeq; see separate recommendations for dolutegravir/rilpivirine, Juluca):
Dolutegravir should be administered 2 hours before or 6 hours after medications containing polyvalent cations (e.g., Mg, Al, Fe, or Ca) including cation-containing antacids or laxatives, sucralfate, oral iron or calcium supplements, and buffered medications. If taken with food, dolutegravir may be taken at the same time as calcium or iron supplements.
Dolutegravir can be co-administered with multivitamins with minerals if taken together with food. Alternately, dolutegravir should be taken 2 hours before or 6 hours after medications containing polyvalent cations.
Dolutegravir/rilpivirine (Juluca):
Administer dolutegravir/rilpivirine and calcium/iron supplements together with a meal or take dolutegravir/rilpivirine 4 hours before or 6 hours after taking these supplements.
Data:
Calcium carbonate 1200 mg or ferrous fumarate 324 mg:
- Dolutegravir exposures comparable to dolutegravir given alone if co-administered under fed conditions.
- Dolutegravir exposures ↓ 37-39% with calcium and ↓ 54-57% with iron, if co-administered in the fasted state.2330 2394
Dolutegravir (Tivicay, Triumeq; see separate recommendations for dolutegravir/rilpivirine, Juluca):
Dolutegravir should be administered 2 hours before or 6 hours after medications containing polyvalent cations (e.g., Mg, Al, Fe, or Ca) including cation-containing antacids or laxatives, sucralfate, oral iron or calcium supplements, and buffered medications. If taken with food, dolutegravir may be taken at the same time as calcium or iron supplements.2330
Rilpivirine/dolutegravir (Juluca):
- Antacids: Administer dolutegravir/rilpivirine 4 hours before or 6 hours after taking antacids.2974
- Oral calcium/iron supplements including multivitamins: Administer together with a meal or take these supplements 4 hours before or 6 hours after taking dolutegravir/rilpivirine.2974
Multivitamins:
Healthy volunteers received four single-dose treatments: dolutegravir 50 mg alone, dolutegravir 50 mg with a multivitamin with minerals (One a Day Maximum- each tablet containing elemental calcium 162 mg, magnesium 100 mg, and iron, zinc and copper), dolutegravir 50 mg with a liquid antacid (Maalox Advanced Maximum Strength- each 5 mL containing 400 mg AlOH and MgOH), and dolutegravir 50 mg 2 hours before an antacid. Dolutegravir AUC was ↓ by 33% when coadministered with a multivitamin, however the dolutegravir Cmin was still 5-fold above the protein-adjusted IC-90 with this combination. Dolutegravir AUC was ↓ 74% with simultaneous antacid administration, and ↓ 26% with staggered antacid administration.1944
Although the interaction between dolutegravir and co-administered multivitamins with minerals is likely not clinically significant,1944 to mitigate the interaction the manufacturer recommends taking any calcium and iron-containing products and dolutegravir together with food or taking dolutegravir 2 hours before or 6 hours after medications containing polyvalent cations.2330
