Date of report 22 Jun 2020
Reported case interaction between
Dolutegravir and Mineral supplements
Dolutegravir and Mineral supplements
Drugs suspected to be involved in the DDI
Complete list of drugs taken by the patient
Magnessium supplements
Clinical case description
40 year-old woman, diagnosed with HIV infection in April 2004. Since April 2018 on cART with DTG/ABC/3TC, with undetectable plasma viral load (pVL). In March 2019 pVL was 120 copies/mL, but she assured being adherent to cART. Three months after, repeated pVL was 380 copies/mL. TDM showed low dolutegravir Ctrough (0.38 μg/mL). Repeated adherence consultation revealed intake of Mg++ supplements (magnesium citrate, 420 mg QD) together with Triumeq at night. The patient was advised to stop taking magnesium at the same time with dolutegravir, and to take it either 2-3 hours before or 6 hours after taking dolutegravir. After several months she achieved undetectable pVL again.
Clinical Outcome
Drug Interaction Probability Scale (DIPS)
Editorial Comment
Dolutegravir binds to divalent cations, such as magnesium, and forms a complex at the level of the gastro-intestinal tract which results in less dolutegravir being absorbed. Dolutegravir should be administered 2 hours before or 6 hours after taking medications containing magnesium. Dolutegravir should be administered 2 hours before or 6 hours after taking medications containing magnesium.
University of Liverpool Recommendation
Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration