Drugs suspected to be involved in the DDI-summary
Complete list of drugs taken by the patient
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.
Drug Interaction Probability Scale (DIPS)
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.