Date of report: 22 Jun 2020
Reported case interaction between
 Dolutegravir and Mineral Supplements

FLS Science

Drugs suspected to be involved in the DDI

Drug A
Dolutegravir (Victim)
Daily Dose
50 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
April 2, 2018
End date
Ongoing
Drug B
Mineral Supplements (Perpetrator)
Daily Dose
420 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Unknown
End date
Unknown

Complete list of drugs taken by the patient

Antiretroviral treatment
Dolutegravir/Abacavir/Lamivudine
Complete list of all comedications taken by the patient, included that involved in the DDI
Magnessium supplements

Clinical case description

Gender
Female
Age
40
eGFR (mL/min)
>60
Liver function impairment
No
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.

Outcome

Loss of efficacy

Drug Interaction Probability Scale (DIPS)

Score
6 - Probable

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.