Date of report 22 Dec 2021
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
Magnesium supplements
Clinical case description
An overall healthy man living with HIV had long history of ART for more than 12 years including several ARV regimens (3TC/ABC/NEV; 3TC/ABC/ATV/r; 3TC/ABC/DTG and 3TC/DTG ). He always presented undetectable viral load for more than 10 years and always reported good adherence to ART. He had no other relevant medical history and he was not taking any other regular medication apart from ART.
In august 2021, he presented with detectable VL at 80 copies/mL for the first time since ART initiation more than 10 years before. He denied any adherence problems or any new medication. However, when specifically asked, he referred had started some months before a natural supplement recommended by his personal trainer at the gym. Checking the composition of the supplement, it included Mg2+. It was indicated to stop this supplement and VL was repeated 6 weeks later, becoming again undetectable.
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