Date of report 09 May 2024
Reported case interaction between
Dolutegravir and ESLICABAZEPINE
Dolutegravir and ESLICABAZEPINE
Drugs suspected to be involved in the DDI
Complete list of drugs taken by the patient
Eslicarbazepine 800mg/d
Dolutegravir 50mg/d
Lamivudine 300mg/d
Clinical case description
Male person with HIV and long-term epilepsy. HIV infection diagnosed 8 years before, nadir CD4 count 360 cells/ul, current CD4 count 704 cells/ul. Always undetectable VL since ART initiation, months after diagnosis. No virological failures, blips or low-level viremia during follow-up. Due to lack of response to treatment of the epilepsy, levetiracetam was changed to eslicarbazepine, which is expeced to reduce DTG exposure. DTG dose was increased to 50mg/12 hs, and the person remained undetectable since then, and he mantained the same treatments until now.
Clinical Outcome
Editorial Comment
This is an interesting case on the possible use of twice daily dolutegravir with eslicarbazepine. No data is available on this specific drug-to-drug interaction but data on CYP3A4 and UGT1A1 induction by eslicarbamazepine have been published. While therapeutic drug monitoring could be useful and it may inform on the need of an increased dose of dolutegravir (given also the recent studies on once daily dolutegravir and rifampicin) it seems reasonable to suggest an increse in the dose of the integrase inhibitor. The case support this indication and confirm the maintained efficacy and the lack of side effect with this combination.
University of Liverpool Recommendation
Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration