An HIV integrase inhibitor

Dolutegravir

An integrase inhibitor that is a preferred, potent part of modern HIV combination therapy.

What is Dolutegravir?

Dolutegravir is an HIV integrase inhibitor used as part of combination treatment for HIV. It is potent, generally well tolerated and works quickly to lower the amount of virus, but it is not a cure and must be taken every day as prescribed. It is often combined with one or two other antiretrovirals.

Education and reference only. This is a plain-language guide to Dolutegravir — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.

Written by Meds Global Health Clinical Team · Clinically reviewed by Dr Muhammad Suffyan, MB BS, Founder & Clinical Director · Last reviewed · How we review
Class: Antiretrovirals (HIV) → Brands: Tivicay
Dolutegravir (Antiretrovirals (HIV)) — Meds Global Health reference card with 2D molecular structure
Dolutegravir — Antiretrovirals (HIV). The image shows the active ingredient's 2D molecular structure.

What it is

Dolutegravir is an integrase strand transfer inhibitor used to treat HIV. It is a preferred medicine in many UK regimens because it is effective, has a high barrier to resistance and is usually well tolerated. It is used with other antiretrovirals, and in some regimens with just one partner medicine.

How it works

After HIV enters a cell, it uses an enzyme called integrase to insert its genetic material into the cell's own DNA. Dolutegravir blocks integrase, so the virus cannot complete this step and cannot set up a lasting infection in new cells. This rapidly lowers the amount of virus in the body and helps the immune system recover.

Company & origin

Originated / developed by: Developed by ViiV Healthcare..

Approved in the early 2010s and now a preferred component of many UK HIV regimens.

Practical use

How to take Dolutegravir

General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.

  • Take it every day, at around the same time, as part of your regimen.
  • It can be taken with or without food, though food can help if taken with certain other medicines.
  • Separate it in time from antacids and supplements containing calcium, magnesium or iron.
  • Keep taking it even when you feel well, and do not skip doses.
  • If you miss a dose, take it as soon as you remember unless the next is near, then skip it; never double up.
  • Tell your team if you are planning a pregnancy so your regimen can be reviewed.

Weighing it up

Advantages & disadvantages of Dolutegravir

Advantages

  • Potent and fast-acting, with a high barrier to resistance.
  • Generally well tolerated and taken once a day.
  • Allows simpler regimens, sometimes with only one partner medicine.

Disadvantages

  • Can cause weight gain in some people.
  • Interacts with antacids and mineral supplements, which must be spaced apart.
  • Needs a prescriber discussion around conception because of an earlier, now largely reassured, neural-tube signal.

Practical use

Good to know

Dolutegravir must be taken every day, exactly as prescribed, to keep the virus suppressed and prevent resistance. It is not a cure. Some people gain weight on it. If you might become pregnant, discuss this with your team: an early signal of a rare risk to the baby's neural-tube development has since been largely reassured, but it is worth talking through around the time of conception.

Who should not take it / use with caution

  • People who are allergic to dolutegravir.
  • People taking certain medicines (such as dofetilide) that must be avoided with it.
  • Anyone planning pregnancy should discuss the latest advice with their HIV team.

Monitoring

  • HIV viral load and CD4 count to confirm suppression.
  • Weight and general metabolic health over time.
  • Pregnancy plans and the latest safety advice where relevant.

Side effects

  • Headache, difficulty sleeping and nausea.
  • Weight gain over time in some people.
  • Occasional mood changes or low mood; report these to your team.

Key interactions

  • Antacids and supplements with calcium, magnesium or iron reduce its absorption if taken together.
  • Some epilepsy medicines and rifampicin can lower its levels.
  • Share a full medicines list, including supplements, with your HIV team.

Available as: Available as tablets, sometimes combined with other antiretrovirals in a single pill.

Answers

Dolutegravir: frequently asked questions

Why must I separate it from antacids?

Calcium, magnesium and iron in antacids and supplements bind dolutegravir and stop it being absorbed properly. Take them well apart, as advised by your team.

Can dolutegravir cause weight gain?

Some people do gain weight on dolutegravir. If you notice this, your team can review your diet, activity and overall regimen.

Is dolutegravir safe in pregnancy?

An earlier concern about a rare neural-tube effect has been largely reassured by later evidence. Still discuss any pregnancy plans with your team so they can give you up-to-date advice.

Does it cure HIV?

No. It powerfully suppresses HIV as part of your regimen but does not remove the virus, so it must be taken every day.

Can I take it once a day?

Yes, dolutegravir is usually a once-daily medicine, which makes regimens simpler. Follow the exact instructions for your specific product.

The wider class

About Antiretrovirals (HIV)

Dolutegravir belongs to the antiretrovirals (hiv) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.

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Authoritative sources

  • BNF
  • NICE CKS

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