dolutegravir (Tivicay, DTG)
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Indications
- for use in combination with other antiretrovral agents (tenofovir (TDF) & lamivudine (3TC) or tenofovir (TDF) & emtricitabine (FTC) in treatment of HIV1 patients age 12 and older at least 40 kg who have not previously taken an integrase inhibitor[1]
- dolutegravir is more effective, has fewer side effects, is easier to take, and is less likely to develop drug resistance compared with other antiretroviral drugs[5]
- WHO recommends dolutegravir as the preferred 1st- & 2nd-line HIV1 treatment for all patients, including pregnant women & those of childbearing age[5]
Contraindications
* previously avoid during pregnancy (data insufficient)[2] or conception[4]
* WHO has determined that dolutegravir is safe during pregancny[5]
Dosage
Adverse effects
common
- insomnia
- headache
- increase in serum creatinine due to decrease in tubular secretion, not GFR[3]
- otherwise well tolerated[3]
serious
- hypersensitivity reactions
- abnormal liver function in participants co-infected with hepatitis B &/or hepatitis C
increased risk of neural tube defects in babies born to women who became pregnant while receiving the drug[4]
Mechanism of action
More general terms
Component of
References
- ↑ 1.0 1.1 FDA News Release: Aug. 12, 2013 FDA approves new drug to treat HIV infection
- ↑ 2.0 2.1 Zuger A Use of Antiretroviral Drugs in Pregnancy. Physician's First Watch, April 22, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States. 2014. AIDSinfo. Clinical Guidelines Portal. March 28, 2014. http://aidsinfo.nih.gov/Guidelines/HTML/3/perinatal-guidelines/0 (corresponding NGC guideline withdrawn March 2016) - ↑ 3.0 3.1 3.2 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ 4.0 4.1 4.2 Sax PE Why the Dolutegravir Pregnancy Warning is Important - and What We Should Do Now NEJM Journal Watch. HIV and ID Observations. May 21, 2018 https://blogs.jwatch.org/hiv-id-observations/index.php/dolutegravir-pregnancy-warning-important-now/2018/05/20/
- ↑ 5.0 5.1 5.2 5.3 World Health Organization (WHO). News Release. July 22, 2019 WHO recommends dolutegravir as preferred HIV treatment option in all populations. https://www.who.int/news-room/detail/22-07-2019-who-recommends-dolutegravir-as-preferred-hiv-treatment-option-in-all-populations
Zash R, Holmes L, Diseko M et al Neural-Tube Defects and Antiretroviral Treatment Regimens in Botswana. N Engl J Med. July 22, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31329379 https://www.nejm.org/doi/full/10.1056/NEJMoa1905230
Raesima MM, Ogbuabo CM, Thomas V et al Dolutegravir Use at Conception - Additional Surveillance Data from Botswana. N Engl J Med. July 22, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31329378