Table 3. Established or potential drug interactions requiring dose or regimen alterations¹.

Concomitant drug class: drug name	Effect on dolutegravir and/or concomitant drug	Clinical recommen dations
HIV-1 antiviral agents
NNRTI: etravirine	↓ dolutegravir	Avoid use with etravirine without coadministration of atazanavir/ritonavir, darunavir/ritonavir, or lopinavir/ritonavir
NNRTI: efavirenz	↓ dolutegravir	↑ dolutegravir dosage to 50 mg twice daily in treatment-naive or treatment-experienced INSTI-naive patients; consider alternative combinations for patients with potential INSTI-resistance
NNRTI: nevirapine	↓ dolutegravir	Avoid use with nevirapine; insufficient data to make dosing recommendations
Protease inhibitor: fosamprenavir/ritonavir and tipranavir/ritonavir	↓ dolutegravir	↑ dolutegravir dosage to 50 mg twice daily in treatment-naive or treatment-experienced INSTI-naive patients; consider alternative combinations for patients with potential INSTI-resistance
Other agents
CYP3A inducers (oxcarbazepine, phenytoin, phenobarbital, carbamazepine, St. John’s wort)	↓ dolutegravir	Avoid concomitant use; insufficient data to make dosing recommendations
Rifampin	↓ dolutegravir	↑ dolutegravir dosage to 50 mg twice daily in treatment-naive or treatment-experienced INSTI-naive patients; consider alternative combinations for patients with potential INSTI-resistance
Polyvalent cation containing medications (eg, magnesium, aluminum, iron, calcium; antacids, iron supplements, oral supplements, buffered medications, antacids)	↓ dolutegravir	Administer dolutegravir 2 hours before or 6 hours after taking medications containing polyvalent cations
Sucralfate	↓ dolutegravir	Administer dolutegravir 2 hours before or 6 hours after taking medications containing polyvalent cations
Metformin	↑ metformin	Monitor closely; a dose adjustment of metformin may be necessary

Note: INSTI = integrase strand transfer inhibitor; NNRTI = nonnucleoside reverse transcriptase inhibitor.