Abacavir, dolutegravir, and lamivudine and Multivitamins with minerals

Dolutegravir and multivitamin with minerals should not be taken orally at the same time. Products that contain aluminum, calcium, iron, magnesium and/or other minerals may interfere with the absorption of dolutegravir and reduce its effectiveness in treating HIV infection. You should take dolutegravir at least two hours before or six hours after the multivitamin with minerals dose. Talk to your doctor if you have any questions or concerns, or if you have trouble separating the dosing times. Your doctor may be able to prescribe alternatives that do not interact. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

ADJUST DOSING INTERVAL: Coadministration with medications containing polyvalent cations such as aluminum, calcium, iron, or magnesium may decrease the oral bioavailability of dolutegravir. The mechanism of interaction has not been established. In 16 study subjects, administration of a single 50 mg dose of dolutegravir simultaneously with an antacid (Maalox) decreased dolutegravir peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Cmin; 24 hours post-dose) by 72%, 74% and 74%, respectively, compared to administration without the antacid. When the antacid was administered 2 hours after dolutegravir, the Cmax, AUC and Cmin of dolutegravir decreased by just 18%, 26% and 30%, respectively. Administration of single-dose dolutegravir simultaneously with a multivitamin (One-A-Day) decreased the Cmax, AUC and Cmin of dolutegravir by 35%, 33% and 32%, respectively.

MANAGEMENT: Dolutegravir should be administered 2 hours before or 6 hours after medications containing polyvalent cations such as antacids, laxatives, or mineral supplements.