Tivicay (dolutegravir) is an antiretroviral medicine used as part of combination treatment for HIV-1 infection. It belongs to the integrase inhibitor class and works by blocking HIV integrase, an enzyme the virus uses to insert its genetic material into human cells.

Dolutegravir has a high genetic barrier to resistance: HIV rarely develops significant resistance to dolutegravir when used in a properly constructed regimen. It is a key component of many recommended first-line HIV regimens.

Dolutegravir is also found as a component in the combination tablets Triumeq (dolutegravir/abacavir/lamivudine) and Juluca (dolutegravir/rilpivirine).

For most patients: take one 50 mg tablet once daily, with or without food.

Depending on other medicines you take, your HIV doctor may adjust the dose or schedule. Always follow your doctor's instructions.

Tivicay must always be used in combination with other antiretroviral medicines.

Take the missed dose as soon as you remember. If it is nearly time for the next dose, skip and continue your schedule. Never take a double dose. Contact your HIV doctor if you miss doses regularly.

Contact your HIV specialist or a poison control centre.

• Store below 30°C
• Keep in the original container with the lid tightly closed
• Keep out of reach of children

Dolutegravir is generally very well tolerated.

Common side effects:

• Insomnia and sleep disturbances: one of the more commonly reported effects. Usually mild and often improves. If troublesome, taking the dose in the morning rather than evening may help
• Headache
• Nausea (usually mild)

Less common but important:

• Hypersensitivity reaction: rare but can include rash, fever, and internal organ involvement. Stop immediately and seek urgent care if a rash develops with systemic symptoms
• Raised creatinine: dolutegravir inhibits a transporter in the kidneys that secretes creatinine. This raises the measured creatinine level slightly without reflecting true kidney damage. Your doctor is aware of this effect
• Raised liver enzymes in people with hepatitis B or C co-infection

Regular viral load, kidney function, and liver function tests are done routinely.

Dolutegravir has several important interactions:

• Antacids, calcium, iron, magnesium, and multivitamins: these can significantly reduce dolutegravir absorption. If you take any of these, timing around your dose matters, so raise it with your pharmacist
• Rifampicin: dramatically reduces dolutegravir levels. If you take or need to start rifampicin, let your HIV doctor know so they can review your regimen
• Metformin: dolutegravir can raise metformin levels. Let your doctor know you take metformin so they can monitor appropriately
• Dofetilide and pilsicainide: contraindicated with dolutegravir as levels of these heart medicines are increased

Always check for interactions before starting any new medicine while on Tivicay.

Why is dolutegravir so widely used as first-line HIV therapy?

Dolutegravir has several properties that make it an excellent first-line option: it is highly potent, has a high barrier to resistance (meaning it is very difficult for HIV to become resistant to it), has a relatively simple interaction profile compared to protease inhibitors, is available as a once-daily tablet, and is well tolerated by most people. It is the backbone of recommended first-line regimens in most international HIV treatment guidelines.

What is the effect on creatinine levels?

Dolutegravir inhibits a transporter protein in the kidneys called MATE1/2-K, which normally secretes creatinine into urine. Blocking this transporter raises measured creatinine levels (often by 0.1 to 0.15 mg/dL) without any actual decline in true kidney filtration function (GFR). Your HIV doctor knows this effect and will interpret your creatinine results accordingly. It is not a sign of kidney damage.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.