Treatment for Dolutegravir (Tivicay) Exposure
For dolutegravir (Tivicay) exposure, standard supportive care is the recommended treatment as there is no specific antidote or treatment regimen available. 1
Initial Management
- There is no known specific treatment for dolutegravir overdose; standard supportive treatment should be applied as required 1
- Monitor the patient closely for adverse effects, particularly focusing on vital signs and symptoms 1
- Dolutegravir is highly bound to plasma proteins, making it unlikely to be significantly removed by dialysis 1
Clinical Monitoring
- Assess for central nervous system effects, which are among the most common adverse reactions to dolutegravir 2
- Monitor renal function as dolutegravir can affect renal tubule secretion of substances excreted via OCT2, potentially causing slight increases in creatinine 2
- Check for drug interactions if the patient is taking other medications, particularly those containing polyvalent cations (aluminum, calcium, iron, magnesium) 3
Special Populations Considerations
Pregnancy
- If exposure occurs in a pregnant woman, consider that dolutegravir with TAF/FTC (or TDF/FTC if TAF/FTC is not available) is the recommended ART regimen in pregnancy 3
- Dolutegravir has been shown to have high antiviral efficacy and low rates of adverse birth outcomes in pregnancy 3
Patients with HIV
- For HIV-positive individuals with dolutegravir exposure, assess their current antiretroviral regimen 3
- Dolutegravir-based regimens are recommended for most people with HIV, including combinations like BIC/TAF/FTC or dolutegravir plus TXF/XTC 3
Follow-up Recommendations
- If the exposure was related to an overdose, consider psychiatric evaluation and follow-up 2
- For patients on metformin, monitor blood glucose levels as dolutegravir can increase metformin concentrations 2
- For patients on hormonal contraceptives, reassure that dolutegravir has no significant effect on the pharmacokinetics of oral contraceptives containing norgestimate/ethinyl estradiol 4
Important Caveats
- Dolutegravir has a favorable pharmacokinetic profile with once-daily dosing (50 mg), with or without food 2
- The drug has a high barrier to resistance and is generally active against viral strains resistant to first-generation integrase inhibitors 5
- Weight gain has been observed with dolutegravir-containing regimens, especially when combined with tenofovir alafenamide fumarate (TAF) 6
Remember that while dolutegravir is generally well-tolerated with most adverse events being mild to moderate in intensity, close monitoring is essential following significant exposure 5.