Dovato
Take missed dose as soon as possible, as long as it is at least 12 hours before your next dose. Do not double up on your next dose. Dovato is not recommended for people who have severe liver impairment. According to the drug label, Dovato is not recommended for people with decreased kidney function (now down to a creatinine clearance less than 30 mL/min) due to the lamivudine component. This medication combination, however, is often used in reduced renal function below 30 mL/min because of the relatively minimal risk of lamivudine accumulation and side effects. In addition, reduced doses may be obtained by using the individual components of this medication as needed.
- See the individual drugs contained in this medication: Tivicay and Epivir.
- See package insert for more complete information on potential side effects and interactions.
viivhealthcare.com; dovato.com
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JO-ANN JOSE, MD, MPH:
Dovato is a two-drug regimen that works well to control HIV. It is well tolerated and is a small pill. Dovato should not be used as initial therapy for people who acquired HIV after taking Apretude unless an INSTI genotype is available and shows sensitivity to dolutegravir. People with suppressed virus on a TAF-based regimen who have never experienced prior treatment failure and who don’t have hepatitis B may safely switch to Dovato. This regimen has a slightly lower genetic barrier to resistance. As doctors, we tell you with any HIV treatment that it’s important to be adherent to your regimen, but that’s particularly important with Dovato for that reason. HHS guidelines have strict rules about what we need to have on file for you before starting Dovato as initial treatment. Because it does not contain tenofovir, if you have co-infection with hepatitis B, Dovato will not treat your hep B. Dovato has potential interactions with other medications, among the most significant is the diabetes drug metformin. Dolutegravir levels decrease with some seizure or tuberculosis medicines and with St. John’s wort. Multi-vitamins that include minerals containing metals like calcium, magnesium and zinc may interfere with absorption of Biktarvy, so take them at least six hours apart from Dovato. For all these considerations, with rare exceptions, Dovato should not be used for rapid start treatment before lab results are available. The University of Liverpool maintains an online HIV drug interactions checker; GO TO hiv-druginteractions.org/checker. Drinking alcohol while taking the drug may worsen some of Dovato’s side effects. You may experience worsened fatigue, headache or nausea; consuming large amounts of alcohol can cause liver damage. All HIV drugs can impact the liver, so in general, it’s important to moderate the use of alcohol.
Do not take Dovato with Epivir-HBV or the antiarrhythmic dofetilide (a heart medication). When taking carbamazepine or rifampin, take an additional dose of dolutegravir (in the form of one Tivicay tablet) 50 mg 12 hours after taking your Dovato dose. When starting or stopping dolutegravir by people on metformin, dose adjustment of metformin may be necessary to maintain optimal glycemic control or tolerability. Do not take with oxcarbazepine, eslicarbazepine, phenytoin or phenobarbital. Dovato should be taken two hours before or six hours after taking laxatives or antacids, the ulcer medication sucralfate, oral iron or calcium supplements/vitamins or buffered medications. It can be taken with iron- or calcium-containing supplements/vitamins if taken together with food. Acid reducers (Pepcid, Zantac, Tagamet) and proton pump inhibitors (for example, Aciphex, Dexilant, Prilosec, Prevacid, Protonix and Nexium) are okay to use. Avoid use of sorbitol-containing medicines with lamivudine; there are many, such as acetaminophen liquid (Tylenol liquid and others). There are no known drug-drug interactions with Daklinza, Epclusa, Harvoni, Olysio, Sovaldi, Viekira Pak or Zepatier. Not intended to be taken with other HIV medications, unless prescribed that way. Tell your provider or pharmacist about all medications, herbals and supplements you are taking or thinking of taking, prescribed or not, as there are other drug interactions which are not listed here.
Dolutegravir and lamivudine are both generally well tolerated. Side effects occurring in at least 2% of study participants receiving Dovato included headache, nausea, diarrhea, insomnia, fatigue and dizziness. INSTIs are associated with weight gain. Dolutegravir can cause a small, reversible increase in kidney function test (serum creatinine) within the first few weeks of treatment that does not affect actual kidney function. There have been rare reports of depression and suicidal ideation with INSTIs, primarily in people with a history of psychiatric illnesses. HHS guidelines recommend closely monitoring people with pre-existing psychiatric conditions. Prior to initiation, test for hepatitis B virus (HBV). Dovato by itself is not enough to treat HBV and must be taken with an additional HBV medication. Severe exacerbations of HBV have been reported by people with HBV co-infection who have discontinued Dovato (due to elimination of the lamivudine component, which also treats HBV). Monitor liver enzymes closely. Initiation of HBV therapy may be warranted upon Dovato discontinuation. Call your health care provider right away if you develop any of the following signs of hepatitis: yellowing of the skin or whites of the eyes; dark or tea-colored urine; pale-colored bowel movements; nausea or vomiting; loss of appetite or pain, aching or tenderness on the right side below the ribs.
Basically, this medicine is Triumeq without the abacavir component (brand name Ziagen, also found in Epzicom). It is the only 2-drug combination with HHS recommendation for first-time therapy, but should not be used if viral load is above 500,000. Dovato is now available in a blister pack option (in foil-backed sheets instead of in a bottle), which may be hard to open. The benefits of using a two-drug regimen for HIV include less exposure to HIV medication while maintaining viral suppression and minimizing the potential for side effects. At one, two and nearly three years into the GEMINI-1 and GEMINI-2 studies, DTG + 3TC was found to be non-inferior to the triple drug regimen of DTG + Truvada (emtricitabine and tenofovir DF combined in one pill). Dovato has also been successful for treatment-experienced people switching to it after being undetectable (viral load less than 50 copies per mL). The TANGO study evaluated treatment switch from TAF-containing regimens with three or more drugs and at both 48 and 96 weeks, found Dovato to be non-inferior to the three-drug regimen standard of care. Weight gain is being increasingly recognized as a side effect of INSTIs. Although dolutegravir is a preferred medication during pregnancy as well as for people who are trying to conceive, U.S. HIV perinatal treatment guidelines suggest using three-drug regimens for these individuals. Find the discussion on page C-55 of perinatal guidelines at hivinfo.nih.gov. Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; GO TO apregistry.com.
JUAN MICHAEL PORTER II:
Dovato’s claim to fame is that it contains only two drugs. That “fewer drugs in your body” aspect makes it an attractive option to some people. Some of my friends have switched to it because their doctors told them it will be better for their bone health. But that doesn’t mean the switch is necessary or that Dovato is for everyone. Case in point, it’s not for people who use metformin to treat diabetes and can also have interactions among people being treated for tuberculosis (TB) unless they take extra dolutegravir—which rather negates the whole “fewer drugs” in one’s body perk.