Calcium and Dolutegravir: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Dolutegravir
Calcium
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Reduced dolutegravir exposure and reduced efficacy of dolutegravir
Interaction Deep Dive
Dolutegravir used concomitantly with products containing polyvalent cations (eg, aluminum, calcium, magnesium, iron, laxatives, sucralfate, buffered medications, multivitamins) may decrease dolutegravir exposure and result in loss of efficacy1 and potential development of viral resistance 2. Give dolutegravir/rilpivirine (Juluca(R)) at least 4 hours before or 6 hours after calcium-containing product. Give dolutegravir (Tivicay(R)), abacavir/dolutegravir/lamivudine (Triumeq(R) and Triumeq PD(R)), or dolutegravir/lamivudine (Dovato(R)) at least 2 hours before or 6 hours after the calcium-containing product. If given with a meal, oral calcium supplements may be administered at the same time as dolutegravir 3415.
Why it happens (mechanism)
Chelation with polyvalent cations resulting in reduced dolutegravir absorption
Literature reports
1 report — tap to read
a) In a pharmacokinetic study, a single oral dose of calcium carbonate 1200 mg was simultaneously administered with dolutegravir 50 mg on an empty stomach and resulted in a Cmax reduction of 27% and AUC reduction of 29%. Cmax and AUC decreased by approximately 1-fold when a single oral dose of calcium carbonate 1200 mg was simultaneously administered with a single oral dose of dolutegravir 50 mg with food or when coadministered 2 hours after dolutegravir. Hence, coadministration of oral calcium with dolutegravir in the fasted state significantly decreased dolutegravir Cmax and AUC; however, when coadministered 2 hours after dolutegravir or in a fed state, the changes in dolutegravir Cmax and AUC were not clinically significant 15.
Common questions
Can I take Calcium and Dolutegravir together?
Reduced dolutegravir exposure and reduced efficacy of dolutegravir Always confirm with your pharmacist or prescriber before making any change.
How serious is the Calcium and Dolutegravir interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Calcium or Dolutegravir need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (5)
- Product Information: TIVICAY oral tablets, dolutegravir oral tablets. ViiV Healthcare (per FDA), Research Triangle Park, NC, 2022. DailyMed
- AIDSinfo and Panel on Antiretroviral Guidelines for Adults and Adolescents: Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. Department of Health and Human Services. Rockville, MD. 2018.
- Product Information: DOVATO oral tablets, dolutegravir lamivudine oral tablets. ViiV Healthcare (per manufacturer), Research Triangle Park, NC, 2019. DailyMed
- Product Information: JULUCA oral tablets, dolutegravir rilpivirine oral tablets. ViiV Healthcare (per manufacturer), Research Triangle Park, NC, 2018. DailyMed
- Product Information: TRIUMEQ oral tablets, abacavir, dolutegravir, lamivudine oral tablets. ViiV Healthcare (per FDA), Durham, NC, 2023. DailyMed
Keep reading about Dolutegravir
Keep reading about Calcium
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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