Metformin and Dolutegravir: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Dolutegravir
Metformin
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
Increased metFORMIN exposure and an increased risk of lactic acidosis
Interaction Deep Dive
Concomitant use of drugs that interfere with common renal tubular transport systems involved in the renal elimination of metFORMIN, such as, dolutegravir (an OCT2 inhibitor and MATE inhibitor) and metFORMIN (an OCT2 substrate and MATE substrate) may result in increased exposure of metFORMIN, increasing the risk of adverse effects, including lactic acidosis134. If coadministration is required, limit the total daily dose of metFORMIN to 1000 mg when starting metFORMIN or dolutegravir. If treatment with dolutegravir is discontinued, dosage adjustment of metFORMIN may be required. Monitor blood glucose when initiating coadministration and after withdrawal of dolutegravir 4. Consider the benefits and risks of concomitant use 2.
Why it happens (mechanism)
Inhibition of OCT2-mediated efflux transport of dolutegravir
Literature reports
1 report — tap to read
a) During drug interaction studies, coadministration of dolutegravir 50 mg once daily and metFORMIN 500 mg twice daily resulted in a 79% increase in metFORMIN AUC and a 66% increase in metFORMIN Cmax. Coadministration of dolutegravir 50 mg twice daily and metFORMIN 500 mg twice daily resulted in a 2.5-fold increase in metFORMIN AUC and a 2-fold increase in metFORMIN Cmax 4.
Common questions
Can I take Metformin and Dolutegravir together?
Increased metFORMIN exposure and an increased risk of lactic acidosis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Metformin 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 "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Metformin 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 (4)
- Product Information: SYNJARDY(R) oral tablets, empagliflozin metformin hydrochloride oral tablets. Boehringer Ingelheim Pharmaceuticals Inc (per FDA), Ridgefield, CT, 2025. DailyMed
- Product Information: KAZANO oral tablets, alogliptin, metformin hydrochloride oral tablets. Takeda Pharmaceuticals America Inc (per FDA), Lexington, MA, 2023. DailyMed
- Product Information: ACTOPLUS MET oral tablets, pioglitazone metformin hydrochloride oral tablets. Takeda Pharmaceuticals America, Inc. (per FDA), Lexington, MA, 2024. DailyMed
- Product Information: TIVICAY oral tablets, dolutegravir oral tablets. ViiV Healthcare (per FDA), Research Triangle Park, NC, 2022. DailyMed
Keep reading about Dolutegravir
Keep reading about Metformin
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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