Rifampin and Dolutegravir: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Rifampin
Dolutegravir
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
The concomitant administration of dolutegravir and rifAMPin may result in loss of efficacy and possible resistance to dolutegravir or background antiretroviral therapy. Adjust the dolutegravir dose to 50 mg twice daily in treatment-naive or treatment-experienced, integrase strand transfer inhibitor (INSTI)-naive adults1 and in pediatric patients 25 kg or greater 3. In pediatrics weighing 6 to less than 25 kg, administer an additional weight-based dose of dolutegravir; (6 to less than 10 kg) 15 mg; (10 to less than 14 kg) 20 mg; (14 to less than 20 kg) 25 mg; (20 to less than 25 kg) 30 mg 4. Whenever possible, use alternatives to rifAMPin in INSTI-experienced patients with certain INSTI-associated resistance substitutions or clinically suspected INSTI resistance 1. When administering dolutegravir-containing combination products, separate the additional dolutegravir dose by 12 hours 23.
Why it happens (mechanism)
Induction of CYP3A-mediated metabolism of dolutegravir by rifAMPin
Literature reports
1 report — tap to read
a) RifAMPin 600 mg once daily was coadministered to subjects receiving dolutegravir 50 mg twice daily (n=11). Compared with dolutegravir 50 mg twice daily alone, the coadministration of rifAMPin decreased dolutegravir exposure significantly. Cmax was reduced by 43% and AUC by 54%. However, relative to a dolutegravir regimen of 50 mg once daily, the change in dolutegravir Cmax and AUC with coadministered rifAMPin was not as large but still significant: The dolutegravir Cmax increased 18% and AUC increased 33% 1.
Common questions
Can I take Rifampin 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 Rifampin 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.
Questions for your pharmacist
- Does my dose of Rifampin 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: TIVICAY oral tablets, dolutegravir oral tablets. ViiV Healthcare (per FDA), Research Triangle Park, NC, 2022. DailyMed
- Product Information: DOVATO oral tablets, dolutegravir lamivudine oral tablets. ViiV Healthcare (per manufacturer), Research Triangle Park, NC, 2019. DailyMed
- Product Information: TRIUMEQ oral tablets, abacavir, dolutegravir, lamivudine oral tablets. ViiV Healthcare (per FDA), Durham, NC, 2023. DailyMed
- Product Information: TRIUMEQ PD oral tablets for suspension, abacavir, dolutegravir, lamivudine oral tablets. ViiV Healthcare (per FDA), Durham, NC, 2023. DailyMed
Keep reading about Rifampin
Keep reading about Dolutegravir
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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