Sucralfate with Dolutegravir Interaction Details
Brand Names Associated with Sucralfate
- Carafate®
- Sucralfate
Brand Names Associated with Dolutegravir
- Dolutegravir
- Juluca® (as a combination product containing dolutegravir, rilpivirine)
- Tivicay®
- Tivicay® PD
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 25, 2023
Interaction Effect
Reduced dolutegravir exposure and reduced efficacy of dolutegravir
Interaction Summary
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 efficacy and potential development of viral resistance . Give dolutegravir/rilpivirine (Juluca(R)) at least 4 hours before or 6 hours after the polyvalent cation-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 polyvalent cation-containing product .
Severity
Major
Onset
Rapid
Evidence
Probable
How To Manage Interaction
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 efficacy and potential development of viral resistance . Give dolutegravir/rilpivirine (Juluca(R)) at least 4 hours before or 6 hours after the polyvalent cation-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 polyvalent cation-containing product .
Mechanism Of Interaction
Chelation with polyvalent cations resulting in reduced dolutegravir absorption
Literature Reports
A) Simultaneous administration of Maalox(R) and a single dose of dolutegravir 50 mg significantly decreased dolutegravir Cmax by 72% and AUC by 74%; however, when Maalox(R) was administered 2 hours after dolutegravir, the changes in dolutegravir Cmax and AUC were not clinically significant .
B) Coadministration of oral calcium or oral iron 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 .
Sucralfate Overview
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Sucralfate is used to treat and prevent the return of duodenal ulcers (ulcers located in first part of the small intestine). Treatment with other medications, such as antibiotics, may also be necessary to treat and prevent the return of ulcers caused by a certain type of bacteria (H. pylori) Sucralfate is in a class of medications called protectants. It sticks to damaged ulcer tissue and protects against acid and enzymes so healing can occur.
Dolutegravir Overview
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Dolutegravir is used with other medications to treat human immunodeficiency virus (HIV) infection in adults and children 4 weeks of age and older who weigh at least 6.6 lbs (3 kg). It is also used in combination with rilpivirine (Edurant) to treat HIV in certain adults to replace their current HIV medication(s) that has been taken for at least 6 months. Dolutegravir is in a class of medications called HIV integrase inhibitors. It works by decreasing the amount of HIV in your blood and increasing the number of immune cells that help fight infections in your body. Although dolutegravir does not cure HIV, using it along with other medications may decrease your chance of developing acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer. Taking these medications along with practicing safer sex and making other lifestyle changes may decrease the risk of transmitting (spreading) the HIV virus to other people.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.