Dovato dolutegravir sodium and lamivudine 50 mg; 300 mg Tablet, Film Coated, 14-count — NDC 49702-246-61 (Billing 49702-0246-61)
This is a package of 14 tablets of Dovato dolutegravir sodium and lamivudine 50 mg; 300 mg Tablet, Film Coated from ViiV Healthcare Company, marketed since Apr 2019 and currently FDA-listed.
NDC database record
One package, one record: these facts belong to NDC 49702-246-61 alone.
- Record
- FDA NDC Directory package listing · Human prescription drug
- Code segments
- 49702 labeler · 246 product · 61 package
- Listing certified through
- Dec 31, 2027
- Billing quantity
- 14 EA per package
- Barcode (UPC-A, from the NDC)
- 3 4970224661 4
- FDA record last changed
- Oct 8, 2026
Identity & classification
Regulatory identifiers FDA, NLM and CMS codes for this package
Drug-database identifiers Medi-Span GPI and First Databank GCN / HICL / AHFS classification
- GSN (GCN sequence number): 079638
- GCN: 46175
- GPI-14 (Medi-Span): 12109902260320
- HICL (First Databank): 045679
- AHFS class code: 08:18.08.12
- RxCUI (RxNorm): 2122519
Where does this data come from?
- FDA openFDA NDC Directory · synced Oct 8, 2026
- FDA label on DailyMed · label index refreshed Oct 6, 2026
- RxNorm (NLM RxNav) · catalog refreshed Oct 1, 2026
- Medi-Span GPI (licensed)
- First Databank (licensed) · refreshed Oct 8, 2026
RxNorm drug class
This medicine belongs to the Human Immunodeficiency Virus Integrase Strand Transfer Inhibitor class.
Where does this data come from?
- RxClass (NLM) · catalog refreshed Oct 1, 2026
Clinical
- Dovato treats HIV-1 infection. It is a complete regimen in one tablet for adults and adolescents 12 and older who weigh at least 25 kg. It can be a first treatment, or it can repla...
- Take one tablet by mouth once a day. Food does not matter. Take it exactly as your prescriber directs, and let us know if you take carbamazepine or rifampin, since you may need an...
- Lamivudine also affects hepatitis B. If you have both infections, stopping Dovato can cause a severe hepatitis flare. Your doctor needs to know your status first and may add hepati...
- Some people get headache, nausea, diarrhea, trouble sleeping, tiredness or anxiety. Call your doctor if you notice mood changes or thoughts of suicide. Stop it and get help right a...
Patient education
Supplement & herbal interactions
Where does this data come from?
- MedlinePlus (NLM) · refreshed Oct 1, 2026
- FDA label on DailyMed · label index refreshed Oct 6, 2026
Ask a licensed pharmacist directly — free, answered by our team.
Pricing
A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.
| Price system | Per each | Per package |
|---|---|---|
| Retail pharmacies payNADAC · weekly | Not in the retail survey — common for institutional, discontinued, or low-volume packs. | |
| Medicaid paysCMS SDUD · 12 mo | No recent Medicaid claims on file for this NDC — rare and low-volume NDCs are suppressed in the public data. | |
| Medicare drug plans payPart D · quarterly | No Part D plan price is available for this NDC in our data. | |
Where does this data come from?
- CMS NADAC weekly file
- CMS ASP pricing files · refreshed Sep 20, 2026
- CMS Medicaid State Drug Utilization Data · refreshed Oct 8, 2026
- CMS Part D plan pricing files · refreshed Sep 24, 2026
- VA National Acquisition Center price file
Packaging — all sizes for this product
| Package NDC | Description | Per unit | Per pack | Marketing start | Marketing end | Status |
|---|---|---|---|---|---|---|
| 49702-0246-13 49702-246-13 Main listing | 30 TABLET, FILM COATED in 1 BOTTLE | $105.23 / ea | $3,156.75 | 2019-04-08 | — | Active |
| 49702-0246-61 You're viewing this | 14 TABLET, FILM COATED in 1 BOTTLE | — | — | 2019-08-06 | — | Active |
| 49702-0246-33 49702-246-33 | 1 BLISTER PACK in 1 CARTON / 30 TABLET, FILM COATED in 1 BLISTER PACK | $105.23 / ea | $3,156.75 | 2024-01-01 | — | Active |
| 49702-0246-62 49702-246-62 | 1 BLISTER PACK in 1 CARTON / 14 TABLET, FILM COATED in 1 BLISTER PACK | — | — | 2024-01-01 | — | Active |
This pack shows little to no recent Medicaid volume — the 30 tablets pack carries most fills. See all packs ↓
Pack size FAQ
What quantity is in this package?
How does this package differ from NDC 49702-0246-62?
What NDC number is used to bill for this package of Dovato dolutegravir sodium and lamivudine 50 mg; 300 mg Tablet, Film Coated?
Prices are the latest CMS NADAC pharmacy acquisition cost per NDC; per-pack figures are per-unit × pack quantity, shown only when the pack is denominated in the same measure NADAC prices.
Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Dovato 50 mg/1; 300 mgthis 49702-0246-61 | ViiV | 14 tablets | — | — | FDA listed | — |
Where does this data come from?
- FDA openFDA NDC Directory · synced Oct 8, 2026
- FDA Orange Book · refreshed Oct 3, 2026
- CMS NADAC weekly file
Availability & generic status
We did not find an FDA-approved generic match for this exact strength, form and route. Patent/protection dates below may affect future generic timing.
Why the date isn’t exact: Generic timing can change because patents may be challenged, settled, licensed, added, removed, or worked around with a narrower label — and FDA approval does not always mean a pharmacy can get the generic today.
🛈 What do these terms mean?
- Patent
- Legal protection listed in the Orange Book that may delay generic approval or launch. Issued by the U.S. Patent & Trademark Office.
- Substance patent
- Covers the active drug molecule itself — the hardest to design around. A generic generally can’t launch until it expires.
- Formulation (product) patent
- Covers a specific formulation or dosage form. A generic can sometimes work around it with a different formulation.
- Method-of-use patent
- A patent covering one specific approved use of the drug — not necessarily the whole molecule. A generic can sometimes launch with a “skinny label” that carves out the protected use and keeps the others.
- Skinny label
- A generic label that omits a still-patented use when the FDA allows it — letting a generic reach the market for the unprotected uses.
- Exclusivity
- FDA-granted marketing protection, separate from patents — e.g. 5-yr new chemical entity, 7-yr orphan drug, or a +6-month pediatric extension.
- Paragraph IV
- A generic applicant’s formal challenge to a listed patent. It can potentially lead to earlier generic entry, but often involves litigation or a settlement.
- RLD / RS
- Reference Listed Drug — the brand product the FDA uses as the reference for generic applications. Reference Standard — the product the FDA expects generics to compare against in bioequivalence testing.
- TE / AB rating
- FDA therapeutic-equivalence rating. An AB rating generally means the FDA considers a generic therapeutically equivalent to — and substitutable for — the brand.
- LOE (loss of exclusivity)
- The latest patent or exclusivity currently listed — the loss-of-exclusivity / latest-listed-protection date shown on this page. Paragraph-IV challenges and settlements can move the real date earlier; FDA approval and a manufacturer’s decision to market can move it later.
Built from the FDA Orange Book. The bars above are scaled to each protection’s expiry; the red LOE marker is the last one to lapse.
| Patent | Type | Use code | Expires |
|---|---|---|---|
| US 11234985 ↗ | Method of use | U-257 | Jan 24, 2031 |
| US 9242986 ↗ | Drug substance | — | Dec 8, 2029 |
| US 8129385 ↗ | Drug substance | — | Oct 5, 2027 |
| US 8129385*PED ↗ | Drug product | — | Apr 5, 2028 |
| US 9242986*PED ↗ | Drug product | — | Jun 8, 2030 |
| Code | What it grants | Expires |
|---|---|---|
| NPP | New Patient Population | Apr 5, 2027 |
Is there a generic version of DOVATO 50-300 MG TABLET?
The FDA approved a generic — why can’t I get it at my pharmacy yet?
Why do different websites show different generic release dates?
What does “FDA listed” mean?
What does a patent or protection date mean here?
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Can a generic come out before the last patent expires?
Can a generic come out after the listed dates?
What is the difference between patents and exclusivity?
Why are there multiple patent dates?
Where does this data come from?
- FDA Orange Book · refreshed Oct 3, 2026
What it looks like
Where does this data come from?
- FDA label on DailyMed · label index refreshed Oct 6, 2026
Inactive Ingredients / Excipients
Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.
🧪 Avoiding an ingredient? See Dolutegravir and Lamivudine inactive ingredients by manufacturer: every current product's list side by side, so you can ask your pharmacy for the version that does not list it.
Where does this data come from?
IACT rows and label-wide narrative are kept separate; availability and product-level specificity depend on the submitted label.- FDA label on DailyMed · label index refreshed Oct 6, 2026
- FDA openFDA NDC Directory · synced Oct 8, 2026
Inactive ingredient FAQ
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Manufacturer & labeler
More NDCs from ViiV Healthcare Company labeler code 49702
- Tivicay dolutegravir sodium 10 mg Tablet, Film Coated NDC 49702-226-13
- Tivicay dolutegravir sodium 25 mg Tablet, Film Coated NDC 49702-227-13
- Tivicay dolutegravir sodium 50 mg Tablet, Film Coated NDC 49702-228-13
- Triumeq abacavir sulfate, dolutegravir sodium, lamivudine 600 mg; 50 mg; 300 mg Tablet, Film Coated NDC 49702-231-13
- Cabenuva cabotegravir and rilpivirine Kit NDC 49702-240-15
- Juluca dolutegravir sodium and rilpivirine hydrochloride 50 mg; 25 mg Tablet, Film Coated NDC 49702-242-13
- Vocabria cabotegravir sodium 30 mg Tablet, Film Coated NDC 49702-248-13
- Rukobia fostemsavir tromethamine 600 mg Tablet, Film Coated, Extended Release NDC 49702-250-18
- Cabenuva cabotegravir and rilpivirine Kit NDC 49702-253-15
- Tivicay PD dolutegravir sodium 5 mg Tablet, For Suspension NDC 49702-255-37
- Triumeq PD abacavir sulfate, dolutegravir sodium, lamivudine Kit NDC 49702-258-37
- SELZENTRY maraviroc Kit NDC 49702-260-55
Where does this data come from?
- FDA openFDA NDC Directory · synced Oct 8, 2026
- Drugs@FDA
Full prescribing information FDA SPL
🚨 Boxed Warning ▾
WARNING: PATIENTS CO-INFECTED WITH HEPATITIS B VIRUS (HBV) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV-1): EMERGENCE OF LAMIVUDINE-RESISTANT HBV AND EXACERBATIONS OF HBV All patients with HIV-1 should be tested for the presence of HBV prior to or when initiating DOVATO. Emergence of lamivudine-resistant HBV variants associated with lamivudine-containing antiretroviral regimens has been reported. If DOVATO is used in patients co-infected with HIV-1 and HBV, additional treatment should be considered for appropriate treatment of chronic HBV; otherwise, consider an alternative regimen.
Severe acute exacerbations of HBV have been reported in patients who are co-infected with HIV-1 and HBV and have discontinued lamivudine, a component of DOVATO. Closely monitor hepatic function in these patients and, if appropriate, initiate anti-HBV treatment [see Warnings and Precautions ( 5.1 )] . WARNING: PATIENTS CO-INFECTED WITH HEPATITIS B VIRUS (HBV) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV-1): EMERGENCE OF LAMIVUDINE-RESISTANT HBV AND EXACERBATIONS OF HBV See full prescribing information for complete boxed warning. • All patients with HIV-1 should be tested for the presence of HBV prior to or when initiating DOVATO.
Emergence of lamivudine-resistant HBV variants associated with lamivudine-containing antiretroviral regimens has been reported. If DOVATO is used in patients co-infected with HIV-1 and HBV, additional treatment should be considered for appropriate treatment of chronic HBV; otherwise, consider an alternative regimen. • Severe acute exacerbations of HBV have been reported in patients who are co-infected with HIV-1 and HBV and have discontinued lamivudine, a component of DOVATO. Closely monitor hepatic function in these patients and, if appropriate, initiate anti-HBV treatment.
( 5.1 )
🎯 Indications and Usage ▾
1 INDICATIONS AND USAGE DOVATO is indicated as a complete regimen for the treatment of HIV-1 infection in adults and adolescents 12 years of age and older and weighing at least 25 kg with no antiretroviral treatment history or to replace the current antiretroviral regimen in those who are virologically suppressed (HIV-1 RNA less than 50 copies/mL) on a stable antiretroviral regimen with no history of treatment failure and no known substitutions associated with resistance to the individual components of DOVATO. DOVATO, a two-drug combination of dolutegravir (integrase strand transfer inhibitor [INSTI]) and lamivudine (nucleoside analogue reverse transcriptase inhibitor [NRTI]) is indicated as a complete regimen for the treatment of HIV-1 infection in adults and adolescents 12 years of age and older and weighing at least 25 kg with no antiretroviral treatment history or to replace the current antiretroviral regimen in those who are virologically suppressed (HIV-1 RNA less than 50 copies/mL) on a stable antiretroviral regimen with no history of treatment failure and no known substitutions associated with resistance to the individual components of DOVATO.
( 1 )
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION • Prior to or when initiating DOVATO, test patients for hepatitis B virus (HBV) infection. ( 2.1 ) • One tablet taken orally once daily with or without food. ( 2.2 ) • The dolutegravir dose (50 mg) in DOVATO is insufficient when coadministered with carbamazepine or rifampin.
If DOVATO is coadministered with carbamazepine or rifampin, take one tablet of DOVATO once daily, followed by an additional dolutegravir 50-mg tablet, approximately 12 hours from the dose of DOVATO. ( 2.3 )
2.1Testing Prior to or When Initiating Treatment with DOVATO Prior to or when initiating DOVATO, test patients for HBV infection [see Warnings and Precautions ( 5.1 )].
2.2Recommended Dosage DOVATO is a fixed-dose combination product containing 50 mg of dolutegravir and 300 mg of lamivudine. The recommended dosage regimen of DOVATO in adults and adolescents 12 years of age and older and weighing at least 25 kg is one tablet taken orally once daily with or without food [see Clinical Pharmacology ( 12.3 )] .
2.3Recommended Dosage with Certain Coadministered Drugs The dolutegravir dose (50 mg) in DOVATO is insufficient when coadministered with drugs listed in Table 1 that may decrease dolutegravir concentrations; the following dolutegravir dosage regimen is recommended. Table 1. Dosing Recommendations for DOVATO with Coadministered Drugs Coadministered Drug Dosing Recommendation Carbamazepine, rifampin An additional dolutegravir 50-mg tablet, separated by 12 hours from DOVATO, should be taken.
2.4Not Recommended in Patients with Renal Impairment Because DOVATO is a fixed-dose tablet and cannot be dose adjusted, DOVATO is not recommended in patients with creatinine clearance less than 30 mL/min [see Use in Specific Populations ( 8.6 )] .
2.5Not Recommended in Patients with Severe Hepatic Impairment DOVATO is not recommended in patients with severe hepatic impairment (Child-Pugh Score C) [see Use in Specific Populations ( 8.7 )] .
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS DOVATO tablets are oval, biconvex, white, film-coated tablets, debossed with “SV 137” on one face. Each tablet contains 50 mg of dolutegravir and 300 mg of lamivudine. Tablets: 50 mg of dolutegravir and 300 mg of lamivudine. ( 3 )
⛔ Contraindications ▾
4 CONTRAINDICATIONS DOVATO is contraindicated in patients: • with prior hypersensitivity reaction to dolutegravir or lamivudine [see Warnings and Precautions ( 5.2 )] . • receiving dofetilide due to the potential for increased dofetilide plasma concentrations and the risk for serious and/or life-threatening events [see Drug Interactions ( 7.2 )] . • Prior hypersensitivity reaction to dolutegravir or lamivudine. ( 4 ) • Coadministration with dofetilide. ( 4 )
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS • Hypersensitivity reactions characterized by rash, constitutional findings, and sometimes organ dysfunction, including liver injury, have been reported with dolutegravir. Discontinue DOVATO immediately if signs or symptoms of hypersensitivity reactions develop, as a delay in stopping treatment may result in a life-threatening reaction. ( 5.2 ) • Hepatotoxicity has been reported in patients receiving a dolutegravir-containing regimen.
Patients with underlying hepatitis B or C may be at increased risk for worsening or development of transaminase elevations with DOVATO. Monitoring for hepatotoxicity is recommended. ( 5.3 ) • Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogues.
( 5.4 ) • Immune reconstitution syndrome has been reported in patients treated with combination antiretroviral therapy. ( 5.6 )
5.1Patients Co-infected with HIV-1 and HBV: Emergence of Lamivudine-Resistant HBV and the Risk of Posttreatment Exacerbations of HBV All patients with HIV-1 should be tested for the presence of HBV prior to or when initiating DOVATO. Emergence of Lamivudine-Resistant HBV Safety and efficacy of lamivudine have not been established for treatment of chronic HBV in subjects dually infected with HIV-1 and HBV. Emergence of HBV variants associated with resistance to lamivudine has been reported in HIV‑1–infected subjects who have received lamivudine‑containing antiretroviral regimens in the presence of concurrent infection with HBV.
If a decision is made to administer DOVATO to patients co-infected with HIV-1 and HBV, additional treatment should be considered for appropriate treatment of chronic HBV; otherwise, consider an alternative regimen. Severe Acute Exacerbations of HBV in Patients Co-infected with HIV-1 and HBV Severe acute exacerbations of HBV have been reported in patients who are co-infected with HIV-1 and HBV and have discontinued products containing lamivudine, and may occur with discontinuation of DOVATO. Patients who are co-infected with HIV-1 and HBV who discontinue DOVATO should be closely monitored with both clinical and laboratory follow-up for at least several months after stopping treatment with DOVATO.
If appropriate, initiation of anti-HBV therapy may be warranted, especially in patients with advanced liver disease or cirrhosis, since posttreatment exacerbation of hepatitis may lead to hepatic decompensation and liver failure.
5.2Hypersensitivity Reactions Hypersensitivity reactions have been reported with the use of dolutegravir, a component of DOVATO, and were characterized by rash, constitutional findings, and sometimes organ dysfunction, including liver injury. These events were reported in <1% of subjects receiving dolutegravir in Phase 3 clinical trials. Discontinue DOVATO immediately if signs or symptoms of hypersensitivity reactions develop (including, but not limited to, severe rash or rash accompanied by fever, general malaise, fatigue, muscle or joint aches, blisters or peeling of the skin, oral blisters or lesions, conjunctivitis, facial edema, hepatitis, eosinophilia, angioedema, difficulty breathing).
Clinical status, including liver aminotransferases, should be monitored and appropriate therapy initiated. Delay in stopping treatment with DOVATO or other suspect agents after the onset of hypersensitivity may result in a life-threatening reaction [see Contraindications ( 4 )] .
5.3Hepatotoxicity Hepatic adverse events have been reported in patients receiving a dolutegravir-containing regimen [see Adverse Reactions ( 6.1 )] . Patients with underlying hepatitis B or C may be at increased risk for worsening or development of transaminase elevations with use of DOVATO [see Adverse Reactions ( 6.1 )] . In some cases, the elevations in transaminases were consistent with immune reconstitution syndrome or HBV reactivation particularly in the setting where anti-hepatitis therapy was withdrawn.
Cases… [Excerpted — this section continues on DailyMed.]
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS The following adverse reactions are discussed in other sections of the labeling: • Patients co-infected with HIV-1 and HBV [see Warnings and Precautions ( 5.1 )] • Hypersensitivity reactions [see Warnings and Precautions ( 5.2 )] • Hepatotoxicity [see Warnings and Precautions ( 5.3 )] • Lactic acidosis and severe hepatomegaly with steatosis [see Warnings and Precautions ( 5.4 )] • Immune reconstitution syndrome [see Warnings and Precautions ( 5.6 )] The most common adverse reactions (all grades) observed in ≥2% (in those receiving DOVATO) were headache, nausea, diarrhea, insomnia, fatigue, and anxiety.
( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact ViiV Healthcare at 1-877-844-8872 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
6.1Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. Clinical Trials in Adults with No Antiretroviral Treatment History The safety assessment of DOVATO in HIV-1–infected adults with no antiretroviral treatment history and with a plasma viral load ≤500,000 HIV-1 RNA copies/mL at the screening visit, is based on the pooled Week 144 analyses of data from 2 identical, multicenter, double-blind, controlled trials, GEMINI-1 and GEMINI-2.
A total of 1,433 HIV-1–infected adults with no antiretroviral treatment history received either dolutegravir (TIVICAY) 50 mg plus lamivudine (EPIVIR) 300 mg, as a complete regimen once daily, or TIVICAY 50 mg plus fixed-dose combination tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) (TRUVADA), administered once daily. The rates of adverse events leading to discontinuation in the pooled analysis were 4% of subjects who received TIVICAY plus EPIVIR and 5% in subjects who received TIVICAY plus TRUVADA. The most common adverse events leading to discontinuation were psychiatric disorders: 2% of subjects who received TIVICAY plus EPIVIR and 1% in subjects who received TIVICAY plus TRUVADA.
Adverse reactions (all grades) observed in at least 2% of subjects in either treatment arm of the Week 144 pooled analysis from GEMINI-1 and GEMINI-2 trials are provided in Table 2 . The adverse reactions observed for TIVICAY plus EPIVIR in the Week 144 analysis of the pooled data from GEMINI-1 and GEMINI-2 were generally consistent with the adverse reaction profiles and severities for the individual components when administered with other antiretroviral agents. Table 2.
Adverse Reactions (All Grades) Reported in ≥2% of Subjects in Any Treatment Group in Adults with No Antiretroviral Treatment History in GEMINI-1 and GEMINI-2 (Week 144 Pooled Analysis) a Fatigue: includes fatigue, asthenia, and malaise. Adverse Reaction TIVICAY plus EPIVIR (n = 716) TIVICAY plus TRUVADA (n = 717) Headache 3% 4% Nausea 2% 6% Diarrhea 2% 3% Insomnia 2% 3% Fatigue a 2% 2% Anxiety 2% 1% Dizziness 1% 2% Adverse reactions of at least Grade 2 occurring in ≥1% of subjects treated with TIVICAY plus EPIVIR were headache, anxiety, suicidal ideation, and insomnia (all at 1%).
Less Common Adverse Reactions: The following adverse reactions (all grades) occurred in <2% of subjects receiving dolutegravir plus lamivudine or are from studies described in the prescribing information of the individual components, TIVICAY (dolutegravir) and EPIVIR (lamivudine). Some events have been included because of their seriousness and assessment of potential causal relationship. Blood and Lymphatic Systems Disorders: Anemia, neutropenia, thrombocytopenia.
Gastrointestinal Disorders: Abdominal discomfort, abdominal pain, flatulence, upper abdominal pain, vomiting. General: Fever. Hepatobiliary Disorders: Hepatitis.
Immune System Disorders: Hypersensitivity, immune reconstitution syndrome. Musculoskeletal Disorders: Myositis. Nervous System Disorders: Somnole… [Excerpted — this section continues on DailyMed.]
🔄 Drug Interactions ▾
7 DRUG INTERACTIONS • DOVATO is a complete regimen for the treatment of HIV-1 infection; therefore, coadministration with other antiretroviral drugs for the treatment of HIV-1 infection is not recommended. ( 7.1 ) • Refer to the full prescribing information for important drug interactions with DOVATO. ( 4 , 5.5 , 7 )
7.1Coadministration with Other Antiretroviral Drugs DOVATO is a complete regimen for the treatment of HIV-1 infection; therefore, coadministration with other antiretroviral drugs for the treatment of HIV-1 infection is not recommended [see Indications and Usage ( 1 )] . Information regarding potential drug-drug interactions with other antiretroviral drugs is not provided [see Contraindications ( 4 ), Warnings and Precautions ( 5.5 ), Clinical Pharmacology ( 12.3 )].
7.2Potential for DOVATO to Affect Other Drugs Dolutegravir, a component of DOVATO, inhibits the renal organic cation transporters (OCT)2 and multidrug and toxin extrusion transporter (MATE)1; thus, it may increase plasma concentrations of drugs eliminated via OCT2 or MATE1 such as dofetilide, dalfampridine, and metformin [see Contraindications ( 4 ), Drug Interactions ( 7.4 ), Clinical Pharmacology ( 12.3 )].
7.3Potential for Other Drugs to Affect the Components of DOVATO Dolutegravir is metabolized by uridine diphosphate (UDP)-glucuronosyl transferase (UGT)1A1 with some contribution from cytochrome P450 (CYP)3A. Dolutegravir is also a substrate of UGT1A3, UGT1A9, breast cancer resistance protein (BCRP), and P-glycoprotein (P-gp) in vitro. Drugs that induce those enzymes and transporters may decrease dolutegravir plasma concentrations and reduce the therapeutic effect of DOVATO [see Drug Interactions ( 7.4 ), Clinical Pharmacology ( 12.3 )] .
Coadministration of DOVATO and other drugs that inhibit these enzymes may increase dolutegravir plasma concentrations. Coadministration of dolutegravir with polyvalent cation-containing products may lead to decreased absorption of dolutegravir [see Drug Interactions ( 7.4 ), Clinical Pharmacology ( 12.3 )] .
7.4Established and Other Potentially Significant Drug Interactions No drug interaction studies were conducted with DOVATO. The drug interactions described are based on studies conducted with dolutegravir or lamivudine when administered alone [see Clinical Pharmacology ( 12.3 )] . Information regarding potential drug interactions with DOVATO are provided in Table 5 .
These recommendations are based on either drug interaction trials or predicted interactions due to the expected magnitude of interaction and potential for serious adverse events or loss of efficacy [see Contraindications ( 4 ), Clinical Pharmacology ( 12.3 )]. Table 5. Established and Other Potentially Significant Drug Interactions for DOVATO: Alterations in Dose May Be Recommended Based on Drug Interaction Trials or Predicted Interactions ↑ = Increase, ↓ = Decrease. a See Clinical Pharmacology ( 12.3 ) Table 8 or Table 9 for magnitude of interaction.
Coadministered Drug Class: Drug Name Effect on Concentration Clinical Comment Antiarrhythmic: Dofetilide ↑Dofetilide Coadministration is contraindicated with DOVATO [see Contraindications ( 4 )] . Anticonvulsant: Carbamazepine a ↓Dolutegravir An additional dolutegravir 50-mg dose should be taken, separated by 12 hours from DOVATO [see Dosage and Administration ( 2.3 )] . Anticonvulsants: Oxcarbazepine Phenytoin Phenobarbital ↓Dolutegravir Avoid coadministration with DOVATO because there are insufficient data to make dosing recommendations.
Antidiabetic: Metformin a ↑Metformin Refer to the prescribing information for metformin for assessing the benefit and risk of concomitant use of DOVATO and metformin. Antimycobacterial: Rifampin a ↓Dolutegravir An additional 50-mg dose of dolutegravir should be taken, separated by 12 hours from DOVATO [see Dosage and Administration ( 2.3 )] . Herbal product: St.
John’s wort ( Hypericum perforatum ) ↓Dolutegravir Avoid coadministration with DOVATO because there a… [Excerpted — this section continues on DailyMed.]
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS • Renal impairment: DOVATO is not recommended in patients with creatinine clearance less than 30 mL/min. ( 8.6 ) • Hepatic impairment: DOVATO is not recommended in patients with severe hepatic impairment (Child-Pugh Score C). ( 8.7 )
8.1Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in individuals exposed to DOVATO during pregnancy. Healthcare providers are encouraged to register patients by calling the Antiretroviral Pregnancy Registry (APR) at 1‑800‑258‑4263. Risk Summary Data from two, ongoing birth outcome surveillance studies in Botswana and Eswatini which together include over 14,000 individuals evaluated during pregnancy show similar prevalence of neural tube defects among infants born to individuals taking dolutegravir at the time of conception compared to those born to individuals taking non-dolutegravir-containing regimens at conception or infants born to HIV-negative individuals (see Data) .
There are insufficient human data on the use of DOVATO during pregnancy to definitively assess a drug-associated risk for birth defects and miscarriage. However, available human data from the APR with the individual components of DOVATO do not indicate an increased risk of birth defects (see Data) . The background risk for major birth defects for the indicated population is unknown.
In the U.S. general population, the estimated background rate for major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. In animal reproduction studies, no evidence of adverse developmental outcomes (including neural tube defects) was observed with dolutegravir at systemic exposures (AUC) less than (rabbits) and 50 times (rats) the exposure in humans at the recommended human dose (RHD) (see Data) . Oral administration of lamivudine to pregnant rabbits during organogenesis resulted in embryolethality at systemic exposure (AUC) similar to the RHD; however, no adverse developmental effects were observed with oral administration of lamivudine to pregnant rats during organogenesis at plasma concentrations (C max ) 35 times the RHD (see Data).
Data Human Data: Dolutegravir: Observational studies: The first interim analysis from an ongoing birth outcome surveillance study in Botswana identified an association between dolutegravir and an increased risk of neural tube defects when dolutegravir was administered at the time of conception and in early pregnancy. A subsequent analysis was conducted based on a larger cohort from the birth outcome surveillance study in Botswana and included over 9,460 individuals exposed to dolutegravir at conception, 23,664 individuals exposed to non-dolutegravir-containing regimens, and 170,723 HIV-negative pregnant individuals.
The prevalence of neural tube defects in infants delivered to individuals taking dolutegravir at conception was 0.11% (95% CI: 0.05-0.19%). The observed prevalence rate did not differ significantly from that of infants delivered to individuals taking non-dolutegravir-containing regimens (0.11%, 95% CI: 0.07-0.16%), or to HIV-negative individuals (0.06%, 95% CI: 0.05-0.08%). The Eswatini birth outcome surveillance study includes 9,743 individuals exposed to dolutegravir at conception, 1,838 individuals exposed to non-dolutegravir-containing regimens, and 32,259 HIV-negative pregnant individuals.
The prevalence of neural tube defects in infants delivered to individuals taking dolutegravir at conception was 0.08% (95% CI: 0.04-0.16%). The observed prevalence rate did not differ significantly from that of infants delivered to individuals taking non-dolutegravir-containing regimens (0.22%, 95% CI: 0.06-0.56%) or to HIV-negative individuals (0.08%, 95% CI: 0.06-0.12%). The observed prevalence of neural tube defects in infants delivered to individuals taking non-dolutegravir-containing regimens had a wide confidence interval due to low sample size.
Limitations… [Excerpted — this section continues on DailyMed.]
🤰 Pregnancy ▾
8.1Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in individuals exposed to DOVATO during pregnancy. Healthcare providers are encouraged to register patients by calling the Antiretroviral Pregnancy Registry (APR) at 1‑800‑258‑4263. Risk Summary Data from two, ongoing birth outcome surveillance studies in Botswana and Eswatini which together include over 14,000 individuals evaluated during pregnancy show similar prevalence of neural tube defects among infants born to individuals taking dolutegravir at the time of conception compared to those born to individuals taking non-dolutegravir-containing regimens at conception or infants born to HIV-negative individuals (see Data) .
There are insufficient human data on the use of DOVATO during pregnancy to definitively assess a drug-associated risk for birth defects and miscarriage. However, available human data from the APR with the individual components of DOVATO do not indicate an increased risk of birth defects (see Data) . The background risk for major birth defects for the indicated population is unknown.
In the U.S. general population, the estimated background rate for major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. In animal reproduction studies, no evidence of adverse developmental outcomes (including neural tube defects) was observed with dolutegravir at systemic exposures (AUC) less than (rabbits) and 50 times (rats) the exposure in humans at the recommended human dose (RHD) (see Data) . Oral administration of lamivudine to pregnant rabbits during organogenesis resulted in embryolethality at systemic exposure (AUC) similar to the RHD; however, no adverse developmental effects were observed with oral administration of lamivudine to pregnant rats during organogenesis at plasma concentrations (C max ) 35 times the RHD (see Data).
Data Human Data: Dolutegravir: Observational studies: The first interim analysis from an ongoing birth outcome surveillance study in Botswana identified an association between dolutegravir and an increased risk of neural tube defects when dolutegravir was administered at the time of conception and in early pregnancy. A subsequent analysis was conducted based on a larger cohort from the birth outcome surveillance study in Botswana and included over 9,460 individuals exposed to dolutegravir at conception, 23,664 individuals exposed to non-dolutegravir-containing regimens, and 170,723 HIV-negative pregnant individuals.
The prevalence of neural tube defects in infants delivered to individuals taking dolutegravir at conception was 0.11% (95% CI: 0.05-0.19%). The observed prevalence rate did not differ significantly from that of infants delivered to individuals taking non-dolutegravir-containing regimens (0.11%, 95% CI: 0.07-0.16%), or to HIV-negative individuals (0.06%, 95% CI: 0.05-0.08%). The Eswatini birth outcome surveillance study includes 9,743 individuals exposed to dolutegravir at conception, 1,838 individuals exposed to non-dolutegravir-containing regimens, and 32,259 HIV-negative pregnant individuals.
The prevalence of neural tube defects in infants delivered to individuals taking dolutegravir at conception was 0.08% (95% CI: 0.04-0.16%). The observed prevalence rate did not differ significantly from that of infants delivered to individuals taking non-dolutegravir-containing regimens (0.22%, 95% CI: 0.06-0.56%) or to HIV-negative individuals (0.08%, 95% CI: 0.06-0.12%). The observed prevalence of neural tube defects in infants delivered to individuals taking non-dolutegravir-containing regimens had a wide confidence interval due to low sample size.
Limitations of these birth outcome surveillance studies include insufficient data to determine if baseline characteristics were balanced between the study groups or to assess other factors such as the use of folic acid during the preconception or first trimester periods. Anti… [Excerpted — this section continues on DailyMed.]
🧒 Pediatric Use ▾
8.4Pediatric Use The safety and efficacy of DOVATO for the treatment of HIV-1 infection have been established in adolescents 12 years of age and older and weighing at least 25 kg. Use of DOVATO for this indication is supported by DANCE trial in treatment-naïve adolescents and evidence from adequate and well-controlled trials in adults, GEMINI-1, GEMINI-2 (treatment-naïve adults) and TANGO (virologically-suppressed adults) [see Adverse Reactions ( 6.1 ), Clinical Pharmacology ( 12.3 ), Clinical Studies ( 14 )] . Overall, the safety and efficacy data in adolescent subjects from the DANCE trial were comparable to those observed in adults, and there was no clinically significant difference in exposure for the components of DOVATO [see Adverse Reactions ( 6.1 ), Clinical Pharmacology ( 12.3 ), Clinical Studies ( 14.4 )] .
The safety and efficacy of DOVATO have not been established in pediatric patients less than 12 years of age or weighing less than 25 kg.
🧓 Geriatric Use ▾
8.5Geriatric Use Clinical trials of DOVATO did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. In general, caution should be exercised in the administration of DOVATO in elderly patients reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy [see Clinical Pharmacology ( 12.3 )].
🆘 Overdosage ▾
10 OVERDOSAGE There is no known specific treatment for overdose with DOVATO. If overdose occurs, the patient should be monitored, and standard supportive treatment applied as required. Dolutegravir As dolutegravir is highly bound to plasma proteins, it is unlikely that it will be significantly removed by dialysis.
Lamivudine Because a negligible amount of lamivudine was removed via (4-hour) hemodialysis, continuous ambulatory peritoneal dialysis, and automated peritoneal dialysis, it is not known if continuous hemodialysis would provide clinical benefit in a lamivudine overdose event.
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action DOVATO is a fixed-dose combination of the HIV‑1 antiretroviral agents, dolutegravir and lamivudine [see Microbiology ( 12.4 )] .
12.2Pharmacodynamics Cardiac Electrophysiology The effect of combination therapy as DOVATO or lamivudine given alone on the QT interval has not been studied. At a 250-mg suspension dose (exposures approximately 3-fold that of the 50-mg once-daily dose at steady state), dolutegravir given alone did not prolong the QTc interval to any clinically relevant extent. Effects of Dolutegravir on Renal Function No clinically significant dolutegravir exposure-response relationship on the glomerular filtration rate or effective renal plasma flow was observed.
The effect of dolutegravir on renal function was evaluated in an open-label, randomized, 3-arm, parallel, placebo-controlled trial in healthy subjects (n = 37) who received dolutegravir 50 mg once daily (n = 12), dolutegravir 50 mg twice daily (n = 13), or placebo once daily (n = 12) for 14 days.
12.3Pharmacokinetics The C max , C trough, and AUC tau parameters of the components of DOVATO are provided in Table 6 . Table 6. Multiple-Dose Pharmacokinetic Parameters of the Components of DOVATO C max = Maximum concentration; C trough = Lowest concentration before administration of the next dose; AUC tau = Area under the concentration-time curve integrated across the dosing interval. a Based on dolutegravir 50-mg once-daily dosage administered to antiretroviral treatment-naive adults. b Based on lamivudine 300-mg once-daily dosage administered to healthy subjects.
Parameter Mean (%CV) Dolutegravir a Lamivudine b C max (mcg/mL) 3.67 (20%) 2.04 (26%) C trough (mcg/mL) 1.11 (46%) 0.042 (38%) AUC tau (mcg · h/mL) 53.6 (27%) 8.87 (21%) The absorption, distribution, and elimination pharmacokinetic parameters of the components of DOVATO are provided in Table 7 . Table 7. Pharmacokinetic Properties of the Components of DOVATO T max = Time to maximum concentration (C max ); t 1/2 = Elimination half-life; UGT = Uridine diphosphate glucuronosyl transferase; CYP = Cytochrome P450; OCT = Organic cation transporter. a After administration of DOVATO (fasted state). b High-fat meal is approximately 900 kcal, 56% fat. c The geometric mean (90% confidence interval) AUC ratio (fed/fasted) of dolutegravir and lamivudine is 1.33 (1.18, 1.48) and 0.91 (0.87, 0.96), respectively. d Based on in vitro data. e Based on single-dose, mass balance study of radiolabeled dolutegravir. f Based on 24-hour urine collection obtained after oral or IV administration.
Pharmacokinetic Parameters Dolutegravir Lamivudine Absorption T max (h), median a 2.5 1 Effect of Food High-fat meal b (relative to fasting) No clinically significant differences in the pharmacokinetics of either component (after administration of DOVATO) were observed c . Distribution Plasma protein binding d Approximately 99% 36% Blood-to-plasma ratio 0.44 - 0.54 1.1 -
1.2Elimination t 1/2 (h) Approximately 14 13 - 19 Metabolism Metabolic pathways UGT1A1 (primary) CYP3A (minor) Not significantly metabolized Excretion Major route of elimination Metabolism Renal, by OCT system Urine (unchanged) 31% (<1%) e Approximately 70% f Feces (unchanged) 64% (53%) e − Specific Populations No clinically significant differences in the pharmacokinetics of the components of DOVATO were observed based on age, sex, or race. Pharmacokinetic data for dolutegravir and lamivudine in subjects 65 years of age and older are limited.
Patients with Renal Impairment: The pharmacokinetics for the individual components of DOVATO have been evaluated in patients with renal impairment. See the U.S. prescribing information for the individual components, TIVICAY (dolutegravir) and EPIVIR (lamivudine). Patients with Hepatic Impairment: The pharmacokinetics for the individual components of DOVATO have been evaluated in patients with varying degrees of hepatic impairment.
See the U.S. prescribing information for the ind… [Excerpted — this section continues on DailyMed.]
🧬 Mechanism of Action ▾
12.1Mechanism of Action DOVATO is a fixed-dose combination of the HIV‑1 antiretroviral agents, dolutegravir and lamivudine [see Microbiology ( 12.4 )] .
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED/STORAGE AND HANDLING Each DOVATO tablet contains 50 mg of dolutegravir as dolutegravir sodium and 300 mg lamivudine and is an oval, biconvex, white, film-coated tablet, debossed with “SV 137” on one face. Bottle of 30 tablets with child-resistant closure NDC 49702-246-13. Blister pack of 30 tablets with child-resistant closure NDC 49702-246-33. Store below 30°C (86°F).
📋 Description ▾
11 DESCRIPTION DOVATO is a fixed-dose combination tablet containing dolutegravir (as dolutegravir sodium), an integrase strand transfer inhibitor (INSTI), and lamivudine (also known as 3TC), a nucleoside analogue reverse transcriptase inhibitor (NRTI). DOVATO tablets are for oral administration. Each film-coated tablet contains the active ingredients 50 mg of dolutegravir (equivalent to 52.6 mg dolutegravir sodium) and 300 mg of lamivudine and the inactive ingredients magnesium stearate, mannitol, microcrystalline cellulose, povidone K29/32, sodium starch glycolate, sodium stearyl fumarate.
The tablet film-coating contains the inactive ingredients hypromellose, polyethylene glycol, titanium dioxide. Dolutegravir The chemical name of dolutegravir sodium is sodium (4 R ,12a S )-9-{[(2,4-difluorophenyl)methyl]carbamoyl}-4-methyl-6,8-dioxo-3,4,6,8,12,12a-hexahydro-2 H -pyrido[1',2':4,5]pyrazino[2,1- b ][1,3]oxazin-7-olate. The empirical formula is C 20 H 18 F 2 N 3 NaO 5 , and the molecular weight is 441.36 g/mol.
It has the following structural formula: Dolutegravir sodium is a white to light yellow powder and is slightly soluble in water. Lamivudine The chemical name of lamivudine is (2R,cis)-4-amino-1-(2-hydroxymethyl-1,3-oxathiolan-5-yl)-(1H)-pyrimidin-2-one. Lamivudine is the (‑)enantiomer of a dideoxy analogue of cytidine.
Lamivudine has also been referred to as (‑)2′,3′-dideoxy, 3′-thiacytidine. It has a molecular formula of C 8 H 11 N 3 O 3 S and a molecular weight of 229.3 g/mol. It has the following structural formula: Lamivudine is a white to off‑white crystalline solid and is soluble in water.
Dolutegravir sodium chemical structure Lamivudine chemical structure
💬 Information for Patients ▾
17 PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Patient Information). Emergence of Lamivudine-Resistant HBV in Hepatitis B Co-infection Advise all patients with HIV-1 to be tested for the presence of HBV prior to or when initiating DOVATO. Advise patients co-infected with HIV-1 and HBV that emergence of HBV variants associated with resistance to lamivudine has been reported in HIV‑1–infected subjects who have received lamivudine‑containing antiretroviral regimens.
Advise patients co-infected with HIV-1 and HBV who are being treated with DOVATO to discuss with their healthcare provider if additional treatment should be considered for appropriate treatment of chronic HBV [see Warnings and Precautions ( 5.1 )] . Severe Acute Exacerbations of Hepatitis in Patients with HBV Co-infection Advise all patients with HIV-1 to be tested for the presence of HBV prior to or when initiating DOVATO. Advise patients co‑infected with HIV‑1 and HBV that worsening of liver disease has occurred in some cases when treatment with lamivudine was discontinued.
Advise patients to discuss any changes in regimen with their healthcare provider [see Warnings and Precautions ( 5.1 )]. Hypersensitivity Reactions Advise patients to immediately contact their healthcare provider if they develop a rash. Instruct patients to immediately stop taking DOVATO and seek medical attention if they develop a rash associated with any of the following symptoms, as it may be a sign of a more serious reaction such as severe hypersensitivity: fever; generally ill feeling; extreme tiredness; muscle or joint aches; blisters or peeling of the skin; oral blisters or lesions; eye inflammation; facial swelling; swelling of the eyes, lips, tongue, or mouth; breathing difficulty; and/or signs and symptoms of liver problems (e.g., yellowing of the skin or whites of the eyes; dark or tea-colored urine; pale-colored stools or bowel movements; nausea; vomiting; loss of appetite; or pain, aching, or sensitivity on the right side below the ribs).
Advise patients that if hypersensitivity occurs, they will be closely monitored, laboratory tests will be ordered, and appropriate therapy will be initiated [see Warnings and Precautions ( 5.2 )] . Hepatotoxicity Inform patients that hepatotoxicity has been reported with dolutegravir, a component of DOVATO [see Warnings and Precautions ( 5.3 ), Adverse Reactions ( 6.1 )] . Inform patients that monitoring for hepatotoxicity during therapy with DOVATO is recommended.
Lactic Acidosis/Hepatomegaly with Steatosis Inform patients that some HIV medicines, including DOVATO, can cause a rare, but serious condition called lactic acidosis with liver enlargement (hepatomegaly) [see Warnings and Precautions ( 5.4 )]. Drug Interactions DOVATO may interact with many drugs; therefore, advise patients to report to their healthcare provider the use of any other prescription or nonprescription medication or herbal products, including St. John’s wort [see Contraindications ( 4 ), Warnings and Precautions ( 5.5 ), Drug Interactions ( 7 )] .
Immune Reconstitution Syndrome Advise patients to inform their healthcare provider immediately of any signs and symptoms of infection as inflammation from previous infection may occur soon after combination antiretroviral therapy, including DOVATO, is started [see Warnings and Precautions ( 5.7 )]. Pregnancy Registry Inform patients that there is an antiretroviral pregnancy registry to monitor fetal outcomes in those exposed to DOVATO during pregnancy [see Use in Specific Populations ( 8.1 )] . Lactation Inform individuals with HIV-1 infection that the potential risks of breastfeeding include: (1) HIV-1 transmission (in HIV‑1–negative infants), (2) developing viral resistance (in HIV‑1–positive infants), and (3) adverse reactions in a breastfed infant similar to those seen in adults [see Use in Specific Populations ( 8.2 )] .
Missed Dose Instruct patients that if they miss a dose of DO… [Excerpted — this section continues on DailyMed.]
🧬 Pharmacokinetics ▾
12.3Pharmacokinetics The C max , C trough, and AUC tau parameters of the components of DOVATO are provided in Table 6 . Table 6. Multiple-Dose Pharmacokinetic Parameters of the Components of DOVATO C max = Maximum concentration; C trough = Lowest concentration before administration of the next dose; AUC tau = Area under the concentration-time curve integrated across the dosing interval. a Based on dolutegravir 50-mg once-daily dosage administered to antiretroviral treatment-naive adults. b Based on lamivudine 300-mg once-daily dosage administered to healthy subjects.
Parameter Mean (%CV) Dolutegravir a Lamivudine b C max (mcg/mL) 3.67 (20%) 2.04 (26%) C trough (mcg/mL) 1.11 (46%) 0.042 (38%) AUC tau (mcg · h/mL) 53.6 (27%) 8.87 (21%) The absorption, distribution, and elimination pharmacokinetic parameters of the components of DOVATO are provided in Table 7 . Table 7. Pharmacokinetic Properties of the Components of DOVATO T max = Time to maximum concentration (C max ); t 1/2 = Elimination half-life; UGT = Uridine diphosphate glucuronosyl transferase; CYP = Cytochrome P450; OCT = Organic cation transporter. a After administration of DOVATO (fasted state). b High-fat meal is approximately 900 kcal, 56% fat. c The geometric mean (90% confidence interval) AUC ratio (fed/fasted) of dolutegravir and lamivudine is 1.33 (1.18, 1.48) and 0.91 (0.87, 0.96), respectively. d Based on in vitro data. e Based on single-dose, mass balance study of radiolabeled dolutegravir. f Based on 24-hour urine collection obtained after oral or IV administration.
Pharmacokinetic Parameters Dolutegravir Lamivudine Absorption T max (h), median a 2.5 1 Effect of Food High-fat meal b (relative to fasting) No clinically significant differences in the pharmacokinetics of either component (after administration of DOVATO) were observed c . Distribution Plasma protein binding d Approximately 99% 36% Blood-to-plasma ratio 0.44 - 0.54 1.1 -
1.2Elimination t 1/2 (h) Approximately 14 13 - 19 Metabolism Metabolic pathways UGT1A1 (primary) CYP3A (minor) Not significantly metabolized Excretion Major route of elimination Metabolism Renal, by OCT system Urine (unchanged) 31% (<1%) e Approximately 70% f Feces (unchanged) 64% (53%) e − Specific Populations No clinically significant differences in the pharmacokinetics of the components of DOVATO were observed based on age, sex, or race. Pharmacokinetic data for dolutegravir and lamivudine in subjects 65 years of age and older are limited.
Patients with Renal Impairment: The pharmacokinetics for the individual components of DOVATO have been evaluated in patients with renal impairment. See the U.S. prescribing information for the individual components, TIVICAY (dolutegravir) and EPIVIR (lamivudine). Patients with Hepatic Impairment: The pharmacokinetics for the individual components of DOVATO have been evaluated in patients with varying degrees of hepatic impairment.
See the U.S. prescribing information for the individual components, TIVICAY (dolutegravir) and EPIVIR (lamivudine). Pediatric Subjects: In adolescents receiving DOVATO, dolutegravir and lamivudine exposures were higher as compared to adults; however, the differences in exposure were not considered clinically significant. Lamivudine and dolutegravir exposures were within the observed ranges at the recommended doses in adults and pediatrics receiving the individual components of DOVATO ( Table 8 ).
Table 8. Pharmacokinetic Parameters Following Dovato in Adolescent Subjects 12 to Less than 18 Years of Age Weighing at Least 25 kg (n = 32) Age/weight Dose Pharmacokinetic Parameter Estimates Geometric Mean (CV%) AUC (0-24) mcg·h/mL C max mcg/mL C 24 mcg/mL 12 to <18 years of age and ≥25 kg Dolutegravir 50 mg once daily 78.2 (91.6) 6.71 (69.5) 1.46 (154) 12 to <18 years of age and ≥25 kg Lamivudine 300 mg once daily 14.7 (112) 2.95 (82.8) 0.106 (312) Pregnant women: Lamivudine: Lamivudine pharmacokinetics were studied in 36 pregnant women during 2 clinical trials conduct… [Excerpted — this section continues on DailyMed.]
🧬 Pharmacodynamics ▾
12.2Pharmacodynamics Cardiac Electrophysiology The effect of combination therapy as DOVATO or lamivudine given alone on the QT interval has not been studied. At a 250-mg suspension dose (exposures approximately 3-fold that of the 50-mg once-daily dose at steady state), dolutegravir given alone did not prolong the QTc interval to any clinically relevant extent. Effects of Dolutegravir on Renal Function No clinically significant dolutegravir exposure-response relationship on the glomerular filtration rate or effective renal plasma flow was observed.
The effect of dolutegravir on renal function was evaluated in an open-label, randomized, 3-arm, parallel, placebo-controlled trial in healthy subjects (n = 37) who received dolutegravir 50 mg once daily (n = 12), dolutegravir 50 mg twice daily (n = 13), or placebo once daily (n = 12) for 14 days.
🔬 Clinical Studies ▾
14 CLINICAL STUDIES
14.1Description of Clinical Trials The efficacy and safety of DOVATO were evaluated in the studies summarized in Table 12 . Table 12. Trials Conducted with DOVATO in HIV-1–Infected Subjects TBR = Tenofovir alafenamide-based regimen.
Population Trial Trial Arms Timepoint (Week) Adults: Treatment-naïve GEMINI-1 [NCT02831673] GEMINI-2 [NCT02831764] Pooled presentation TIVICAY plus EPIVIR (n = 716) TIVICAY plus TRUVADA (n = 717) 144 Virologically suppressed TANGO [NCT03446573] DOVATO (n = 369) TBR (n = 372) 144 Adolescents: Treatment-naïve (12 to less than 18 years of age and weighing at least 25 kg) DANCE [NCT03682848] DOVATO (n = 32) 48
14.2Clinical Trial Results in HIV-1–Infected Adult Subjects with No Antiretroviral Treatment History GEMINI-1 and GEMINI-2 are identical 148-week, Phase 3, randomized, multicenter, parallel-group, non-inferiority trials. A total of 1,433 HIV-1–infected adults with no antiretroviral treatment history received treatment in the trials. Subjects were enrolled with a screening plasma HIV-1 RNA of 1,000 to ≤500,000 copies/mL and without evidence of major resistance-associated mutations or evidence of HBV infection.
Subjects were randomized to receive a 2-drug regimen of TIVICAY 50 mg plus EPIVIR 300 mg administered once daily or TIVICAY 50 mg plus fixed-dose TRUVADA administered once daily. The primary efficacy endpoint for each GEMINI trial was the proportion of subjects with plasma HIV-1 RNA <50 copies/mL at Week 48 (Snapshot algorithm) who were randomized and treated. At baseline, in the pooled analysis, the median age of subjects was 33 years of age, 15% female, 69% white, 9% were CDC Stage 3 (AIDS), the median plasma HIV-1 RNA was 4.4 log 10 copies/mL, 20% had HIV-1 RNA >100,000 copies/mL, the median CD4 + cell count was 432 cells/mm 3 , and 8% had CD4 + cell count ≤200 cells/mm 3 ; these characteristics were similar between trials and treatment arms within each trial.
Week 144 outcomes (including outcomes by key baseline covariates) for the pooled GEMINI-1 and GEMINI-2 trials are shown in Table 13 . The results of the pooled analysis are consistent with the results from the individual trials, for which the secondary endpoint is the difference in proportion of subjects with plasma HIV-1 RNA <50 copies/mL at Week 144 based on the Snapshot algorithm for TIVICAY plus EPIVIR versus TIVICAY plus TRUVADA. The proportions of subjects with plasma HIV-1 RNA <50 copies/mL in the group receiving TIVICAY plus EPIVIR versus TIVICAY plus TRUVADA were 79% and 83%, respectively, in GEMINI‑1 and 84% in both treatment arms of GEMINI-2.
The adjusted difference was -3.6% (95% CI: -9.4%, 2.1) for GEMINI-1 and 0.0% (95% CI: -5.3%, 5.3%) for GEMINI-2. At Week 144, no subjects who met the protocol-defined confirmed virologic withdrawal criteria had any treatment-emergent substitutions associated with resistance to dolutegravir or NRTIs. Table 13.
Pooled Virologic Outcomes of Randomized Treatment of HIV-1–Infected Adults with No Antiretroviral Treatment History in GEMINI-1 and GEMINI-2 Trials at Weeks 48 and 144 (Snapshot Algorithm) ART = antiretroviral treatment. a The results of the pooled analysis are similar to the individual trials, for which the primary endpoint (proportion of subjects with plasma HIV-1 RNA <50 copies/mL at Week 48 based on the Snapshot algorithm for TIVICAY plus EPIVIR versus TIVICAY plus TRUVADA) was met. The adjusted difference was -2.6% (95% CI: -6.7%, 1.5%) for GEMINI-1 and -0.7% (95% CI: -4.3%, 2.9%) for GEMINI-2. b Based on Cochran–Mantel–Haenszel-stratified analysis adjusting for the following baseline stratification factors: plasma HIV-1 RNA (≤100,000 copies/mL versus >100,000 copies/mL) and CD4 + cell count (≤200 cells/mm 3 versus >200 cells/mm 3 ).
Pooled analysis also stratified by trial. The other Snapshot outcomes (HIV-1 RNA ≥50 copies/mL and no virologic data in the visit window) were combined into a single category for the analysis. Virologic Outcomes GEMINI-1 a… [Excerpted — this section continues on DailyMed.]
🧪 Nonclinical Toxicology ▾
13 NONCLINICAL TOXICOLOGY
13.1Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenicity Dolutegravir: Two-year carcinogenicity studies in mice and rats were conducted with dolutegravir. Mice were administered doses of up to 500 mg/kg, and rats were administered doses of up to 50 mg/kg. In mice, no significant increases in the incidence of drug-related neoplasms were observed at the highest doses tested, resulting in dolutegravir AUC exposures approximately 26 times higher than those in humans at the recommended dose.
In rats, no increases in the incidence of drug-related neoplasms were observed at the highest dose tested, resulting in dolutegravir AUC exposures 17 times higher than those in humans at the recommended dose. Lamivudine: Long‑term carcinogenicity studies with lamivudine in mice and rats showed no evidence of carcinogenic potential at exposures up to 12 times (mice) and 57 times (rats) the human exposures at the recommended dose. Mutagenicity Dolutegravir: Dolutegravir was not genotoxic in the bacterial reverse mutation assay, in a mouse lymphoma assay, or in the in vivo rodent micronucleus assay.
Lamivudine: Lamivudine was mutagenic in an L5178Y mouse lymphoma assay and clastogenic in a cytogenetic assay using cultured human lymphocytes. Lamivudine was not mutagenic in a microbial mutagenicity assay, in an in vitro cell transformation assay, in a rat micronucleus test, in a rat bone marrow cytogenetic assay, and in an assay for unscheduled DNA synthesis in rat liver. Impairment of Fertility Dolutegravir or lamivudine did not affect male or female fertility in rats at doses associated with exposures approximately 44 or 112 times, respectively, higher than the exposures in humans at the recommended dose.
📄 Carcinogenesis, Mutagenesis, Impairment of Fertility ▾
13.1Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenicity Dolutegravir: Two-year carcinogenicity studies in mice and rats were conducted with dolutegravir. Mice were administered doses of up to 500 mg/kg, and rats were administered doses of up to 50 mg/kg. In mice, no significant increases in the incidence of drug-related neoplasms were observed at the highest doses tested, resulting in dolutegravir AUC exposures approximately 26 times higher than those in humans at the recommended dose.
In rats, no increases in the incidence of drug-related neoplasms were observed at the highest dose tested, resulting in dolutegravir AUC exposures 17 times higher than those in humans at the recommended dose. Lamivudine: Long‑term carcinogenicity studies with lamivudine in mice and rats showed no evidence of carcinogenic potential at exposures up to 12 times (mice) and 57 times (rats) the human exposures at the recommended dose. Mutagenicity Dolutegravir: Dolutegravir was not genotoxic in the bacterial reverse mutation assay, in a mouse lymphoma assay, or in the in vivo rodent micronucleus assay.
Lamivudine: Lamivudine was mutagenic in an L5178Y mouse lymphoma assay and clastogenic in a cytogenetic assay using cultured human lymphocytes. Lamivudine was not mutagenic in a microbial mutagenicity assay, in an in vitro cell transformation assay, in a rat micronucleus test, in a rat bone marrow cytogenetic assay, and in an assay for unscheduled DNA synthesis in rat liver. Impairment of Fertility Dolutegravir or lamivudine did not affect male or female fertility in rats at doses associated with exposures approximately 44 or 112 times, respectively, higher than the exposures in humans at the recommended dose.
📄 Patient Package Insert ▾
PATIENT INFORMATION DOVATO (doe VAH toe) (dolutegravir and lamivudine) tablets What is the most important information I should know about DOVATO? If you have both human immunodeficiency virus-1 (HIV-1) infection and Hepatitis B virus (HBV) infection, DOVATO can cause serious side effects, including: • Resistant HBV. Your healthcare provider will test you for HBV infection before you start treatment with DOVATO.
If you have HIV-1 and hepatitis B, the HBV can change (mutate) during your treatment with DOVATO and become harder to treat (resistant). It is not known if DOVATO is safe and effective in people who have HIV-1 and HBV infection. • Worsening of HBV infection. If you have HBV infection and take DOVATO, your HBV may get worse (flare-up) if you stop taking DOVATO.
A “flare-up” is when your HBV infection suddenly returns in a worse way than before. o Do not run out of DOVATO. Refill your prescription or talk to your healthcare provider before your DOVATO is all gone. o Do not stop DOVATO without first talking to your healthcare provider. o If you stop taking DOVATO, your healthcare provider will need to check your health often and do blood tests regularly for several months to check your liver function and monitor your HBV infection. It may be necessary to give you a medicine to treat hepatitis B.
Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking DOVATO. For more information about side effects, see “What are the possible side effects of DOVATO?” What is DOVATO? DOVATO is a prescription medicine that is used without other HIV-1 medicines to treat HIV-1 infection in adults and adolescents 12 years of age and older who weigh at least 55 pounds (25 kg): • who have not received HIV-1 medicines in the past, or • to replace their current HIV-1 medicines when their healthcare provider determines that they meet certain requirements.
HIV-1 is the virus that causes Acquired Immune Deficiency Syndrome (AIDS). It is not known if DOVATO is safe and effective in children less than 12 years of age or weighing less than 55 pounds (25 kg). Do not take DOVATO if you: • have ever had an allergic reaction to a medicine that contains dolutegravir or lamivudine.
See the end of this Patient Information for a complete list of ingredients in DOVATO. • take dofetilide. Taking DOVATO and dofetilide can cause side effects that may be serious or life-threatening. Before you take DOVATO, tell your healthcare provider about all of your medical conditions, including if you: • have or have had liver problems, including hepatitis B or C infection. • have kidney problems. • are pregnant or plan to become pregnant.
Talk to your healthcare provider about the benefits and risks of treatment with DOVATO during pregnancy. • Pregnancy Registry . There is a pregnancy registry for those who take DOVATO during pregnancy. The purpose of this registry is to collect information about the health of you and your baby.
Talk with your healthcare provider about how you can take part in this registry. • are breastfeeding or plan to breastfeed. DOVATO passes to your baby in your breast milk. Talk with your healthcare provider about the following risks to your baby from breastfeeding during treatment with DOVATO: o the HIV-1 virus may pass to your baby if your baby does not have HIV-1 infection. o the HIV-1 virus may become harder to treat if your baby has HIV-1 infection. o your baby may get side effects from DOVATO.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Some medicines interact with DOVATO. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. • You can ask your healthcare provider or pharmacist for a list of medicines that interact with DOVATO. • Do not start taking a new medicine without telling your healthcare provider .
Your healthcare provider can tell y… [Excerpted — this section continues on DailyMed.]
📄 Package Label / Principal Display Panel ▾
Principal Display Panel NDC 49702-246-33 Dovato (dolutegravir and lamivudine) Tablets, for oral use 50 mg/300 mg Rx Only Note to pharmacist: Do not cover ALERT box with pharmacy label. ALERT: Find out about medicines that should NOT be taken with DOVATO. See prescribing information for dosage information.
Contents: • 4 blisters of 7 tablets and 1 blister of 2 tablets • Prescribing Information • Patient Information 30 tablets Do not accept if membrane seal under cap is missing or broken. Mfd for: ViiV Healthcare Durham, NC 27701 by: GlaxoSmithKline , Durham, NC 27701 Trademarks owned or licensed by ViiV Healthcare group of companies. ©2023 ViiV Healthcare group of companies or its licensor. Rev.
10/23 62000000089925 Dovato Tablet 30 count blisterpack carton
Medicaid utilization by pack size
Medicare Part D spend CMS · PART D · 2026 (Q1)
About this NDC listing & data coverage
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| NDC identity (package / product / labeler codes) | ✓ Available |
| Labeler | ✓ Available |
| Product & package description | ✓ Available |
| Marketing category & status | ✓ Available |
| Active ingredient / dosage form / route | ✓ Available |
| FDA label (SPL via DailyMed) | ✓ Available |
| Package photos | ✓ Available |
| Inactive ingredients (structured) | — Not published for this NDC The labeler did not submit a structured excipient list, or no SPL is available. |
| NADAC pharmacy acquisition price (CMS) | — Not published for this NDC CMS publishes NADAC only for NDCs reported in its retail-pharmacy survey. |
| Orange Book / therapeutic-equivalence data | ✓ Available |
| HCPCS J-code billing crosswalk | — Not published for this NDC Most self-administered / retail products have no J-code — that is normal. |
| Medicaid utilization (CMS SDUD) | — Not published for this NDC CMS reports utilization only for NDCs with Medicaid claims above its privacy threshold. |