Perform pregnancy testing before initiation of TIVICAY in adolescents and adults of childbearing potential.
Dosing recommendations for TIVICAY in combination with other ARV agents
Dosing considerations with other medications
TIVICAY has no known clinically relevant effects on the pharmacokinetics of the following agents based on available drug interaction studies
Please see the Drug Interactions table above for additional drug interaction information.
TIVICAY has no known clinically relevant effects on the pharmacokinetics of the following agents based on metabolic pathways and/or available drug interaction studies1,2
Dolutegravir-based regimens are a booster-free treatment option16
Indications and Usage
TIVICAY is a human immunodeficiency virus type 1 (HIV-1) integrase strand transfer inhibitor (INSTI) indicated in combination with:
- other antiretroviral agents for the treatment of HIV-1 infection in adults and pediatric patients weighing at least 30 kg
- rilpivirine as a complete regimen for the treatment of HIV-1 infection in adults to replace the current antiretroviral regimen in those who are virologically suppressed (HIV-1 RNA <50 copies per mL) on a stable antiretroviral regimen for ≥6 months with no history of treatment failure or known substitutions associated with resistance to either antiretroviral agent
Important Safety Information
- Do not use TIVICAY in patients with previous hypersensitivity reaction to dolutegravir
- Do not use TIVICAY in patients receiving dofetilide
WARNINGS AND PRECAUTIONS
- Hypersensitivity reactions have been reported with dolutegravir and were characterized by rash, constitutional findings, and sometimes organ dysfunction, including liver injury
- Discontinue TIVICAY immediately if signs or symptoms of hypersensitivity reaction develop, as a delay in stopping treatment may result in a life-threatening reaction. Clinical status, including liver aminotransferases, should be monitored and appropriate therapy initiated
- Hepatic adverse events have been reported, including cases of hepatic toxicity (elevated serum liver biochemistries, hepatitis, and acute liver failure) in patients receiving a dolutegravir-containing regimen without pre-existing hepatic disease or other identifiable risk factors
- Patients with underlying hepatitis B or C or marked elevations in transaminases prior to treatment may be at increased risk for worsening or development of transaminase elevations with use of TIVICAY. In some cases the elevations in transaminases were consistent with immune reconstitution syndrome or hepatitis B reactivation, particularly in the setting where anti-hepatitis therapy was withdrawn
- Monitoring for hepatotoxicity is recommended
- Avoid use of TIVICAY at the time of conception through the first trimester due to the risk of neural tube defects
- Perform pregnancy testing before use of TIVICAY and advise that consistent use of effective contraception is recommended while using TIVICAY in adolescents and adults of childbearing potential
Risk of Adverse Reactions or Loss of Virologic Response Due to Drug Interactions:
The concomitant use of TIVICAY and other drugs may result in known or potentially significant drug interactions (see Contraindications or Drug Interactions)
Immune Reconstitution Syndrome,
including the occurrence of autoimmune disorders with variable time to onset, has been reported with the use of TIVICAY.
The most common adverse reactions (incidence ≥2%, Grades 2-4) in treatment-naïve adults receiving TIVICAY in a combination regimen were insomnia (3%), headache (2%), and fatigue (2%).
- Coadministration of TIVICAY with drugs that induce or inhibit UGT1A1 and/or CYP3A may affect plasma concentrations
- Administer TIVICAY 2 hours before or 6 hours after taking antacids, polyvalent cation-containing products or laxatives, sucralfate, oral supplements containing iron or calcium, or buffered medications. Alternatively, oral calcium and iron supplements (including multivitamins containing calcium or iron) can be taken with TIVICAY if coadministered with a meal
- Consult the full Prescribing Information for TIVICAY for more information on potentially significant drug interactions, including clinical comments
USE IN SPECIFIC POPULATIONS
There are insufficient human data on the use of TIVICAY during pregnancy to definitively assess a drug-associated risk for birth defects and miscarriage. An Antiretroviral Pregnancy Registry has been established. Avoid use of TIVICAY at the time of conception through the first trimester of pregnancy. If planning a pregnancy or if pregnancy is confirmed while taking dolutegravir during the first trimester, if possible, switch to an alternative regimen
Breastfeeding is not recommended due to the potential for HIV-1 transmission, developing viral resistance in HIV-positive infants, and adverse reactions in a breastfed infant
Females and Males of Reproductive Potential:
Perform pregnancy testing before initiation of TIVICAY. Advise adolescents and adults of childbearing potential to consistently use effective contraception while taking TIVICAY
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. Department of Health and Human Services. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf. Accessed July 23, 2018.
- HCV guidance: recommendations for testing, managing, and treating hepatitis C. American Association for the Study of Liver Diseases and Infectious Diseases Society of America. https://www.hcvguidelines.org/unique-populations/hiv-hcv. Accessed July 23, 2018.
- Luetkemeyer AF, McDonald C, Ramgopal M, et al. 12 weeks of daclatasvir in combination with sofosbuvir for HIV-HCV coinfection (ALLY-2 study): efficacy and safety by HIV combination antiretroviral regimens. Clin Infect Dis. 2016;62(12):1489-1496.
- Garrison K, Custodio J, Pang P, et al. Drug interactions between anti-HCV antivirals ledipasvir/sofosbuvir and integrase strand transfer inhibitor-based regimens [abstract 71]. Presented at:16th International Workshop on Clinical Pharmacology of HIV & Hepatitis Therapy; May 26-28, 2015; Washington, DC.
- Harvoni [package insert]. Gilead Sciences, Inc.: Foster City, CA; November 2017.
- Olysio [package insert]. Janssen Therapeutics: Titusville, NJ; November 2017.
- Rockstroh JK, Nelson M, Katlama C, et al. Efficacy and safety of grazoprevir (MK-5172) and elbasvir (MK-8742) in patients with hepatitis C virus and HIV co-infection (C-EDGE CO-INFECTION): a non-randomised, open-label trial. Lancet HIV. 2015;2(8):e319-e327.
- Yeh W, Feng HP, Guo Z, et al. Drug-drug interaction between HCV inhibitors grazoprevir/elbasvir with dolutegravir [abstract 522]. Presented at: Conference on Retroviruses and Opportunistic Infections (CROI); February 23-26, 2015; Seattle, WA.
- Song I, Jerva F, Zong J, et al. Evaluation of drug interactions between dolutegravir and daclatasvir in healthy subjects [abstract 79]. Presented at: 16th International Workshop on Clinical Pharmacology of HIV & Hepatitis Therapy; May 26-28, 2015; Washington, DC.
- Daklinza [package insert]. Bristol-Myers Squibb Company: Princeton, NJ; November 2017.
- Khatri A, Trinh R, Zhao W, et al. Drug-drug interactions of ombitasvir/paritaprevir/r plus dasabuvir with dolutegravir or abacavir plus lamivudine. Presented at: Clinical Pharmacology of HIV and Hepatitis Therapy; May 26-28, 2015; Washington, DC.
- Viekira Pak [package insert]. AbbVie Inc: North Chicago, IL; November 2017.
- Epclusa [package insert]. Gilead Sciences, Inc.: Foster City, CA; November 2017.
- Vosevi [package insert]. Gilead Sciences, Inc.: Foster City, CA; November 2017.
- Mavyret [package insert]. Abbvie, Inc: North Chicago, IL; February 2018.
- Min S, Song I, Borland J, et al. Pharmacokinetics and safety of S/GSK1349572, a next-generation HIV integrase inhibitor, in healthy volunteers. Antimicrob Agents Chemother.2010;54(1):254-258.