Delstrigo
Delstrigo is an HIV antiretroviral (ARV) combination tablet made of three medications: doravirine, lamivudine, and tenofovir. With just one tablet once a day, it's a full treatment regimen for many people. But it's not a first-choice treatment option for most people at this time.
What is Delstrigo?
What is Delstrigo used for?
HIV treatment in:
- People who have never taken HIV ARVs
- People who are well controlled on an HIV ARV regimen, have a viral load of less than 50, and want to switch regimens
How Delstrigo works
Delstrigo is an HIV ARV combination medication. It contains three medications that prevent HIV from infecting your cells and making copies of itself.
- Doravirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI). It stops reverse transcriptase, an important enzyme needed for the virus to make DNA (genetic material).
- Lamivudine and tenofovir are nucleoside reverse transcriptase inhibitors (NRTIs). They insert themselves into the virus' DNA and stop the DNA-making process.
Drug facts
Side effects of Delstrigo
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Dizziness (7%)
- Nausea (5%)
- Abnormal dreams (5%)
Less Common Side Effects
- Headache
- Sleepiness
- Trouble falling or staying asleep
- Diarrhea
- Rash
Delstrigo serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Liver problems if you have hepatitis B and suddenly stop taking Delstrigo: fever, tiredness, nausea, vomiting, stomach pain, dark urine, yellowing of your skin or eyes
- Kidney problems: swelling in your legs and feet, difficulty urinating, confusion, bone or muscle pain, pain in the arms or legs
The following Delstrigo side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Infection—fever, chills, cough, or sore throat
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
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Pros and cons of Delstrigo
Pros
- Convenient; one tablet once a day
- Contains three medications in a single pill and is a full HIV ARV regimen
- Contains tenofovir, a first-choice treatment for hepatitis B (HBV)
- Can be taken with or without food
- Doesn't have to be separated from antacids or other heartburn medications
Cons
- Brand only, so it can be expensive
- Not a good option for people with moderate or severe kidney problems
- Can cause sleep disturbances, like trouble sleeping and abnormal dreams
- Risk of bone loss; might need to take calcium and vitamin D supplements
- Other medications can affect how Delstrigo breaks down in the body, which can lead to HIV resistance (making it harder to treat).
Pharmacist tips for Delstrigo
- Since the medication can be used to treat both HIV and hepatitis B, your healthcare provider might order lab tests before starting Delstrigo to see if you have both viruses. The dose of Delstrigo won't change if you have either virus or both viruses, but your provider might add other medications to your treatment plan if you have HBV.
- Don't stop taking Delstrigo without talking to your provider first, especially if you have a history of hepatitis B. If you have both HIV and hepatitis B, suddenly stopping this medication can cause a hepatitis B flare up, which can lead to serious liver damage. Let your provider know if you experience symptoms of liver problems, such as fever, tiredness, nausea, vomiting, stomach pain, dark urine, or yellowing of your skin or eyes.
- Taking calcium and vitamin D supplements can help prevent bone problems while taking Delstrigo.
- Always talk to your care team before starting any new medications so they can check for interactions and make adjustments if needed. Some medications can speed up how fast your body breaks down Delstrigo and can't be taken at the same time. But one exception is rifabutin (Mycobutin). You can take both rifabutin (Mycobutin) and Delstrigo at the same time, but you'll have to add a tablet of Pifeltro (doravirine) 12 hours after Delstrigo every day while you're taking rifabutin (Mycobutin).
- Make sure you contact your pharmacy to order a refill when you're running low on tablets. Sometimes, it can take a little extra time to process refills for high-cost medications like HIV ARVs, and you don't want to run out of medication.
- If you have to go to the hospital or emergency room, bring your Delstrigo tablets. Not every hospital will have this medication in their pharmacy and you don't want to miss doses.
Common questions about Delstrigo
No, as of right now, there's no cure for HIV. Delstrigo and other HIV ARV combination medications are very good at controlling HIV. Many people who take Delstrigo as directed will have an undetectable viral load. This means that the amount of HIV virus in your body (viral load) is low enough that the virus can't be detected in lab work. However, the virus is still there, so continue to take Delstrigo even when your viral load is undetectable.
You can take Delstrigo at any time of the day. The most important thing is to pick a time of day when you'll always remember to take it. If you experience a lot of side effects, like dizziness or headache with Delstrigo, taking it at night allows you to sleep through them.
There isn't enough data to know if Delstrigo is safe in pregnancy. Let your provider know if you have plans to become pregnant, since there might be other HIV regimens that are appropriate and have data regarding pregnancy safety. If you become pregnant while taking Delstrigo, continue to take it and let your provider know. Discuss with your provider about the risks and benefits of continuing Delstrigo or switching to a different HIV regimen. You're encouraged to enroll in the Antiretroviral Pregnancy Registry (APR) that monitors your health and your baby's health. If you're interested, ask your provider to help you enroll in the registry.
In general, it's not recommended for people living with HIV to breastfeed, due to the risk of passing HIV to the breastfed infant.
The FDA approved Delstrigo for people new to HIV ARVs and for people who have controlled HIV on their current regimen with a low viral load but want to change regimens. This viral load requirement comes from the results of the manufacturer's DRIVE-SHIFT study that looked at an HIV ARV regimen switch to a regimen containing Delstrigo in people who had low viral loads. Right now, there isn't any data about an HIV ARV switch to Delstrigo in people with high viral loads on their current HIV ARV regimen.
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Risks and warnings for Delstrigo
Delstrigo can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Worsening of hepatitis B
- Risk factors: Hepatitis B virus (HBV) | Stopping Delstrigo
Don't stop taking Delstrigo without talking to your provider, especially if you have a history of hepatitis B. Doing so can make your hepatitis B get worse. If you have hepatitis B and your provider has instructed you to stop the medication or switch to a different antiviral medication, make sure you follow up with your provider and get your labs drawn regularly. This is how your provider will monitor your liver and hepatitis B infection. Let your provider know if you experience symptoms of hepatitis B infection, such as fever, tiredness, nausea, vomiting, dark urine, clay-colored stool, or yellowing of your skin or eyes.
Kidney problems
- Risk factors: History of kidney damage | Current or recent use of other medications that are known to harm kidneys
Some people taking Delstrigo have developed kidney problems. Sometimes, it happens right after starting the medication; for others, the damage happens over time. Try to avoid other medications that can also harm the kidney, like high doses of anti-inflammatory drugs called NSAIDs (e.g., ibuprofen (Motrin, Advil), naproxen (Aleve)). Make sure you get your labs drawn regularly so your provider can monitor your kidneys. Let your provider know if you have symptoms of kidney problems, such as swelling in your legs and feet, difficulty urinating, or confusion. Contact your provider right away if you experience bone or muscle pain, pain in the arms or legs, or fractures, as these can be signs of a specific kidney problem.
Serious interactions with other medications
- Risk factors: Taking a lot medications
Always make sure your healthcare team has a full list of the medications you're taking, including over-the-counter (OTC) medications and supplements. Don't start taking any new medications without talking to your provider or pharmacist first. Many medications can interact with Delstrigo. Some interactions can cause unpleasant side effects, while other interactions can affect how well Delstrigo works and lead to HIV resistance.
Bone problems
- Risk factors: History of bone fractures | Osteoporosis
Delstrigo can lower your bone mineral density (BMD) and weaken your bones. This can potentially lead to osteoporosis and raise your risk of fractures (broken bones). Many people take calcium and vitamin D supplements to help prevent this. Your provider might order additional tests to check your bone density if you have a fracture or other risk factors for bone problems.
Immune reconstitution syndrome (inflammation)
- Risk factors: Weakened immune system | Current untreated infection
Delstrigo can cause harmful inflammation in your body as it starts to work. As the medication helps your body fight against HIV, your immune system starts to recover and becomes more active in fighting other infections that you may have. Recovery of your immune system is good, but the inflammation that can result from this can be dangerous. This is called immune reconstitution syndrome. Your healthcare provider might check for opportunistic infections (underlying infections that can happen with a weakened immune system) before you start Delstrigo, especially if it's your first time taking an HIV ARV. You might need medications to help treat any infections that your provider detects. Call your provider if you experience fever, difficulty breathing, or sudden changes to your health after starting Delstrigo.
Delstrigo dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 100mg/300mg/300mg | 30 tablets | $2,761.83 | $92.06 |
Typical dosage for Delstrigo
The recommended dose is 1 tablet by mouth once a day with or without food. Each tablet contains 100 mg of doravirine, 300 mg of lamivudine, and 300 mg of tenofovir.
How much does Delstrigo cost?
$2,761.83
Delstrigo contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Delstrigo will not be safe for you to take.
- Taking medications that strongly affect how your body breaks down Delstrigo, such as the herbal product St. John's wort, some antiseizure medications, and some tuberculosis (TB) treatment medications
What are alternatives to Delstrigo?
Treatment of HIV infection in adults and children weighing at least 30 lbs, and: