Dovato
Dovato (dolutegravir / lamivudine) is used to treat human immunodeficiency virus (HIV) infections. It's considered a complete HIV treatment regimen with only two antiretroviral (ARV) medications: dolutegravir and lamivudine. One of the benefits of Dovato (dolutegravir / lamivudine) is that it combines two medications into a single tablet so it's convenient to take. Possible side effects of Dovato (dolutegravir / lamivudine) can include headache and weight gain, but they aren't very common with this medication.
What is Dovato (dolutegravir / lamivudine)?
What is Dovato (dolutegravir / lamivudine) used for?
- Treatment of HIV infection in adults
How Dovato (dolutegravir / lamivudine) works
Dovato (dolutegravir / lamivudine) is a combination of two medications that help fight HIV.
- Dolutegravir is an integrase inhibitor. Integrase is an enzyme (protein) that HIV uses to insert its genetic information into your cells. Once inserted, HIV uses your cells to make more copies of itself. Dolutegravir works by blocking integrase, which then helps prevent HIV from spreading.
- Lamivudine is a nucleoside reverse transcriptase inhibitor (NRTI). It blocks an enzyme found in HIV called reverse transcriptase that usually helps the virus make copies of itself. By blocking reverse transcriptase, lamivudine prevents HIV from making copies of itself and spreading.
Drug facts
Side effects of Dovato (dolutegravir / lamivudine)
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
- Higher blood sugar levels (up to 11%)
- Lower phosphate levels (up to 11%)
- Higher creatine kinase levels in the blood (up to 8%)
- Higher lipase levels (up to 7%)
- Abnormal liver labs (up to 5%)
- Headache (3%)
- Weight gain (3%)
- Nausea (2%)
- Diarrhea (2%)
- Trouble sleeping (2%)
- Feeling tired (2%)
- Anxiety (2%)
Less Common Side Effects
- Dizziness
- Belly pain
- Vomiting
- Passing gas
- Feeling depressed
- Strange dreams
Dovato (dolutegravir / lamivudine) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severe allergic reactions: fever, rash, extreme tiredness, body aches, mouth sores, blisters, trouble breathing
- Serious liver problems: nausea, vomiting, not feeling hungry, pain in the right side of the stomach, yellowing of the whites of the eyes or skin, dark-colored urine, light-colored stool
- Too much lactic acid in the blood: weakness, tiredness, fast and shallow breathing, nausea, vomiting, fast heartbeat, confusion
The following Dovato (dolutegravir / lamivudine) 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
- High lactic acid level—muscle pain or cramps, stomach pain, trouble breathing, general discomfort and fatigue
- Infection—fever, chills, cough, or sore throat
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Diarrhea
- Fatigue
- Headache
- Nausea
- Trouble sleeping
- Worsening mood, feelings of depression
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Pros and cons of Dovato (dolutegravir / lamivudine)
Pros
- First-choice treatment option for most adults starting HIV medications
- Only contains two ARVs and is considered a complete HIV treatment regimen, which is less medications than other complete regimens
- Combines two medications into one pill for convenience
- Only taken once a day
- Can take with or without food
Cons
- Interacts with a lot of medications, such as anti-seizure medications (e.g., oxcarbazepine (Trileptal)), metformin, and antacids
- Can't take with dofetilide (Tikosyn) because of risk of serious side effects
- Not approved for use in children
- Not recommended for use if you have severe kidney or liver problems
- Shouldn't use if you have both HIV and hepatitis B (HBV)
Pharmacist tips for Dovato (dolutegravir / lamivudine)
- Make sure to get your routine blood tests done on time while you’re taking Dovato (dolutegravir / lamivudine). This helps your provider make sure the medication is working for you and not causing side effects.
- Let your provider or pharmacist know what medications you're taking or planning to take, including over-the-counter products and supplements. Dovato (dolutegravir / lamivudine) can interact with many medications. These interactions can affect how well your medications work or how safe they are for you.
- Take Dovato (dolutegravir / lamivudine) 2 hours before or 6 hours after antacids (e.g., Tums) and medications containing calcium, iron, magnesium, or aluminum. These medications can interfere with how your body absorbs Dovato (dolutegravir / lamivudine) and cause it to not work as well at treating HIV.
- You can take iron and calcium supplements at the same time as Dovato (dolutegravir / lamivudine) as long as you take everything together with food. Otherwise, take Dovato (dolutegravir / lamivudine) 2 hours before or 6 hours after the supplement.
- Dovato (dolutegravir / lamivudine) can cause life-threatening allergic reactions. If you experience fever, rash, extreme tiredness, body aches, or trouble breathing, get medical attention right away.
- Talk to your provider before stopping Dovato (dolutegravir / lamivudine) or any of your HIV medications. Doing so can cause the virus to spread and become harder to treat. And if you also have hepatitis B, stopping Dovato (dolutegravir / lamivudine) suddenly can cause your hepatitis B infection to come back or worsen.
Common questions about Dovato (dolutegravir / lamivudine)
Dovato (dolutegravir / lamivudine) and Biktarvy (bictegravir / emtricitabine / tenofovir alafenamide) are both first-choice treatment options for people with HIV. Both combination medications are considered a complete HIV regimen. But while Biktarvy contains three HIV ARVs, Dovato is the only HIV combination tablet that contains two ARVs. To date, there aren't any studies that directly compare Dovato to Biktarvy. But separate clinical studies showed that Dovato and Biktarvy each work well to lower the amount of HIV in your body. Overall, it's up to you and your provider to discuss which option is the best for you.
No, Dovato (dolutegravir / lamivudine) isn't used for PrEP, also known as pre-exposure prophylaxis (prevention). PrEP is a combination of HIV medications that people who don't have HIV can take to prevent infection before getting potentially exposed to the virus (e.g., through sex, through sharing needles). According to the CDC guidelines, the preferred PrEP medications are Truvada or Descovy. If you're interested in taking medications for PrEP, talk to your provider about the best option for you.
Dovato (dolutegravir / lamivudine) can lower the amount of HIV in your body to the point where the virus is no longer detectable in lab work. This is called an undetectable viral load. Having an undetectable viral load helps keep your immune system working to protect you from infections. It also helps lower the risk of spreading HIV to others. In clinical studies that looked at how well Dovato (dolutegravir / lamivudine) worked in people who've never taken HIV medications before, results showed that the majority of people had an undetectable viral load after about a year of treatment. They continued to have an undetectable viral load through 3 years of Dovato (dolutegravir / lamivudine) treatment. It's important to note that having an undetectable viral load doesn't mean that you're cured of HIV. All HIV medications, including Dovato (dolutegravir / lamivudine), can't cure HIV; they help control the virus so you can stay healthy.
In a clinical study, about 3% of people with HIV who took Dovato (dolutegravir / lamivudine) noticed some weight gain. Keep in mind that weight gain is common for people who are starting HIV medications. It's not clear whether this weight gain comes from an improvement in health with HIV treatment or from HIV treatment side effects. But, some studies suggest that people taking certain HIV ARV regimens, such as medications that contain dolutegravir like Dovato (dolutegravir / lamivudine), experience more weight gain than other regimens. In general, too much weight gain and obesity can lead to serious health problems, such as diabetes or heart disease. Discuss with your provider about appropriate weight management plans (e.g., 10,000 steps per day) if you notice significant weight gain during treatment with Dovato (dolutegravir / lamivudine).
If you're pregnant or thinking of becoming pregnant, let your provider know right away. They can discuss with you about the risks and benefits of taking Dovato (dolutegravir / lamivudine). They also might consider other HIV treatment options for you. Dovato (dolutegravir / lamivudine) can raise the risk for neural tube defects in babies when it's taken during the first trimester of pregnancy. But, it might be possible to take the medication during your second and third trimesters of pregnancy. If you're pregnant and you're taking Dovato (dolutegravir / lamivudine), you’re encouraged to enroll in the Antiretroviral Pregnancy Registry (APR). This registry collects information about your and your baby’s health during treatment with Dovato (dolutegravir / lamivudine). Learn more about this registry by calling 1-800-258-4263.
The CDC recommends that you don't breastfeed your baby if you have HIV. Doing so can raise the risk of spreading the infection to your baby or make their HIV infection more difficult to treat. In addition, Dovato (dolutegravir / lamivudine) is found in breast milk. While we don't know how Dovato (dolutegravir / lamivudine) might affect breastfed babies, there's a chance that it can cause side effects such as trouble sleeping, tiredness, and diarrhea. Speak to your provider so you can discuss the benefits and risks of taking this medication while breastfeeding.
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Risks and warnings for Dovato (dolutegravir / lamivudine)
Dovato (dolutegravir / lamivudine) 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 infection if you have HIV and hepatitis B
- Risk factors: Have hepatitis B and HIV | Stopping Dovato (dolutegravir / lamivudine) | Severe liver problems
If you have hepatitis B virus (HBV), taking Dovato (dolutegravir / lamivudine) can make it easier for HBV to change form. This means the virus can become harder to treat. Before you begin Dovato (dolutegravir / lamivudine) treatment, your provider will test you for HBV. If you have HBV, your provider will make sure you're getting appropriate treatment for both HIV and HBV.
If you have HBV, suddenly stopping Dovato (dolutegravir / lamivudine) can also make your liver condition worse (also called an HBV flare-up). Don't stop taking Dovato (dolutegravir / lamivudine) without talking with your provider first. Make sure to get your refills on time so that your treatment isn't interrupted. If you need to stop taking Dovato (dolutegravir / lamivudine), your provider will follow up with you for several months after you stop treatment. They'll order blood work to check your liver for an HBV flare-up.
Allergic reaction
- Risk factor: History of allergy to dolutegravir
Although rare, Dovato (dolutegravir / lamivudine) can cause allergic reactions that are sometimes severe and life-threatening. Watch out for allergic reactions, such as severe rash with fever, general discomfort, muscle or joint pain, mouth sores, blisters, facial swelling, or trouble breathing. Stop taking Dovato (dolutegravir / lamivudine) right away and get medical attention if you experience these symptoms.
If you have a serious allergic reaction, your provider will probably switch you to a different medication to treat HIV. Your provider might also check your liver function through blood work since severe allergic reactions can sometimes lead to liver injury.
Liver problems and lactic acidosis
- Risk factors: Obesity | Females | Hepatitis B or C
Rarely, people who take medications that contain dolutegravir, such as Dovato (dolutegravir / lamivudine), can experience liver problems. While liver injury can happen to anyone taking these medications, the risk of worsening liver problems might be higher if you also have hepatitis B or hepatitis C. Talk with your provider about your medical history before starting this medication so they can decide how you can safely take Dovato (dolutegravir / lamivudine).
Additionally, lamivudine in Dovato (dolutegravir / lamivudine) can cause a buildup of lactic acid in the blood (lactic acidosis) and fatty liver. Both conditions can be life-threatening, and you might be more likely to experience them if you're female or obese.
Make sure to get blood tests done while you take Dovato (dolutegravir / lamivudine) so your provider can check your liver health. If you experience signs and symptoms of liver damage, such as upper right stomach pain, yellowing of the skin or whites of the eyes, or dark urine, talk with your provider right away. Also, let your provider know if you experience symptoms of lactic acidosis, such as feeling weak, muscle pain, and trouble breathing.
Overactive immune system
Taking Dovato (dolutegravir / lamivudine) can cause changes to your immune system called immune reconstitution syndrome. This medical condition happens when your immune system becomes more active after you start Dovato (dolutegravir / lamivudine) treatment. Your immune system begins to fight off different infections that it was too weak to fight off before you started treatment. In rare cases, your immune system might improve so much with treatment that it starts to attack normal cells in your body (autoimmune). You can develop immune reconstitution syndrome as early as during the first few weeks of Dovato (dolutegravir / lamivudine) treatment or many months later. Tell your healthcare provider right away if you start having any new symptoms, such as fever, pain, hair loss, bulging eyes, or sweating, after starting Dovato (dolutegravir / lamivudine).
Interaction with other medications
Some medications can interfere with how your body gets rid of Dovato (dolutegravir / lamivudine) from your system. This can affect the amount of Dovato (dolutegravir / lamivudine) in your body, how well it works, and the risk of side effects.
When taken with Dovato (dolutegravir / lamivudine), certain medications can lower the amount of Dovato (dolutegravir / lamivudine) in your body and cause it to not work as well at treating HIV. Because of this effect, avoid taking certain medications for seizures (e.g., carbamazepine (Tegretol), phenytoin (Dilantin)) or antibiotics (e.g., rifampin (Rifadin)) along with Dovato (dolutegravir / lamivudine). Also make sure to take Dovato (dolutegravir / lamivudine) 2 hours before or 6 hours after taking antacids like calcium carbonate (Tums) to prevent this interaction from happening.
Harm to unborn baby
Taking Dovato (dolutegravir / lamivudine) during early pregnancy might raise the risk for birth defects called neural tube defects in babies. Because of this potential risk, if you're able to have a child, your provider will ask you to take a pregnancy test to check if it's safe for you to take Dovato (dolutegravir / lamivudine). They'll also discuss with you about birth control options during your treatment with Dovato (dolutegravir / lamivudine). It might be possible to take Dovato (dolutegravir / lamivudine) in the second and third trimesters of pregnancy, but only if the benefit is greater than the risk of harm to the unborn baby. If you're pregnant or are planning to become pregnant, discuss your HIV treatment options with your provider.
Dovato (dolutegravir / lamivudine) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 50mg/300mg of | 30 tablets | $3,005.61 | $100.19 |
Typical dosage for Dovato (dolutegravir / lamivudine)
The typical dose is 1 tablet by mouth once daily. Each tablet contains 50 mg of dolutegravir and 300 mg of lamivudine.
Your dose might differ if you're also taking carbamazepine (Tegretol) or rifampin (Rifadin).
How much does Dovato (dolutegravir / lamivudine) cost?
$3,005.61
Dovato (dolutegravir / lamivudine) 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 Dovato (dolutegravir / lamivudine) will not be safe for you to take.
- Taking dofetilide (Tikosyn) at the same time
What are alternatives to Dovato (dolutegravir / lamivudine)?
Treatment of HIV infection in adults and children weighing at least 30 lbs, and:
