Liverpool HIV Interactions

Potential Weak Interaction

Dolutegravir/Lamivudine (DTG/3TC)

Ginkgo biloba

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Ginkgo biloba induces CYP3A4 and may decrease dolutegravir concentrations, but the magnitude and clinical relevance of this potential interaction is difficult to predict as CYP3A4 does not play a major role in dolutegravir metabolism. No interaction is expected with lamivudine.

Description:

(See Summary)

No Interaction Expected

Dolutegravir/Lamivudine (DTG/3TC)

Interferon alpha

Quality of Evidence: Very Low

Summary:

Coadministration with dolutegravir/lamivudine has not been studied. Nonpegylated interferon alpha appears to be metabolized principally in the kidney. No interaction is expected with dolutegravir and no pharmacokinetic interaction was observed with lamivudine.

Description:

No clinically significant differences in the pharmacokinetics of lamivudine were observed when coadministered with interferon alfa.

Dovato US Prescribing Information, ViiV Healthcare, April 2019.

The pharmacokinetic interaction between lamivudine (100 mg once daily) and interferon alpha (10 mIU single dose) was studied in 19 HIV-negative subjects. There were no statistically significant differences in any pharmacokinetic parameter for interferon alpha with and without lamivudine. Lamivudine AUC was significantly decreased on the day of IFN-alpha treatment (from 5026 to 4546 ng.h/ml, p<0.001), but returned to previous levels by the following day; Cmax was slightly lower following IFN-alpha, but this was not statistically significant. The small decrease in lamivudine AUC was not considered clinically relevant and there is no requirement for dose modification.

A study of the pharmacokinetic interaction between lamivudine and alpha interferon. Johnson MA, et al. Eur J Clin Pharmacol, 2000, 56: 289-292.

No Interaction Expected

Dolutegravir/Lamivudine (DTG/3TC)

Yohimbine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Yohimbine is predominantly metabolized by CYP2D6 with some participation of CYP3A4 whereas dolutegravir is mainly metabolized by UGT1A1. Dolutegravir has no inhibitory effects on CYP enzymes. Lamivudine does not interfere with yohimbine metabolism.

Description:

(See Summary)

No Interaction Expected

Dolutegravir/Lamivudine (DTG/3TC)

Ginseng (Panax ginseng, Panax quinquefolis)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. No effect on dolutegravir is expected as in vitro studies suggest Asian ginseng (Panax ginseng) is unlikely to affect UGT1A1 at clinically relevant concentrations. No effect on lamivudine is expected. No interaction is expected with American ginseng (Panax quinquefolius).

Description:

(See Summary)

No Interaction Expected

Dolutegravir/Lamivudine (DTG/3TC)

Echinacea

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Echinacea has a selective effect on CYP3A4 activity (inhibition of intestinal CYP3A4 and induction of hepatic CYP3A4) and its effect on the net exposure of a CYP3A4 substrate will depend on the extraction of the drug at the intestinal and hepatic sites. A clinically significant interaction with dolutegravir is not expected as CYP3A4 does not play a major role in dolutegravir metabolism. No interaction is expected with lamivudine.

Description:

(See Summary)

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