Liverpool HIV Interactions

Potential Weak Interaction

Lopinavir/ritonavir (LPV/r)

Dolutegravir/Abacavir/ Lamivudine (DTG/ABC/3TC)

Quality of Evidence: Very Low

Summary:

Triumeq (dolutegravir, abacavir, lamivudine) is indicated for use as a complete regimen for the treatment of HIV-1 infection. However, in specific clinical situations where an intensification of HIV treatment is needed, coadministration with lopinavir/ritonavir would be possible from a pharmacokinetic standpoint. Coadministration of lopinavir/ritonavir and dolutegravir decreased dolutegravir AUC and C24 by 4% and 6% and had no effect on Cmax; there was no effect on lopinavir or ritonavir. Coadministration of lopinavir/ritonavir and abacavir decreased abacavir AUC by 32%. No change in the pharmacokinetics of lopinavir was observed with lamivudine in clinical studies.

Description:

Coadministration of lopinavir and dolutegravir decreased dolutegravir AUC and C24 by 4% and 6% and had no effect on Cmax. There was no effect on lopinavir or ritonavir. Coadministration of lopinavir and abacavir decreased abacavir AUC by 32%. No dose adjustment is necessary.

Triumeq Summary of Product Characteristics, ViiV Healthcare, June 2019.

Coadministration of dolutegravir (30 mg once daily) and lopinavir/ritonavir (400/100 mg twice daily) was studied in 15 HIV-negative subjects. Coadministration had no significant effects on dolutegravir pharmacokinetics (no change in Cmax, 3% decrease in AUC, 6% decrease in Ctrough). Using cross-study comparisons to historical pharmacokinetic data for each interacting drug, dolutegravir did not appear to affect the pharmacokinetics of lopinavir.

Triumeq US Prescribing Information, ViiV Healthcare, May 2019.

Coadministration of dolutegravir (30 mg once daily) and lopinavir/ritonavir (400/100 mg twice daily) was studied in 15 HIV-negative subjects. Coadministration had no significant effects on dolutegravir pharmacokinetics (no change in Cmax, 3% decrease in AUC, 2% increase in Ctrough). The authors recommend no dose adjustment when dolutegravir is coadministered with lopinavir/ritonavir. Note, this study was performed with a dose of dolutegravir lower than the licensed one.

The effect of lopinavir/ritonavir and darunavir/ritonavir on the HIV integrase inhibitor S/GSK1349572 in healthy participants. Song I, Min SS, Borland J, et al. J Clin Pharmacol, 2011, 51: 237-242.

Plasma concentrations of abacavir (300 mg twice daily) and lamivudine (300 mg once daily) with lopinavir/ritonavir (400/100 mg twice daily, n=7) or nevirapine (400 mg once daily) were determined in HIV positive patients. Abacavir AUC, Cmax and Ctrough were 40%, 46% and 29% lower, respectively, in the presence of lopinavir/ritonavir when compared to nevirapine. The authors suggest that the decrease in exposure of abacavir is due to induction of glucuronidation by ritonavir and/or lopinavir. Lamivudine AUC, Cmax and Ctrough were 11%, 21% and 45% higher, respectively in the presence of lopinavir/ritonavir when compared to nevirapine. The changes in lamivudine disposition were not significant.

Pilot pharmacokinetic study of Human Immunodeficiency Virus-infected patients receiving tenofovir disoproxil fumarate (TDF): Investigation of systemic and intracellular interactions between TDF and abacavir, lamivudine, or lopinavir-ritonavir. Pruvost A, Negredo E, Théodoro F, et al. Antimicrob Agents Chemother, 2009, 53(5): 1937-1943.

Coadministration of abacavir (600 mg once daily) and lopinavir/ritonavir (400/100 mg twice daily) was studied in 12 HIV+ subjects. There was no effect on lopinavir or ritonavir pharmacokinetics, but abacavir AUC decreased by 32% and Cmax decreased by 34%.

Abacavir plasma pharmacokinetics in the absence and the presence of atazanavir/ritonavir or lopinavir/ritonavir) and vice versa in HIV+ patients. Waters L, et al. 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, February 2007, abstract 557.

View all available interactions with Lopinavir/ritonavir (LPV/r) by clicking here.