What is Dovato?
Dovato, a distinguished brand in the realm of combination antiretroviral medications, is used in the treatment of HIV-1 infection. It is a blend of two potent drugs: dolutegravir and lamivudine. This brand’s medication is specifically designed for the initiation of therapy in HIV-1 infected individuals and is notable for its dual-action mechanism in inhibiting viral replication.
Composition and Mechanism:
Dovato’s effectiveness stems from its two active components:
- Dolutegravir: This component is an HIV integrase inhibitor, playing a pivotal role in preventing the integration of viral DNA into the DNA of healthy host cells. By blocking the HIV integrase enzyme, dolutegravir disrupts a critical stage in the HIV replication cycle, thereby impeding the virus’s ability to proliferate within the host.
- Lamivudine: As a nucleoside reverse transcriptase inhibitor (NRTI), lamivudine impedes the HIV replication process by inhibiting the reverse transcriptase enzyme. This enzyme is responsible for converting the virus’s RNA into DNA, a crucial step in the replication process. Lamivudine’s structure mimics the natural nucleosides of DNA, leading to premature termination of the viral DNA chain during replication.
Dual Mechanism of Action:
The combination of dolutegravir and lamivudine in Dovato offers a robust approach to managing HIV infection. By targeting two distinct and crucial steps in the HIV life cycle, Dovato provides an effective means to reduce the virus’s ability to multiply and spread. This dual mechanism of action is instrumental in maintaining control over the viral load in patients, contributing significantly to the management of HIV.
Dovato has demonstrated high efficacy in clinical trials, with a significant percentage of patients achieving undetectable viral loads. This outcome is crucial in the long-term management of HIV, as maintaining a low viral load is key to preventing the progression of the disease and reducing the risk of transmission.
How does Dovato work?
The medications in Dovato work to reduce viral replication, but they accomplish this through two distinct mechanisms. Dolutegravir is an HIV integrase inhibitor. This drug prevents the virus from incorporating its DNA into healthy host cells. Lamivudine is a nucleoside reverse transcriptase inhibitor (NRTI) that inhibits the virus from making copies of itself. Viral replication is a multi-step process, and Dovato targets two distinct points within that replication cycle.
- Dolutegravir as an Integrase Strand Transfer Inhibitor (INSTI): Dolutegravir, classified as an INSTI, plays a critical role in inhibiting the HIV integrase enzyme. This enzyme is essential for the viral replication process, as it integrates the viral DNA into the host cell’s DNA. By blocking this enzyme, dolutegravir prevents the integration of HIV DNA into the chromosomes of the human immune cells, thereby interrupting the HIV replication cycle at a crucial stage.
- Lamivudine as a Nucleoside Reverse Transcriptase Inhibitor (NRTI): Lamivudine, an NRTI, works by inhibiting the activity of reverse transcriptase, another vital enzyme in the HIV replication process. Reverse transcriptase converts the virus’s RNA into DNA, a key step in viral replication. Lamivudine mimics the natural building blocks of DNA, thus interfering with the reverse transcriptase enzyme. When incorporated into the newly forming viral DNA chain, it results in premature termination of the DNA chain, thereby halting further replication of the virus.
Together, these two drugs target different steps in the HIV life cycle, making Dovato a potent combination for treating HIV infection by reducing the virus’s ability to multiply and spread. This dual mechanism of action helps in managing the viral load effectively in patients with HIV.
Dovato is available in the following strength:
50 mg/300 mg
The dose of Dovato is started and maintained at 50 mg/300 mg once daily. Special instructions for Dovato intake recommend taking dolutegravir, a component of Dovato, 2 hours before or 6 hours after consuming cation-containing antacids, laxatives, sucralfate, oral iron supplements, oral calcium supplements, or buffered medications. This timing is crucial to prevent drug interactions and maintain the drug’s effectiveness.
For patients taking carbamazepine or rifampin, an additional 50 mg dose of dolutegravir is advised 12 hours after the regular Dovato dose. This adjustment is necessary due to the interaction of these medications with dolutegravir, affecting its plasma concentration.
The goal of all HIV therapies, including Dovato, is to reduce a patient’s viral load to an undetectable level. In clinical trials, Dovato has been shown to be effective in achieving this goal, with 91% of patients reaching undetectable levels of less than 50 copies per mL after 48 weeks of treatment.
The maximum daily dose of Dovato should not exceed 100 mg of dolutegravir and 300 mg of lamivudine. Adhering to this dosage limit is important to avoid potential overdose and associated complications.
Signs or symptoms indicating an overdose of Dovato have not been extensively documented. However, in the event of an overdose, specific measures such as continuous hemodialysis may be employed to remove lamivudine, one of the components of Dovato, from the body. This process can be critical in managing the overdose, as hemodialysis aids in the excretion of the drug.
It’s also important to understand the metabolism and elimination processes for Dovato. Dovato’s components, dolutegravir and lamivudine, are metabolized in the liver and kidneys. Dolutegravir is primarily metabolized by the liver enzymes UGT1A1 and CYP3A. The role of these enzymes is crucial as they help in breaking down the medication for elimination from the body. Drugs that induce these enzymes may decrease plasma concentrations of dolutegravir, while those that inhibit these enzymes may increase its concentrations. Therefore, in the event of an overdose, the impact on these metabolic pathways needs to be considered for appropriate management.
If you suspect an overdose of Dovato, it is imperative to seek immediate emergency medical care or call the Poison Help line at 800-222-1222. Quick and appropriate medical intervention is key in managing an overdose situation effectively.
Dovato Side Effects
The most common side effects of Dovato include the following:
- Trouble sleeping
In addition to these common side effects, Dovato may also cause more significant toxicities, which include:
- Insomnia: Difficulty in falling or staying asleep.
- Weight gain and increased body mass index (BMI): Noted in adults in clinical trials and some pediatric cohorts.
- Neuropsychiatric symptoms: These can be particularly pronounced in patients with a history of psychiatric illness and may include mood changes, depression, or anxiety.
Furthermore, patients should be aware of and report:
- Symptoms of an allergic reaction, including skin rashes, swelling of the face or mouth, and difficulty breathing.
- Liver dysfunction signs, such as jaundice (yellowing of the skin and eyes), dark urine, and abdominal pain.
- Lactic acidosis indicators, like severe muscle pain, breathing difficulties, and feeling unusually cold, especially in the extremities.
Immediate medical attention is crucial if you experience symptoms of liver dysfunction, lactic acidosis, or a severe allergic reaction. These symptoms can indicate serious health issues that require prompt treatment.
Moreover, patients initiating treatment with Dovato, especially those with advanced HIV disease, may experience immune reconstitution inflammatory syndrome (IRIS). This condition is marked by a rapid decline in HIV RNA levels and can cause dormant infections to resurface.
Contact your healthcare provider if you experience any of the above symptoms or have concerns about potential side effects of Dovato.
Warnings & Precautions
This is not a complete list of drug interactions. Notify your doctor of all your medications, including vitamins and over-the-counter supplements.
Dofetilide is an antiarrhythmic used for certain heart conditions. Dovato causes an increased amount of dofetilide in the blood, which can be life-threatening. The use of these two medications together is contraindicated.
Cladribine is a chemotherapeutic agent which can be used in leukemias and multiple sclerosis. Taking cladribine with Dovato is contraindicated because of the decreased efficacy of cladribine.
Organic Cation Transporters (OCT-1 and OCT-2) Substrates and Inhibitors
Caution should be used when taking Dovato in combination with drugs that are either substrates or inhibitors of OCT-1 and OCT-2. E.g., clofarabine, erdafitinib, fexinidazole, gilteritinib, pacritinib, and tafenoquine. These combinations increase the risk of developing side effects or decreasing treatment efficacy.
Dalfampridine is a potassium channel blocker used for patients with multiple sclerosis. Taking Dovato in combination with dalfampridine may increase the risk of seizures. Caution should be exercised when taking both medications.
Anticonvulsants such as oxcarbazepine, phenytoin, and phenobarbital can impact the efficacy of Dovato. Carbamazepine may also reduce the effectiveness but taking an additional 50 mg dose of dolutegravir can offset this. The additional dose of dolutegravir should be separated by 12 hours from your Dovato dose.
Metformin is an antidiabetic medication. The amount of metformin in the blood may increase when taking Dovato. Monitoring for complications while taking both drugs is recommended because the metformin dose may need adjustment.
Rifampin is used to treat certain infections. This combination decreases the amount of dolutegravir in the blood, which could impact the efficacy of Dovato. Data shows that an additional 50 mg dose of dolutegravir should be taken. This dose should be separated by 12 hours from your Dovato dose.
St. John’s Wort (Hypericum perforatum)
St. John’s Wort is a common herbal product that decreases the amount of dolutegravir in the blood; it is not recommended to be taken with Dovato.
Polyvalent Cationic Drugs
Drugs containing polyvalent cations, including antacids, laxatives, and sucralfate, decrease the efficacy of Dovato. Your dose should be taken 2 hours before or 6 hours after taking these polyvalent cationic drugs.
Oral calcium and iron supplements
The amount of dolutegravir in the blood decreases when taking oral calcium, oral iron, or multivitamins that contain calcium or iron. Dovato should be taken 2 hours before or 6 hours after taking calcium or iron-containing medications. However, if these drugs are taken with food, they can all be taken simultaneously.
Sorbitol may lead to a decreased amount of lamivudine in the blood. Taking sorbitol-containing drugs while on Dovato is not recommended and may require monitoring.
Notify your doctor of all prescriptions and supplements you are currently taking. There are individual treatments not listed that you may want to discuss with your doctor.
These medications have fixed doses of various drugs that manage HIV through different mechanisms. This often decreases the total number of pills patients must take.
- Atripla (efavirenz + tenofovir disoproxil fumarate + emtricitabine)
- Biktarvy (bictegravir + tenofovir alafenamide + emtricitabine)
- Cabenuva (cabotegravir + rilpivirine)
- Complera (rilpivirine + tenofovir disoproxil fumarate + emtricitabine)
- Delstrigo (doravirine + tenofovir disoproxil fumarate + lamivudine)
- Genvoya (elvitegravir + cobicistat + tenofovir alafenamide + emtricitabine)
- Juluca (dolutegravir + rilpivirine)
- Odefsey (rilpivirine + tenofovir alafenamide + emtricitabine)
- Stribild (elvitegravir + cobicistat + tenofovir disoproxil fumarate + emtricitabine)
- Symfi And Symfi Lo (efavirenz + tenofovir disoproxil fumarate + lamivudine)
- Symtuza (darunavir + cobicistat + tenofovir alafenamide + emtricitabine)
- Triumeq (dolutegravir + abacavir + lamivudine)
Medication Price & Coupons
Buy Dovato from Canada
For those in the US looking to purchase Dovato, a significant cost-saving option is available through Pharma Giant, a Canadian source. Dovato, a combination antiretroviral medication used for HIV-1 treatment, can be notably expensive in the United States. The cost for a 30-tablet supply can exceed $3,600, posing a financial challenge for many.
However, Pharma Giant offers a more affordable alternative. Through their service, Dovato is available for $1,248.95 for a 30-tablet supply. This price represents a substantial saving compared to US prices.
Special Offer with Coupon Code: To make this deal even more appealing, Pharma Giant provides an additional discount. By using the coupon code DOVATOTEN, customers can save 10% off their purchase of Dovato. This offer further reduces the financial burden and makes this essential medication more accessible.