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Drug Interactions between abacavir / dolutegravir / lamivudine and Co-trimoxazole

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Minor

trimethoprim lamiVUDine

Applies to: Co-trimoxazole (sulfamethoxazole / trimethoprim) and abacavir / dolutegravir / lamivudine

In a study with 14 HIV-positive patients, coadministration of trimethoprim/sulfamethoxazole (trimethoprim/sulfamethoxazole DS once a day for 5 days) and lamivudine (300 mg single dose on day 5) resulted in a mean decrease of 35% in lamivudine renal clearance and a mean increase of 43% in lamivudine area under the plasma concentration-time curve. The mechanism of interaction is thought to be competitive inhibition of tubular secretion by trimethoprim. Lamivudine did not affect the pharmacokinetic profile of trimethoprim/sulfamethoxazole. Given the favorable safety profile of lamivudine, this interaction is unlikely to be of clinical significance. However, patients with renal dysfunction should be monitored carefully and the lamivudine dose adjusted if necessary. In addition, it should be noted that the effect of higher dosages of trimethoprim/sulfamethoxazole on lamivudine pharmacokinetics has not been investigated.

References

  1. (2001) "Product Information. Epivir (lamivudine)." Glaxo Wellcome
  2. Moore KHP, Yuen GJ, Raasch RH, Eron JJ, Martin D, Mydlow PK, Hussey EK (1996) "Pharmacokinetics of lamivudine administered alone and with trimethoprim-sulfamethoxazole." Clin Pharmacol Ther, 59, p. 550-8
  3. Cerner Multum, Inc. "Australian Product Information."

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Drug and food interactions

Moderate

sulfamethoxazole food

Applies to: Co-trimoxazole (sulfamethoxazole / trimethoprim)

MONITOR: Two cases have been reported in which patients on sulfamethoxazole-trimethoprim therapy, after consuming beer, reported flushing, heart palpitations, dyspnea, headache, and nausea (disulfiram - alcohol type reactions). First-generation sulfonylureas have been reported to cause facial flushing when administered with alcohol by inhibiting acetaldehyde dehydrogenase and subsequently causing acetaldehyde accumulation. Since sulfamethoxazole is chemically related to first-generation sulfonylureas, a disulfiram-like reaction with products containing sulfamethoxazole is theoretically possible. However, pharmacokinetic/pharmacodynamic data are lacking and in addition, the two reported cases cannot be clearly attributed to the concomitant use of sulfamethoxazole-trimethoprim and alcohol.

MANAGEMENT: Patients should be alerted to the potential for this interaction and although the risk for this interaction is minimal, caution is recommended while taking sulfamethoxazole-trimethoprim concomitantly with alcohol.

References

  1. Heelon MW, White M (1998) "Disulfiram-cotrimoxazole reaction." Pharmacotherapy, 18, p. 869-70
  2. Mergenhagen KA, Wattengel BA, Skelly MK, Clark CM, Russo TA (2020) "Fact versus fiction: a review of the evidence behind alcohol and antibiotic interactions." Antimicrob Agents Chemother, 64, e02167-19

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Minor

dolutegravir food

Applies to: abacavir / dolutegravir / lamivudine

Food increases the extent of absorption and slows the rate of absorption of dolutegravir. When administered with a low-, moderate- or high-fat meal, dolutegravir peak plasma concentration (Cmax) increased by 46%, 52% and 67%, systemic exposure (AUC) increased by 33%, 41% and 66%, and time to reach Cmax (Tmax) increased from 2 hours to 3, 4 and 5 hours, respectively, compared to administration under fasted conditions. Dolutegravir may be taken with or without food.

References

  1. (2013) "Product Information. Tivicay (dolutegravir)." ViiV Healthcare

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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