Drug Interaction Report

GENERALLY AVOID: Sorbitol may decrease the serum concentration of lamivudine. The mechanism of interaction has not been established. In an open-label, randomized sequence, 4-period, crossover study of 16 healthy adult subjects, a single 300 mg dose of lamivudine oral solution was administered alone or in combination with a single 3.2 g, 10.2 g, or 13.4 g dose of sorbitol oral solution. Coadministration of lamivudine with sorbitol resulted in dose-dependent decreases in lamivudine AUC (14%, 32%, and 36%) and Cmax (28%, 52%, and 55%).

MANAGEMENT: When possible, avoid use of lamivudine with products that contain osmotic polyalcohols (e.g., sorbitol) or monosaccharide alcohols (e.g., lactitol, mannitol). If coadministration cannot be avoided, more frequent monitoring of viral load should be considered.

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.