Drug Interaction Report

ADJUST DOSING INTERVAL: Coadministration with antacids, mineral supplements, or other medications containing polyvalent cations such as magnesium, aluminum, calcium, and iron may decrease the bioavailability of oral cabotegravir. The proposed mechanism involves chelation of cabotegravir by polyvalent cations, forming a complex that is poorly absorbed from the gastrointestinal tract. The interaction has not been studied with cabotegravir, but has been reported with other integrase strand transfer inhibitors (INSTIs).

MANAGEMENT: To minimize the risk of reduced viral susceptibility and resistance development associated with subtherapeutic levels of cabotegravir, medications containing polyvalent cations such as antacids and mineral supplements should be administered at least 2 hours before or 4 hours after the oral cabotegravir dose.

ADJUST DOSING INTERVAL: The administration of sucralfate with enteral nutrition may result in precipitation and the formation of bezoars that may obstruct feeding tubes. The proposed mechanism is the formation of an insoluble aluminum-protein complex between the aluminum in the sucralfate and the protein in the enteral feeding. In addition, sucralfate may not become activated due to the alkaline pH of enteral nutrition products.

MANAGEMENT: Some experts recommend separating the sucralfate doses from enteral feedings by at least 1 hour. Alternatively, consideration may be given to proton pump inhibitors or H2 antagonists.