Used For:

• Treatment of HIV-1 infection in treatment-naïve adults and adolescents weighing ≥30 kg.Often used as part of combination antiretroviral therapy (ART).Can be used in virologically suppressed patients switching from other ART regimens.

Adult Dosage:

• Twinaqt tablet: 1 tablet once daily, with or without food.Taken preferably at the same time each day to maintain consistent drug levels.Dose adjustment generally not required in mild to moderate renal or hepatic impairment.

Contraindications:

• Do not use in patients with:Known hypersensitivity to Dolutegravir, Lamivudine, or any excipients.Severe hepatic impairment if Lamivudine is also contraindicated (rare).Co-administration with dofetilide (risk of life-threatening arrhythmias).Renal impairment: caution if eGFR <50 mL/min/1.73 m² (dose adjustment may be required).

Side Effects:

• Common Side EffectsGastrointestinal: Nausea, vomiting, diarrheaCNS / Neurological: Headache, insomnia, dizzinessGeneral: Fatigue, malaise, increased appetiteLaboratory abnormalities: Elevated liver enzymes, mild increase in creatinine (Dolutegravir effect on tubular secretion)⚠️ Serious Side Effects (Rare)Hypersensitivity reactions (rash, fever, eosinophilia, organ involvement)Liver toxicity (especially in patients with hepatitis B or C)Immune reconstitution inflammatory syndrome (IRIS) — may unmask opportunistic infectionsExacerbation of hepatitis B after discontinuation of Lamivudine in HBV co-infectionNeural tube defects in infants when Dolutegravir is used at conception (pregnancy)

Precautions:

• Hepatitis B or C co-infection: Monitor liver function; abrupt Lamivudine withdrawal may cause HBV flare.Renal impairment: Monitor creatinine and eGFR; Lamivudine is renally excreted.Pregnancy: Dolutegravir may be used after the first trimester; consult physician for use around conception.Drug interactions:Avoid antacids containing aluminum or magnesium within 2 hours of Dolutegravir (↓ absorption).Monitor co-administration with rifampicin, anticonvulsants, or St. John’s Wort (can reduce Dolutegravir levels).Adherence is critical to prevent HIV resistance.

Dietary Restrictions:

• Can be taken with or without food.Avoid supplements or antacids containing aluminum, magnesium, or calcium around the same time as Dolutegravir.Maintain balanced diet and hydration to support overall health and immune function.Avoid alcohol in excess — may worsen liver toxicity.