Used For:

• HIV treatment

Contraindications:

• Hypersensitivity to any of the components (dolutegravir, lamivudine, tenofovir). 
  Co-administration with dofetilide (a heart rhythm drug) is contraindicated. 
  Not recommended in patients with severe renal impairment (creatinine clearance < 50 mL/min) — dose adjustment not possible. 
  Use caution (or avoid) in severe hepatic impairment (little data available).

Side Effects:

• Common / Frequent:
  Headache 
  Diarrhea / GI disturbances 
  Nausea 
  Weakness, fatigue 
  Insomnia / sleep disturbances 
  Rash, itching 
  Elevated liver enzymes 
  Muscle pain / joint pain 
  Depression, anxiety 
  Serious / Less Common:
  Lactic acidosis (rare) 
  Kidney / renal toxicity (especially with tenofovir) 
  Bone mineral density loss (long-term tenofovir use) — need monitoring. 
  Hypersensitivity reactions (severe) 
   

Precautions:

• Adherence is very important: Missing doses can lead to viral resistance.

  
  If stopping treatment (especially in patients co-infected with hepatitis B), monitor for liver flare / hepatitis.

  
  In renal impairment: dose adjustment or alternative regimens may be needed.

  
  In the elderly: use cautiously due to potential decreased kidney/liver function.

  
  Mental health: monitor patients for depression, mood changes.

  Bone health: long-term tenofovir may affect bones — periodic monitoring may be needed.

  Pregnant women: consult clinician about risks vs benefits.

  Do not abruptly stop therapy — could lead to viral rebound / resistance. 
   

Dietary Restrictions:

• Take at the same time every day to maintain consistent drug levels. 
  Avoid antacids, calcium, iron or other divalent cation supplements around the time of taking Viropil — these can reduce uptake of dolutegravir / tenofovir. (General ART advice; consult your doctor about timing.)
  Alcohol: Use with caution. Alcohol may worsen liver issues. 
  Stay well-hydrated, especially because tenofovir can affect kidneys.
  Practice safe sex: Viropil does not prevent HIV transmission — virus suppression helps, but other precautions (condoms) still needed.