Dolutegravir and Insomnia
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Italian doctors say that insomnia, after taking the integrase inhibitor, dolutegravir, occurred less often when patients took the dose of the drug in the morning.
Insomnia has been reported as a common side effect of dolutegravir, affecting at least one in a hundred people who take the drug as part of an antiretroviral combination. Nausea, diarrhea and headache are reported much more frequently than insomnia, but for those who experience it, insomnia can affect the quality of life.
Insomnia is something that the publisher of this site has the right and wrong and neither do dolutegravir
Several recently reported studies have shown that neuropsychiatric side effects - especially insomnia - appear to be common in people taking dolutegravir. Um estudo que analisou os efeitos colaterais em pessoas que iniciaram o tratamento à base de inibidor de integrase na Alemanha found that neuropsychiatric side effects that were severe enough to lead to discontinuation of dolutegravir were more common in people with 60 years and older in women and in people taking dolutegravir in combination with abacavir.
Italian researchers report in a letter to the journal HIV Medicine, that in three quarters of cases, patients reporting insomnia after starting treatment with dolutegravir, found that the problem stopped when they changed the dosage at night for morning dosing.
The Italian researchers, who treated patients at clinics in Northern Italy and Rome, started 1502 patients on dolutegravir since June of 2014. Of these, 3,5% (52 patients) reported insomnia or sleep disorders. Insomnia was more common in women and in older patients, but was not associated with the use of abacavir in this patient population.
After switching to morning dosing, insomnia disappeared in three quarters of the patients, but remained a problem for 13 in 52 (25%), and eight patients finally discontinued the drug as a result. In four of the eight patients who discontinued treatment, additional adverse events such as agitation, dyspepsia or reduced libido contributed to the decision to discontinue treatment. dolutegravir.
Switching to morning dosing did not give rise to new side effects in most patients, although three have reported some anxiety or irritability after switching.
Switching to the morning administration can generate problems for some people who need to take dolutegravir with food. Foods increase blood levels of dolutegravir, so taking the drug with food is recommended for anyone who has resistance to an integrase inhibitor. The higher the fat content of the meal, the greater the increase in drug levels.
People taking dolutegravir should avoid taking the medicine at the same time of day, such as magnesium-based or aluminum-based antacids, iron or calcium supplements, or multivitamins. Prescription counseling recommends that dolutegravir be given two hours before or six hours after taking these agents.
Publication: 31 August 2017
Translated by Cláudio Souza from the original in Taking dolutegravir in the morning may avert insomnia
Reviewed by Mara Macedo
Capetti AF et al. Morning dosage for disorders related to sleep and insomnia-dolutegravir. Medicine against HIV, advanced online publication, 1 August 2017.
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