Description
Viropil (Dolutegravir + Lamivudine + TDF)
Viropil is the combination of three protein inhibitors dolutegravir 50 mg, lamivudine 300 mg and tenofovir disoproxil fumarate (TDF) 300 mg indicated in patients with HIV-1 infection. Among these, dolutegravir inhibits the process of synthesis of genetic material (DNA through integrase strand transfer).
Whereas, lamivudine and TDF replace other proteins in the reaction, hindering the process of replication.
Viropil (Dolutegravir + Lamivudine + TDF) is administered as a complete regimen in HIV-1 patients weighing at least 40 kgs. The tablet is taken in the form of oral dosage on an empty stomach once daily. As Viropil (Dolutegravir + Lamivudine + TDF) is an FDC, it’s dosing cannot be adjusted.
Hence, in patients with severe renal (kidney) impairment or end-stage kidney disease requiring hemodialysis, the triple-drug combo is not recommended.
Other characteristics of this tablet:
| Characteristics | Dolutegravir 50 mg | Lamivudine 300 mg | TDF 300 mg |
| Absorption in the system | 2 to 3 hours | – | 1 hour and 40 minutes |
| Binding with viral cells | Binding affinity- 98.9% | Binding affinity- 99.5 to 99.7% | Binding affinity- 0.7 to 7.2% |
| Bioavailability | – | 80 to 87% | 25% |
| Time for disposing of 50% of drug | 14 hours | 5 to 7 hours | 17 hours |
When should it be avoided or used cautiously:
Drug interactions: The FDC drug might interact with other drugs, it is crucial to inform the doctor about those medicines.
Allergic (hypersensitivity) reactions: There are chances of developing skin rashes, hence patients need to immediately stop the drug if they are seen with symptoms like fever, illness, extreme tiredness, pain in thetab muscles or joints, skin peeling, oral blisters and lesions, inflammation in eyes, swelling of face, lips, tongue or mouth and difficulty in breathing (dyspnea).
Lactic acidosis: If patients procure symptoms like nausea, vomiting, unusual discomfort in the stomach and weakness, causing excessive production of lactic acid in the blood. In such cases, it should be immediately discontinued.
Patients with Hepatitis B or C coinfection: Such patients should not discontinue the drug in the middle of the cycle as it might cause serious problems related to Hepatitis B viral infection.
Pancreatitis: Monitor any signs of pancreatitis (inflammation of the pancreas) especially in children including symptoms like severe pain in the upper part of the stomach-region with or without nausea and vomiting.
Immune reconstitution syndrome: These conditions occur when patients witness any signs of inflammation from previous infections after starting this tablet.
Lactation: It is not recommended in patients who are breastfeeding
Side-effects:
Most common side-effects:
- Sleeping problems (insomnia)
- Tiredness (Fatigue)
- Headache
- Skin rashes
- Depression
- Diarrhea
- Nausea
- Generalized pain
Other side-effects:
| Side-effects associated with liver problems | Side-effects associated with kidney problems |
| Jaundice (white part of skin or eyes turning yellow) | Pain in the bones |
| Loss of appetite | Pain in the arms, legs, or feet |
| Nausea or vomiting | Broken (fractured) bones |
| Pain in the right side of the stomach region | Muscle pain |
| Dark-coloured urine | Weakness |
Note: Viropil (Dolutegravir + Lamivudine + TDF) might depict other side-effects too, get in touch with your healthcare provider for more info.
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