The short answer
Aluminum-containing antacids can reduce dolutegravir absorption. The current instructions place dolutegravir at least two hours before or six hours after the antacid. A general instruction to keep them two hours apart is incomplete because the order matters.
What this answer covers
Oral dolutegravir with aluminum-containing antacid or buffered products. The human trial used a mixed aluminum/magnesium antacid, not elemental aluminum or every aluminum compound.
- Supplement or preparation
- aluminum-containing products
- Medication ingredient
- dolutegravir
What did the study measure?
In sixteen healthy participants, taking dolutegravir with a mixed aluminum/magnesium antacid reduced drug exposure by about 74%. Giving dolutegravir two hours first reduced that effect, although exposure remained about 26% lower. Those percentages describe the tested mixture, not an isolated aluminum ingredient.
Which timing applies?
Both current prescribing information and NIH guidance specify dolutegravir first by at least two hours, or dolutegravir after the antacid by at least six hours. The six-hour instruction is part of clinical guidance; the original abstract does not describe a six-hour comparison arm.
Can I take them together with food?
The food exception in TIVICAY labeling concerns calcium or iron supplements. It does not authorize simultaneous use of an aluminum/magnesium antacid with a meal. Check the active ingredients, because heartburn products with similar names can contain different medicines.
What should my pharmacist check?
Bring the antacid label and the name of your complete HIV regimen. Other ingredients in combination tablets may add their own restrictions. Continue the prescribed antiretroviral schedule while asking how to fit the antacid around it; do not compensate by taking extra dolutegravir.
Evidence and practical considerations
Absorption & effectiveness
Aluminum-containing antacids can reduce dolutegravir absorption. The current instructions place dolutegravir at least two hours before or six hours after the antacid. A general instruction to keep them two hours apart is incomplete because the order matters.
- Exact scope
- Oral dolutegravir with aluminum-containing antacid or buffered products. The human trial used a mixed aluminum/magnesium antacid, not elemental aluminum or every aluminum compound. with Dolutegravir, exact RxCUI 1433868, IN. TIVICAY contains dolutegravir sodium expressed as dolutegravir active-moiety strength in its label. This provides the explicit salt-to-IN bridge. Oral tablets are the primary scope; no automatic extrapolation to another integrase inhibitor or a different combination regimen. TIVICAY PD is not interchangeable milligram for milligram.
- Medication form and route
- oral
What remains uncertain
- Direct evidence comes from a mixed antacid and a small healthy-volunteer study. It demonstrates lower exposure but does not quantify long-term virologic failure or isolate every aluminum form.
Factors that may matter: exact preparation and dose; food and administration order; complete antiretroviral regimen.
Read the supporting source summaries
Source 1: regulatory prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed oral dolutegravir, including tablet and pediatric suspension formulations with separate dosing instructions.
Specifies dolutegravir two hours before or six hours after named mineral products; calcium/iron supplements have a simultaneous-with-food exception for TIVICAY. St. John’s wort co-use is to be avoided because a dosing recommendation cannot be established.
How this applies: Restricted to the preparation and conditions described in this article.
The table includes both measured and predicted interactions. It does not quantify every mineral salt, product or botanical extract. Formulations and combination tablets require their own instructions.
Source 2: primary human pharmacokinetic trial
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Sixteen healthy participants in the antacid/multivitamin crossover experiment; a separate twelve-person omeprazole experiment.
AUC fell 74% with concurrent mixed aluminum/magnesium antacid and 26% when the antacid followed two hours later. One tested multivitamin lowered AUC 33%, judged modest by the authors.
How this applies: Restricted to the preparation and conditions described in this article.
Abstract-level assessment. Mixed antacid does not isolate aluminum or magnesium; a specific multivitamin does not represent every formula. No long-term virologic comparison.
Source 3: government clinical guideline
clinicalinfo.hiv.gov · Source check Sep 10, 2026
Population: Adults and adolescents receiving antiretroviral therapy.
Supports product-specific spacing and the calcium/iron food exception; says not to coadminister St. John’s wort with dolutegravir.
How this applies: Restricted to the preparation and conditions described in this article.
Clinical guidance combines measured and predicted effects. The DTG supplement instructions specifically discuss calcium and iron; the zinc heading is not a zinc-only human experiment.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Current prescribing instructions and original research checked. Article written with product-specific timing and explicit limits of the evidence. | |
| Research summary published |
Article revision: b5b5f01cb8cd45dc
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.