The short answer
Have your pharmacist separate zinc from dolutegravir using the mineral-product guidance. Zinc can bind dolutegravir in laboratory experiments, but a zinc-only human effect size was not established in this source check. WHO guidance uses dolutegravir at least two hours before or six hours after mineral supplements.
What this answer covers
Oral zinc supplements with oral dolutegravir. Zinc-only clinical outcomes are distinguished from laboratory zinc chloride, multivitamin mixtures and studies of other integrase inhibitors.
- Supplement or preparation
- zinc
- Medication ingredient
- dolutegravir
What does the zinc evidence actually show?
Laboratory work tested dolutegravir sodium with zinc ions in solution and intestinal models. At selected ratios, zinc reduced drug permeation. These experiments support a plausible binding mechanism; they do not measure the effect of a particular zinc capsule in a person with HIV.
Does a multivitamin study prove the zinc effect?
No. A small trial tested a complete multivitamin, not zinc in isolation. Minerals can occur together and contribute differently. Likewise, a case involving another integrase inhibitor cannot be used as a direct dolutegravir result simply because both medicines belong to the same class.
Which spacing rule is available?
WHO guidance includes zinc among mineral products to be separated, with dolutegravir at least two hours first or six hours afterward. This is a clinical precaution rather than a zinc-specific trial-proven interval. Current TIVICAY labeling’s food exception names calcium and iron, so it should not be assumed for zinc alone.
How do I apply that to my product?
Check whether the zinc is in a lozenge, capsule, multivitamin or mixed mineral powder, and bring the amount to your pharmacist. Ask for a schedule compatible with all medicines in the HIV regimen. Neither uncertain evidence nor a low supplement dose is a guarantee that concurrent use will be harmless.
Evidence and practical considerations
Absorption & effectiveness
Have your pharmacist separate zinc from dolutegravir using the mineral-product guidance. Zinc can bind dolutegravir in laboratory experiments, but a zinc-only human effect size was not established in this source check. WHO guidance uses dolutegravir at least two hours before or six hours after mineral supplements.
- Exact scope
- Oral zinc supplements with oral dolutegravir. Zinc-only clinical outcomes are distinguished from laboratory zinc chloride, multivitamin mixtures and studies of other integrase inhibitors. 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
- No controlled zinc-only human dolutegravir interaction study was identified. Nonclinical permeation and a mixed multivitamin trial do not quantify zinc-specific treatment failure; practical spacing is guideline-based.
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: WHO clinical decision guidance
smart.who.int · Source check Sep 10, 2026
Population: People taking a dolutegravir-containing regimen.
The decision rule separates dolutegravir at least two hours before or six hours after these products and recommends monitoring virologic response.
How this applies: Restricted to the preparation and conditions described in this article.
Implementation guidance rather than a clinical trial. It does not provide a zinc-specific effect size or replace the formulation-specific calcium/iron food exception in current prescribing information.
Source 3: primary nonclinical permeation research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Laboratory drug solutions, Caco-2 cell layers and rat intestinal tissue; no treated human participants.
Zinc, aluminum and calcium reduced measured permeation under selected laboratory conditions; higher ion amounts generally reduced dissolved drug.
How this applies: Restricted to the preparation and conditions described in this article.
Nonclinical ion solutions cannot establish the magnitude, clinical outcome or preventive interval for an oral zinc supplement in people.
Source 4: 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.
Research assessment: · Open full citations ↗
Timing & monitoring
WHO mineral-product guidance places dolutegravir at least two hours before or six hours after zinc-containing products; this is not a zinc-specific experimental minimum.
- Exact scope
- Oral zinc supplements with oral dolutegravir. Zinc-only clinical outcomes are distinguished from laboratory zinc chloride, multivitamin mixtures and studies of other integrase inhibitors. 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
- Guidance is explicitly distinguished from a demonstrated zinc-only clinical effect or a food exception.
Factors that may matter: mineral formulation; complete regimen.
Read the supporting source summaries
Source 1: WHO clinical decision guidance
smart.who.int · Source check Sep 10, 2026
Population: People taking a dolutegravir-containing regimen.
The decision rule separates dolutegravir at least two hours before or six hours after these products and recommends monitoring virologic response.
How this applies: Restricted to the preparation and conditions described in this article.
Implementation guidance rather than a clinical trial. It does not provide a zinc-specific effect size or replace the formulation-specific calcium/iron food exception in current prescribing information.
Source 2: 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.
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: 891b33367578a4b6
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.