At least one out of every 100 people who take the integrase inhibitor dolutegravir as part of an antiretroviral combination experience insomnia. Although nausea, diarrhea, and headache are the most frequently reported side effects of dolutegravir, for those who experience it, insomnia can really affect the quality of life, reports NAM AIDSMap.
Several recent studies have shown that people taking dolutegravir commonly experience neuropsychiatric side effects, especially insomnia. A German study, which looked at side effects in people who started integrase inhibitor-based treatment, found that neuropsychiatric side effects were serious enough to lead many people to stop taking it. Discontinuation of the drug was most common in people aged 60 and over, women, and people who took dolutegravir in combination with abacavir.
However, a simple change in when you take the drug may be an easy solution to insomnia. Italian researchers reported in the journal HIV Medicine that 75 percent of the patients reporting insomnia found that the problem stopped when they switched from an evening dosing to a morning dosing.
These researchers have been following 1,502 patients on dolutegravir throughout clinics in northern Italy and Rome for several years. Nearly 4 percent of these (52 people) reported insomnia or sleep disorders. Insomnia was more common in women and in older patients, but was not associated with abacavir use in this patient population.
After switching to morning dosing, insomnia went away in 75 percent of patients but remained a problem for 25 percent (13 patients). Eight patients in the study eventually discontinued the drug as a result. Half of the patients who discontinued treatment reported that additional adverse side effects (i.e., agitation, dyspepsia, or reduced libido) also contributed to the decision to discontinue dolutegravir. Switching to morning dosing did not give rise to any new side effects in most patients, although three reported some anxiety or irritability afterward.
If you take dolutegravir and are thinking about switching to a morning dose, here are some important things to consider:
- For some people who need to take dolutegravir with food, switching to morning dosing may raise issues. Food increases blood levels of dolutegravir, so taking the drug with food is recommended for anyone who has resistance to an integrase inhibitor.
- People taking dolutegravir need to avoid taking the drug at the same time of day as magnesium or aluminum-based antacids, iron calcium supplements, or multivitamins. The prescribing guidance recommends that dolutegravir should be taken two hours before or six hours after taking these agents.
- It’s always a good idea to discuss any changes to your medication regimen with your doctor first, even if it’s just the timing you take the medication.
Remember, if you’re having side effects that are affecting your quality of life, talk to your doc, so together you can find the best treatment plan for you.