Suicidal overdose of dolutegravir: A case report

Abstract

Dolutegravir (DTG) is the most recently introduced integrase inhibitor for the treatment of HIV infection and is preferred for its superior tolerability and efficacy in both new and pre-treated patients, and infrequent drug interactions. Since January 2017, Botswana has adopted a ‘treat-all’ approach with a DTG-based antiretroviral (ARV) regimen as first-line treatment. We report a 29-year-old man with clinical stage 1 HIV infection who had been started on DTG, tenofovir and emtricitabine eight months prior, and who was admitted following a suicidal overdose of 1500 mg of DTG. He reported only minor symptoms including vomiting, epigastric pain and dizziness; which promptly resolved following supportive treatment. On admission, full blood count, liver function tests and electrocardiography were unremarkable. However, there was a non-progressive increase in serum creatinine. After a month off ARVs, he was successfully restarted on antiretroviral therapy without any serious adverse effect.

Virgin Coconut Oil Protects Against Dolutegravir-induced Toxicity in Wistar Albino Rats

“…Potential adverse effects include allergic responses and hepatic complications [12]. The administration of INSTIs alone has been linked to adverse effects such as insomnia accompanied by neuropsychiatric reactions [13], as well as diarrhea, vomiting, allergic reactions, and elevated liver enzymes [11] [14]. Decreased creatinine clearance has been reported.…”

Reproductive and Oxidative Stress Toxicity of Dolutegravir-Based Combination Antiretroviral Therapy in Drosophila melanogaster

“…Dolutegravir (DTG), a new generation INSTI, acts by inhibiting the incorporation of HIV DNA into the T-lymphocyte genome of the host, thereby limiting viral propagation [13]. The use of INSTIs singly is associated with side effects like insomnia with neuropsychiatric reactions [11], diarrhea, vomiting, allergy, and increase liver enzymes [13,16] with decreased creatinine clearance [17] have been reported. Similarly, in vitro cell shrinkage and phospholipid scrambling of cell membranes suspected to be oxidative stress-related effects of Dolutegravir have been documented [17].…”