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Two-drug HIV maintenance regimen (INSTI + NNRTI)

Dolutegravir with rilpivirine

Brand names: Juluca

A two-drug, once-daily oral maintenance regimen combining the integrase strand transfer inhibitor dolutegravir with the non-nucleoside reverse transcriptase inhibitor rilpivirine, used to maintain virological suppression in adults with HIV-1 who are already stable on antiretroviral therapy.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Dolutegravir blocks integration of viral DNA into the host genome by inhibiting HIV integrase, while rilpivirine binds and inhibits reverse transcriptase to prevent transcription of viral RNA into DNA.

Prescribing in practice

  • This is a switch (maintenance) regimen only for patients with no history of virological failure or known resistance to either component and stable suppression, not for initiating treatment.
  • Rilpivirine absorption depends on gastric acidity, so proton pump inhibitors are contraindicated and antacids or H2 antagonists must be separated in time and taken with food.
  • Dolutegravir chelates polyvalent cations, so dose timing must be separated from magnesium-, aluminium- or calcium-containing antacids, iron and other mineral supplements.

Monitoring

Monitor HIV viral load to confirm continued suppression, together with liver function during therapy.

Counselling the patient

  • Take both as a single dose once daily with a meal to ensure the medicine is absorbed properly.
  • Avoid indigestion remedies and supplements around dosing time unless advised on correct spacing.
  • Report mood changes or thoughts of self-harm, as these have been linked to the integrase inhibitor.

Evidence & guidelines

Two-drug maintenance regimens are supported by the SWORD trials and are reflected in BHIVA guidance for selected suppressed patients.

Reference: BHIVA HIV guidelines; EACS; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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