HIV-1 attachment inhibitor
Fostemsavir
Brand names: Rukobia
Adult dose
Dose: 600mg PO BD with other antiretrovirals
Route: PO
Frequency: BD
Clinical pearls
- Heavily treatment-experienced multidrug-resistant HIV-1 with limited remaining options
Contraindications
- Concurrent strong CYP3A4 inducers (rifampicin, carbamazepine, phenytoin, St John's wort, enzalutamide, mitotane)
Side effects
- Nausea
- Diarrhoea
- Headache
- QT prolongation
- Hepatotoxicity (HBV/HCV co-infected)
- Immune reconstitution syndrome
Interactions
- Strong CYP3A4 inducers (avoid)
- Statins (raised levels)
- Ethinylestradiol (raised levels — limit 30 mcg)
- QT-prolonging drugs
Monitoring
- LFTs (esp. HBV/HCV co-infection)
- Viral load
- CD4
- ECG if QT risk
Reference: BNF; BHIVA; SmPC; https://bnf.nice.org.uk/drugs/fostemsavir/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
- BALL Score for Relapsed/Refractory CLL · Leukaemia
Pathways
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023