Home Drug Guide Doravirine

Drug Guide

Generic Name

Doravirine

Brand Names Pifeltro

Classification

Therapeutic: Antiretroviral agent, HIV-1 reverse transcriptase inhibitor

Pharmacological: Non-nucleoside reverse transcriptase inhibitor (NNRTI)

FDA Approved Indications

  • Treatment of human immunodeficiency virus type 1 (HIV-1) infection

Mechanism of Action

Doravirine binds directly to reverse transcriptase at an allosteric site, causing a conformational change that inhibits its enzymatic activity, thereby blocking HIV replication.

Dosage and Administration

Adult: 600 mg once daily, with or without food

Pediatric: Not established; not approved for pediatric use

Geriatric: No specific dosage adjustment; use with caution in older adults

Renal Impairment: No dosage adjustment necessary

Hepatic Impairment: Use with caution; no specific dosage recommendation available

Pharmacokinetics

Absorption: Rapidly absorbed; peak plasma concentrations in approximately 2 hours

Distribution: Widely distributed; plasma protein binding ~74%

Metabolism: Primarily metabolized by CYP3A4 and UGT1A1 enzyme pathways

Excretion: Primarily fecal (about 69%), minimal renal excretion

Half Life: Asymptomatic half-life approximately 13 hours

Contraindications

  • Hypersensitivity to doravirine or any component of the formulation

Precautions

  • Use with caution in patients with hepatic impairment; potential for resistance in cases of prior NNRTI failure; co-administration with potent CYP3A4 inducers may decrease effectiveness

Adverse Reactions - Common

  • Nausea (Less than 10%)
  • Headache (Less than 10%)
  • Diarrhea (Less than 10%)
  • Fatigue (Less than 10%)

Adverse Reactions - Serious

  • Hypersensitivity reactions including rash, hepatotoxicity, and hypersensitivity (Rare)

Drug-Drug Interactions

  • CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) may increase doravirine levels
  • CYP3A4 inducers (e.g., rifampin, carbamazepine) may decrease efficacy

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of hypersensitivity, liver function abnormalities, adherence counseling

Diagnoses:

  • Risk for infection due to immunosuppression

Implementation: Take as prescribed; counsel on adherence and potential drug interactions

Evaluation: Assess viral load and CD4 counts periodically to evaluate efficacy

Patient/Family Teaching

  • Take medication exactly as prescribed
  • Report symptoms of allergic reactions, liver problems
  • Maintain regular medical follow-up
  • Inform healthcare provider of all medications and supplements used

Special Considerations

Black Box Warnings:

  • None at this time

Genetic Factors: No specific genetic testing recommended

Lab Test Interference: May affect liver function tests, lipid panel, and viral load testing

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, hypotension

Treatment: Supportive care; no specific antidote; contact poison control center

Storage and Handling

Storage: Store at room temperature between 20°C to 25°C (68°F to 77°F)

Stability: Stable at room temperature; keep in original container, protected from moisture and light

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.