# A client takes dolutegravir each morning and uses an aluminum-magnesium antacid. Which instruction should the nurse provide?

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> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client takes dolutegravir each morning and uses an aluminum-magnesium antacid. Which instruction should the nurse provide?

## Option

1. Take the antacid 30 minutes before dolutegravir each morning because gastric neutralization improves antiviral absorption.
2. Separate dolutegravir from the antacid by taking dolutegravir 2 hours before or 6 hours after it. **✔ Correct answer**
3. Crush dolutegravir and the antacid together, mix them in water, and take the combination on an empty stomach.
4. Skip the scheduled dolutegravir dose whenever the antacid is needed and resume antiviral therapy the next morning.

**Correct answer: 2**

## Explanation

Polyvalent cations can reduce dolutegravir absorption. The labeled instruction is to give dolutegravir 2 hours before or 6 hours after cation-containing antacids.

## In-depth explanation

Quick answer
Protect absorption by separating dolutegravir from the antacid.

Why this is correct
Aluminum and magnesium can bind the integrase inhibitor in the gastrointestinal tract and lower exposure. Timing avoids the interaction without interrupting antiretroviral therapy.

Easy analogy or mental picture
Do not let the antacid handcuff the antiviral before it reaches circulation.

Memory hook
Dolutegravir: 2 hours before or 6 hours after antacid.

NCLEX decision rule
Medication reconciliation must include nonprescription antacids, minerals, and supplements.

Why the other choices are wrong
Close timing, crushing together, or skipping antiretroviral doses increases the chance of inadequate antiviral exposure.References
1DailyMed: TIVICAY (dolutegravir)Separation from polyvalent-cation antacids and food-dependent coadministration guidance

## Clinical scenario

Cation interaction
Review antacids, calcium, iron, magnesium, administration with food, adherence, and the complete antiretroviral schedule.

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