Medications not yet evaluated by P&T are considered NON-FORMULARY. Always check 2 unique patient identifiers - NAME and DATE OF BIRTH - at every step!
Please be sure to document all clinical activities daily.
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dolutegravir

dolutegravir
  • Formulary AIDs/HIV Drugs Formulary
  • Restricted Tivicay PD --> restricted to pediatric patients with HIV-1 infection who are INSTI-naive, at least 4 weeks old, and weigh at least 3 kg.
Drug Name Form Strength Formulary Unrestricted Formulary Restricted Non-Formulary Interchange
Tivicay TABLET, ORAL 50 mg      
Tivicay PD TABLET, SOLUBLE, ORAL 5 mg      
VIEW MORE HIV Integrase Inhibitors
Comments:

Tivicay PD is restricted to pediatric patients with HIV-1 infection who are INSTI-naive, at least 4 weeks old, and weigh at least 3 kg. Rare use is expected, not routinely stocked.

Reviewed: December 17, 2013 (Tivicay),  December 2020 (Tivicay PD)

Last updated: Dec. 18, 2020
  • Formulary, Not Routinely Stocked: Tivicay PD






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