Pharmacology · Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Doravirine !
A newer NNRTI: taken with or without food, independent of stomach acid, with fewer nervous system and lipid effects than efavirenz.
Updated 2026-11-01
Also called: DOR
The figure shows doravirine in the allosteric pocket of HIV-1 reverse transcriptase.
Mechanism of action
It binds the allosteric pocket of HIV-1 reverse transcriptase and blocks viral DNA synthesis. It keeps activity against some of the commonest resistance mutations to older NNRTIs.
- It binds the allosteric pocket of reverse transcriptase
- It locks the enzyme
- Viral DNA synthesis stops
Pharmacokinetics
- Absorption
- Absorbed with or without food; proton pump inhibitors do not affect it much
- Metabolism
- Liver, mainly by CYP3A4
Indications
- HIV-1 infection, combined with other antiretrovirals HIV infection and AIDS →
Adverse effects
Common
- Nausea, diarrhoea, abdominal pain
- Headache, dizziness, tiredness
- Abnormal dreams
Contraindications
- Strong CYP3A inducers: rifampicin, carbamazepine, phenobarbital, phenytoin, St John's wort
Key interactions
- Rifampicin and inducing anticonvulsants
- Greatly lower doravirine: not combined
- Rifabutin
- Can be used with a doravirine adjustment ordered by the team
What is monitored
- Viral load and CD4
- Skin
Administration and safety
- By mouth, with or without food
- Also available combined with lamivudine and tenofovir disoproxil in one tablet
Nursing care
- Check for inducing drugs (TB drugs, anticonvulsants)
- Teach to report rash with fever or mouth sores
- Keep a full list of medicines and herbal products and review it with pharmacy before any new drug
Pregnancy and breastfeeding
Antiretroviral treatment in pregnancy protects the mother and lowers HIV transmission to the baby; the treating team chooses the regimen.
Test yourself
Think of the answer, then tap the question to see it.
What practical absorption difference does doravirine have from rilpivirine?
Doravirine needs neither food nor stomach acid; rilpivirine does.
Why is doravirine not combined with rifampicin?
Rifampicin induces CYP3A4 and greatly lowers doravirine levels, risking failure and resistance.
Which class is doravirine in and where does it bind?
It is an NNRTI: it binds the allosteric pocket of HIV-1 reverse transcriptase.
Related drugs
Related conditions
← Back to the class: Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Doravirine: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 64 (McGraw Hill, 2023).
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Representative model, for educational purposes only.