Alternatives to Isentress If You Can't Fill Your Prescription

If you rely on Isentress (Raltegravir) to keep your HIV under control and suddenly can't fill your prescription, it's understandable to feel worried. Whether it's a stocking issue at your pharmacy, an insurance problem, or cost concerns, going without your HIV medication is not an option.

The good news is that there are several effective alternatives to Isentress in the same drug class. In this article, we'll explain how Isentress works and walk you through the most common alternatives your doctor might consider.

Important: Never switch HIV medications on your own. Always work with your healthcare provider to find the right alternative based on your treatment history, resistance testing, and other medications you take.

What Is Isentress and How Does It Work?

Isentress is the brand name for Raltegravir, manufactured by Merck & Co. It belongs to a class of HIV drugs called integrase strand transfer inhibitors (INSTIs).

Here's how it works in simple terms: When HIV infects a cell, it needs to insert its genetic material into the cell's DNA. An enzyme called integrase is responsible for this step. Isentress blocks integrase, preventing the virus from inserting its DNA and making copies of itself.

By blocking this critical step, Isentress helps reduce the amount of HIV in your blood (your viral load) and allows your immune system to recover. For a deeper dive, read our article on how Isentress works.

Isentress was the first integrase inhibitor approved by the FDA in 2007. Since then, newer integrase inhibitors have been developed that offer some advantages, including once-daily dosing and a higher barrier to drug resistance.

Alternative Integrase Inhibitors to Isentress

The following medications work through the same mechanism as Isentress — blocking HIV integrase. Your doctor may recommend one of these as a substitute:

1. Dolutegravir (Tivicay)

Dolutegravir, sold under the brand name Tivicay, is a second-generation integrase inhibitor made by ViiV Healthcare. It's currently one of the most widely prescribed HIV medications in the world and is a preferred first-line treatment recommended by the U.S. Department of Health and Human Services (DHHS).

Key differences from Isentress:

• Once-daily dosing: Dolutegravir is taken once daily (50 mg) for most patients, compared to Isentress's twice-daily schedule
• Higher resistance barrier: Dolutegravir has a significantly higher barrier to resistance than Raltegravir, meaning the virus is less likely to develop resistance to it
• Fewer drug interactions: Dolutegravir has a more favorable drug interaction profile
• Generic available: Generic Dolutegravir is available, which may lower costs

Dolutegravir is also available in combination tablets like Triumeq (Dolutegravir/Abacavir/Lamivudine) and Dovato (Dolutegravir/Lamivudine), which combine multiple HIV drugs into a single daily pill.

2. Bictegravir (in Biktarvy)

Bictegravir is a second-generation integrase inhibitor made by Gilead Sciences. It is only available as part of the fixed-dose combination pill Biktarvy, which also contains Emtricitabine and Tenofovir Alafenamide (TAF).

Key features:

• Single-tablet regimen: Biktarvy is one pill, once a day — a complete HIV treatment in a single tablet
• High resistance barrier: Like Dolutegravir, Bictegravir has a high barrier to resistance
• Well-tolerated: Clinical trials have shown very few side effects
• No boosting required: Unlike some other HIV medications, Biktarvy does not require a pharmacokinetic booster

Biktarvy is one of the most commonly prescribed HIV regimens in the United States and is recommended as a preferred first-line option.

3. Elvitegravir (in Stribild and Genvoya)

Elvitegravir is a first-generation integrase inhibitor, like Raltegravir. It's available in two fixed-dose combination tablets:

• Genvoya: Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide
• Stribild: Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil Fumarate

Elvitegravir requires a pharmacokinetic booster (Cobicistat) to maintain adequate blood levels. This booster can increase drug interactions, so it's important to review all your medications with your doctor.

Because Elvitegravir has a lower resistance barrier similar to Raltegravir, it's generally considered a less preferred option compared to Dolutegravir or Bictegravir. However, it may still be appropriate for some patients.

4. Cabotegravir (Vocabria / Cabenuva)

Cabotegravir is a newer integrase inhibitor available in two forms:

• Vocabria: Oral tablets used during an initial lead-in period
• Cabenuva: Long-acting injectable given as a monthly or every-two-month injection (combined with Rilpivirine)

Cabotegravir is a unique option for patients who prefer not to take daily pills. The injectable form (Cabenuva) is administered by a healthcare provider and provides sustained HIV suppression with just 6 to 12 injections per year.

Cabotegravir is also available as Apretude for HIV pre-exposure prophylaxis (PrEP) in people who are HIV-negative.

How to Decide Which Alternative Is Right for You

Choosing an alternative to Isentress depends on several factors:

• Your treatment history: If you've been on Isentress for years with an undetectable viral load, your doctor may choose a drug with a similar resistance profile
• Resistance testing: Your doctor may order a genotype test to check if the virus has developed any resistance mutations
• Other medications: Drug interactions vary between integrase inhibitors. Review all your medications, including supplements, with your provider. Learn more about Isentress drug interactions
• Dosing preference: If taking pills twice a day is a challenge, switching to a once-daily option like Biktarvy or Tivicay may improve adherence
• Cost and insurance: Coverage varies by plan. Some alternatives may be more affordable. Check our guide on saving money on HIV medications

Don't Go Without Treatment

The most critical thing to understand is that you should never stop taking your HIV medications without medical guidance. Stopping treatment can cause your viral load to increase rapidly, damage your immune system, and increase the risk of developing drug-resistant HIV.

If you can't find Isentress:

1. Use Medfinder to search for pharmacies with Isentress in stock
2. Contact your doctor immediately to discuss alternatives
3. Ask your pharmacist about emergency supplies

For more tips on locating Isentress, read our guide on how to find Isentress in stock near you.

Final Thoughts

While Isentress was a groundbreaking medication when it launched in 2007, there are now several excellent alternatives available. Dolutegravir (Tivicay), Bictegravir (in Biktarvy), and Cabotegravir (Cabenuva) all offer once-daily or even less frequent dosing with high efficacy and strong resistance barriers.

Talk to your healthcare provider about which option makes the most sense for your situation. And remember — the goal is an undetectable viral load, whether that's achieved with Isentress or one of its alternatives.