References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Doravirine (brand name Pifeltro) is a once-daily HIV medication belonging to the NNRTI class (non-nucleoside reverse transcriptase inhibitor). It was approved in 2018 and is known for having fewer side effects than older NNRTIs like efavirenz, particularly around sleep disturbances and neuropsychiatric symptoms.
If you’ve been prescribed doravirine or your doctor is considering it as part of your HIV treatment, this guide covers how it works, the standard dosage, side effects, and how it compares to other HIV drugs.
What Is Doravirine?
Doravirine is an antiretroviral drug used in combination with other HIV medicines to treat HIV-1 infection in adults. It works by blocking reverse transcriptase, an enzyme HIV needs to replicate inside your cells. By blocking this enzyme, doravirine prevents the virus from multiplying.
It’s available as:
- Pifeltro — doravirine 100mg tablets (taken with two other HIV drugs)
- Delstrigo — a fixed-dose combination tablet containing doravirine + lamivudine + tenofovir disoproxil (a single-tablet regimen)
Who Is Doravirine For?
Doravirine is suitable for:
- Adults newly diagnosed with HIV-1 who are starting treatment for the first time
- Adults currently on a stable HIV regimen who want to switch to a drug with fewer side effects
- People who have experienced side effects with efavirenz (sleep disturbance, vivid dreams, dizziness)
It is not recommended for people with certain drug-resistant HIV strains. Your doctor will check resistance testing results before prescribing.
How to Take Doravirine
- Dose: 100mg once daily
- With or without food
- At the same time each day for consistent drug levels
- Do not stop taking it without consulting your HIV specialist, as this can lead to viral rebound and resistance
If you miss a dose by less than 12 hours, take it as soon as you remember. If more than 12 hours have passed, skip the missed dose and take the next one at the usual time. Don’t double up.
How Effective Is Doravirine?
Clinical trials (DRIVE-FORWARD and DRIVE-AHEAD) showed that doravirine achieves viral suppression (undetectable viral load) in approximately 84% of patients at 48 weeks, comparable to other first-line regimens.
In switching studies, patients who moved from efavirenz to doravirine maintained viral suppression while experiencing improvements in sleep quality, dizziness, and mood-related side effects.
Side Effects
Doravirine is generally well tolerated. The most common side effects include:
| Side Effect | Frequency | Notes |
|---|---|---|
| Nausea | Common (5-7%) | Usually mild and temporary |
| Headache | Common (5-6%) | Settles within first few weeks |
| Fatigue | Common (4-5%) | Usually improves over time |
| Diarrhoea | Common (3-4%) | Mild |
| Abdominal pain | Less common | Take with food if problematic |
| Dizziness | Less common (2-3%) | Significantly less than efavirenz |
| Abnormal dreams | Less common (2%) | Significantly less than efavirenz (~8%) |
The key advantage of doravirine over older NNRTIs is the significantly lower rate of neuropsychiatric side effects. Efavirenz causes vivid dreams, insomnia, and dizziness in up to 20-30% of patients. Doravirine causes these symptoms in fewer than 5%.
Drug Interactions
Doravirine is metabolised by the CYP3A enzyme system. Drugs that strongly induce CYP3A can reduce doravirine levels and must be avoided:
- Do not take with: rifampicin, carbamazepine, phenytoin, phenobarbital, St John’s Wort, mitotane, enzalutamide
- Rifabutin: If needed alongside doravirine, the doravirine dose is increased to 100mg twice daily
- Hormonal contraception: No significant interaction. Safe to use together.
- Methadone: No dose adjustment needed
Always tell your HIV specialist about all medications, supplements, and herbal remedies you take.
Doravirine vs Other HIV Drugs
| Feature | Doravirine (Pifeltro) | Efavirenz (Sustiva) | Dolutegravir (Tivicay) |
|---|---|---|---|
| Class | NNRTI | NNRTI | INSTI |
| Dose | Once daily | Once daily | Once daily |
| CNS side effects | Low | High (20-30%) | Moderate (insomnia, headache) |
| Weight gain risk | Lower | Lower | Higher (well documented) |
| Barrier to resistance | Moderate | Low | High |
| Food requirements | None | Take on empty stomach | None |
Read more: One-pill-a-day HIV treatments | What is HIV? | Starting HIV treatment
Frequently Asked Questions
Is doravirine better than dolutegravir?
Both are effective first-line options. Dolutegravir has a higher barrier to resistance, making it the more common first choice. Doravirine may be preferred for patients concerned about weight gain (associated with dolutegravir and TAF-based regimens) or for those who prefer an NNRTI-based regimen.
Can doravirine make me gain weight?
Weight gain has been reported with many HIV treatments, particularly integrase inhibitors. Doravirine appears to have a more neutral effect on weight compared to dolutegravir, which is one reason some patients and clinicians prefer it.
Is doravirine available on the NHS?
Yes. Both Pifeltro and Delstrigo are available on the NHS. Your HIV specialist will determine whether it’s appropriate for your treatment plan based on resistance testing and your individual circumstances.
Can I switch to doravirine from my current HIV medication?
Yes, if your viral load is undetectable and your virus doesn’t carry resistance mutations to NNRTIs. Switching studies show that patients maintain viral suppression after switching and often experience fewer side effects. Discuss this with your HIV clinic.
Related reading
- Efavirenz for HIV: An Older NNRTI Still in Use
- Eviplera: How This Anti-HIV Drug Works
- Dolutegravir: A Complete Guide to This HIV Medication
- Understanding Efavirenz in HIV Treatment
- Injectable HIV Treatment: Everything You Need to Know
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
