Elvitegravir / Cobicistat

Vardenafil

Dosage adjustment is recommended.

No pharmaceutical opinion available for this interaction.

Mechanism

Elvitegravir / Cobicistat can inhibit the metabolism (CYP 3A4) and increase the plasma concentration of Vardenafil.

Elvitegravir / Cobicistat

Pharmacodynamic effects

Recommendations

Alternative solution(s)

Vardenafil

Pharmacodynamic effects

Possible increase of adverse effects.

Recommendations

Use this combination with caution.

Use a single maximum dose of vardenafil of 2.5 mg every 72 hours according to the US product monograph.

Monitor closely for adverse effects.

The canadian monograph contraindicates this combination.

Alternative solution(s)

Sildenafil or tadalafil.

Monitor

Vardenafil toxicity: hypotension, tachycardia, headache, dizziness, flushing, visual changes (difficulty distinguishing blue and green) and syncope.

Tests

Pharmacokinetic parameters

Comment

Ref #1384 : The monographs of vardenafil and ritonavir contraindicate the coadministration with a potent CYP 3A4 inhibitor.

Ref #2570 : The Canadian Product Monograph for Stribild recommends not co-administer with vardenafil.

Ref #3281 and 3390 : The product monograph of Genvoya, as the american product monograph of vardenafil, recommends to use a single maximum dose of vardenafil 2.5 mg.

Ref #1384 : Indeed, vardenafil AUC has increased by 49-fold when using a 5 mg vardenafil dose associated with ritonavir 600 mg BID, a potent inhibitor of cytochrome 3A4.

Caution:
- Liver impairment (Child Pugh B) : increases AUC to 160% and
- kidney failure (Clcr < 30 ml/min) : increases AUC to 20-30% and
- age > 65 years old : increases 52% of AUC.

See ritonavir and vardenafil.

Reference
  • 1384
    Vardenafil (Levitra), Bayer, Ontario, Canada, 4 juin 2016.
  • 2570
    Elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild), Gilead, Ontario, Canada, 17 septembre 2018.
  • 3390
    Vardenafil (Levitra), Bayer Healthcare, New Jersey, USA, april 2014.
  • 3281
    Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide(Genvoya), Gilead, Ontario, Canada, 17 septembre 2018.