Elvitegravir / Cobicistat

Aluminium / Magnesium hydroxide

Administration time adjustment is recommended.

No pharmaceutical opinion available for this interaction.

Mechanism

Aluminium / Magnesium hydroxide can bind (chelation) to elvitegravir and reduce its absorption .

Elvitegravir / Cobicistat

Pharmacodynamic effects

Possible decrease of clinical efficacy.

Recommendations

The product monograph recommends to separate administration of elvitegravir and antacids by at least 2 hours.

Monitor for clinical efficacy.

Alternative solution(s)

Aluminium / Magnesium hydroxide

Pharmacodynamic effects

Recommendations

Alternative solution(s)

H2 receptor antagonists or proton pump inhibitors.

Monitor

Tests

Viral Load

CD4+

Pharmacokinetic parameters
Parameters
Reference number
# patients
HIV
Dose
Frequency
AUC
Cmax
Cmin
Elvitegravir / Cobicistat
2134 2134 2134 2134 2134
13 11 10 8 10
- - - - -
50 mg * 50 mg * 50 mg * 50 mg * 50 mg *
x 1 † x 1 ‡ x 1 ‡‡ x 1 ° x 1 °°
- 45% - 15% - 20% - 4% - 2%
- 47% - 18% - 21% - 5% - 2%
- 41% - 10% - 20% + 4% ± 0%
Aluminium / Magnesium hydroxide
2134 2134 2134 2134 2134
13 11 10 8 10
- - - - -
20 ml 20 ml 20 ml 20 ml 20 ml
x 1 † x 1 ‡ x 1 ‡‡ x 1 ° x 1 °°
         
         
         
Comment

Ref #2134 : * Elvitegravir administered with ritonavir 100 mg.
† Elvitegravir administered simultaneously with the antacid.
‡ Antacid administered 2 before elvitegravir.
‡‡ Antacid administered 2 hours after elvitegravir.
° Antacid administered 4 hours before elvitegravir.
°° Antacid administered 4 hours after elvitegravir.

Also see Elvitegravir/Ritonavir + antacids.

Also see Famotidine with Elvitegravir\cobicistat and Omeprazole with Elvitegravir/cobicistat.

Reference
  • 2570
    Elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild), Gilead, Ontario, Canada, 17 septembre 2018.
  • 2134
    Ramanathan S, Mathias A, Wei X et al. Pharmacokinetics of once-daily boosted-elvitegravir when administered in combination with acid reducing agents. J Acquir Immune Defic Syndr. 2013 Sep 1; 64(1): 45-50.
  • 3281
    Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide(Genvoya), Gilead, Ontario, Canada, 17 septembre 2018.