No pharmaceutical opinion available for this interaction.
Cobicistat can inhibit the metabolism (CYP 3A4) and decrease the active metabolite formation of Ticagrelor.
Cobicistat can inhibit the metabolism (CYP 3A4) and increase the plasma concentration of Ticagrelor.
Elvitegravir 3A4 and then UGT1A1/3; Cobicistat 3A4 (major) and 2D6 (minor)
Elvitegravir : 2C9 (moderate)
Cobicistat : 3A4 and 2D6 (potent), P-gp, MATE 1, BCRP, OATP1B1 and OATP1B3
3A4 and 3A5: Active metabolite that is similar in activity to ticagrelor; P-gp
3A4 (weak), P-gp (weak)
Possible increase of adverse effects.
Possible decrease of clinical efficacy.
Contraindicated. Use alternative.
Adverse effects of ticagrelor: Bleeding (epistaxis, gastrointestinal/cutaneous hemorrhage), bruising, dyspnea, headache, dizziness, gastrointestinal effects (nausea, vomiting, dyspepsia, diarrhea or constipation), bradycardia.
Ref #3164 : An in vitro study with healthy volunteers showed that ketoconazole, a potent inhibitor of CYP3A4, increased ticagrelor AUC by more than 7.3-fold and Cmax by 2.4-fold and decreased the active metabolite AUC and Cmax by 56% and 89%, respectively.