Cobicistat

Rifampin

Contraindicated.

No pharmaceutical opinion available for this interaction.

Mechanism

Rifampin can induce the metabolism (CYP 3A4) and decrease the plasma concentration of Cobicistat.

Cobicistat

Pharmacodynamic effects

Possible decrease of the pharmacokinetic boosting effect.

Therefore, resulting in loss of therapeutic effect of associated IP.

Risk of a possible development of resistance to antiretroviral class.

Recommendations

Alternative solution(s)

Rifampin

Pharmacodynamic effects

Increased risk of hepatotoxicity.

Recommendations

Choose an alternative.

Alternative solution(s)

Rifabutin with protease inhibitor boosted with ritonavir preferably (see rifabutin with PIs) or choose an antibiotic that does not interact with PIs.

Monitor

Tests

Pharmacokinetic parameters

Comment

Co-administration of rifampicin 600 mg QD with protease inhibitors such as lopinavir/ritonavir, darunavir/ritonavir, atazanavir/ritonavir and atazanavir alone causes a decrease in AUC and Cmin of approximately 75% to 80%.

Ref #3116 : To increase the chance of achieving therapeutic serum levels and reduce the development of resistance and treatment failures some experts, as well as the CDC, recommend a 150mg QD dose. See rifabutin + PIs.

Reference
  • 2949
    Cobicistat (Tybost), European public assessment report (EPAR) Product Information, London, United Kingdom, 4 juin 2015.
  • 3116
    Center for Disease Control and prevention. Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis. Disponible: http://www.cdc.gov/tb/publications/guidelines/tb_hiv_drugs/recommendations03.htm Publié le 22 sept 2014. Consulté le 11 janvier 2018.