No pharmaceutical opinion available for this interaction.
Rifampin can induce the metabolism (CYP 3A4) and decrease the plasma concentration of Cobicistat.
3A4 (major) and 2D6 (minor).
3A4 (strong) et 2D6 (moderate), P-gp, MATE 1, BCRP, OATP1B1 and OATP1B3.
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.
1A2, 2C9, 2E1, P-gp
1A2, 2C9, 2C19, 3A4-7, UGT 1A1, P-gp
Increased risk of hepatotoxicity.
Choose an alternative.
Rifabutin with protease inhibitor boosted with ritonavir preferably (see rifabutin with PIs) or choose an antibiotic that does not interact with PIs.
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.