This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Protease inhibitors and cobicistat may slow down how quickly your body processes cyclosporine, sirolimus, tacrolimus, or temsirolimus.
What might happen:
The amount of cyclosporine, sirolimus, tacrolimus, or temsirolimus in your body may increase and cause more side effects than normal.
What you should do about this interaction:
Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these two medicines together. Your doctor may need to check the amount of cyclosporine, sirolimus, tacrolimus, or temsirolimus in your blood and adjust the dose until you have been stabilized on the combination.Contact your healthcare professional if you experience any chest discomfort, dizziness, shaking, leg cramping, swelling, or any unusual stomach upset, headache, or skin irritation.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
1.Agenerase (amprenavir) Capsules US prescribing information. GlaxoSmithKline May, 2005.
2.Reyataz (atazanavir sulfate) US prescribing information. Bristol-Myers Squibb Company March, 2015.
3.Victrelis (boceprevir) US prescribing information. Schering Corporation July, 2014.
4.Prezista (darunavir) US prescribing information. Tibotec Inc. June, 2016.
5.Lexiva (fosamprenavir calcium) US prescribing information. GlaxoSmithKline March, 2016.
6.Crixivan (indinavir sulfate) US prescribing information. Merck & Co., Inc. March, 2015.
7.Kaletra (lopinavir/ritonavir tablets) US prescribing information. Abbott Laboratories January, 2013.
8.Viracept (nelfinavir mesylate) US prescribing information. Agouron Pharmaceuticals, Inc. March, 2015.
9.Norvir (ritonavir) US prescribing information. Abbott Laboratories November, 2015.
10.Invirase (saquinavir mesylate) US prescribing information. Roche Laboratories, Inc. February, 2016.
11.Incivek (telaprevir) US prescribing information. Vertex Pharmaceuticals Incorporated October, 2013.
12.Aptivus (tipranavir) US prescribing information. Boehringer Ingelheim Pharmaceuticals, Inc. March, 2015.
13.Torisel (temsirolimus) US prescribing information. Wyeth Pharmaceuticals, Inc. July, 2016.
14.Viekira Pak (ombitasvir, paritaprevir, and ritonavir; dasabuvir) US prescribing information. AbbVie Inc. June, 2016.
15.Viekirax (ombitasvir, paritaprevir, ritonavir) UK summary of product characteristics. AbbVie Limited May 16, 2016.
16.Tybost (cobicistat) US prescribing information. Gilead Sciences, Inc. June, 2016.
17.Jain AK, Venkataramanan R, Fridell JA, Gadomski M, Shaw LM, Ragni M, Korecka M, Fung J. Nelfinavir, a protease inhibitor, increases sirolimus levels in a liver transplantation patient: a case report. Liver Transpl 2002 Sep;8(9):838-40.
18.Vogel M, Voigt E, Michaelis HC, Sudhop T, Wolff M, Turler A, Sauerbruch T, Rockstroh JK, Spengler U. Management of drug-to-drug interactions between cyclosporine A and the protease-inhibitor lopinavir/ritonavir in liver-transplanted HIV-infected patients. Liver Transpl 2004 Jul; 10(7):939-44.
19.Guaraldi G, Cocchi S, Codeluppi M, Di Benedetto F, Bonora S, Motta A, Luzi K, Pecorari M, Gennari W, Masetti M, Gerunda GE, Esposito R. Pharmacokinetic interaction between Amprenavir/Ritonavir and FosAmprenavir on cyclosporine in two patients with human immunodeficiency virus infection undergoing orthotopic liver transplantation. Transplant Proc 2006 May;38(4):1138-40.
20.Frassetto L, Thai T, Aggarwal AM, Bucher P, Jacobsen W, Christians U, Benet LZ, Floren LC. Pharmacokinetic interactions between cyclosporine and protease inhibitors in HIV+ subjects. Drug Metab Pharmacokinet 2003; 18(2):114-20.
21.Brinkman K, Huysmans F, Burger DM. Pharmacokinetic interaction between saquinavir and cyclosporine. Ann Intern Med 1998 Dec 1;129(11):914-5.
22.Jain AK, Venkataramanan R, Shapiro R, Scantlebury VP, Potdar S, Bonham CA, Ragni M, Fung JJ. The interaction between antiretroviral agents and tacrolimus in liver and kidney transplant patients. Liver Transpl 2002 Sep;8(9):841-5.
23.Schonder KS, Shullo MA, Okusanya O. Tacrolimus and lopinavir/ritonavir interaction in liver transplantation. Ann Pharmacother 2003 Dec; 37(12):1793-6.
24.Jain AB, Venkataramanan R, Eghtesad B, Marcos A, Ragni M, Shapiro R, Rafail AB, Fung JJ. Effect of coadministered lopinavir and ritonavir (Kaletra) on tacrolimus blood concentration in liver transplantation patients. Liver Transpl 2003 Sep;9(9):954-60.
25.Guaraldi G, Cocchi S, Codeluppi M, Di Benedetto F, Bonora S, Pecorari M, Gennari W, Cautero N, Pinna AD, Gerunda GE, Esposito R. Role of therapeutic drug monitoring in a patient with human immunodeficiency virus infection and end-stage liver disease undergoing orthotopic liver transplantation. Transplant Proc 2005 Jul-Aug;37(6):2609-10.
26.Schvarcz R, Rudbeck G, Soderdahl G, Stahle L. Interaction between nelfinavir and tacrolimus after orthoptic liver transplantation in a patient coinfected with HIV and hepatitis C virus (HCV). Transplantation 2000 May 27;69(10):2194-5.
27.Sheikh AM, Wolf DC, Lebovics E, Goldberg R, Horowitz HW. Concomitant human immunodeficiency virus protease inhibitor therapy markedly reduces tacrolimus metabolism and increases blood levels. Transplantation 1999 Jul 27;68(2):307-9.
28.Mertz D, Battegay M, Marzolini C, Mayr M. Drug-drug interaction in a kidney transplant recipient receiving HIV salvage therapy and tacrolimus. Am J Kidney Dis 2009 Jul;54(1):e1-4.
29.Han Z, Kane BM, Petty LA, Josephson MA, Sutor J, Pursell KJ. Cobicistat Significantly Increases Tacrolimus Serum Concentrations in a Renal Transplant Recipient with Human Immunodeficiency Virus Infection. Pharmacotherapy 2016 Jun;36(6):e50-e53.