Genvoya (cobicistat / elvitegravir / emtricitabine / tenofovir alafenamide) Disease Interactions
There are 7 disease interactions with Genvoya (cobicistat / elvitegravir / emtricitabine / tenofovir alafenamide):
- Hepatotoxicity
- Renal Dysfunction
- Creatinine Clearance
- Hemodialysis
- Renal Dysfunction
- Bone Toxicity
- Liver Disease
Nrtis (Includes Genvoya) ↔ Hepatotoxicity
Severe Potential Hazard, Moderate plausibility
Applies to: Alcoholism, Liver Disease
Hepatotoxicity including lactic acidosis, severe hepatomegaly with steatosis, fulminant hepatitis, and hepatic failure has rarely been associated with the use of nucleoside reverse transcriptase inhibitors (NRTIs) alone or in combination with other antiretroviral agents. Therapy with NRTIs should be administered cautiously in patients with preexisting liver disease, a history of alcohol abuse, or hepatitis. Therapy should be suspended if clinical or laboratory findings suggestive of lactic acidosis or pronouced hepatotoxicity occur.
References
- Dolin R, Lambert JS, Morse GD, et al "2',3'-dideoxyinosine in patients with AIDS or AIDS-related complex." Rev Infect Dis 12 (1990): s540-51
- Montaner JSG, Rachlis A, Beaulieu R, Gill J, Schlech W, Phillips P, Auclair C, Boulerice F, Schindzielorz A, Smaldone L, Wainber "Safety profile of didanosine among patients with advanced HIV disease who are intolerant to or deteriorate despite zidovudine therapy: results of the canadian open ddi treatment program." J Acquir Immune Defic Syndr 7 (1994): 924-30
- "Product Information. Retrovir (zidovudine)." Glaxo Wellcome, Research Triangle Park, NC.
- "Product Information. Viread (tenofovir)." Gilead Sciences, Foster City, CA.
- Chen SC, Barker SM, Mitchell DH, et al "Concurrent zidovudine-induced myopathy and hepatoxicity in patients treated for human immunodeficiency virus (HIV) infection." Pathology 24 (1992): 109-11
- Yarchoan R, Mitsuya H, Pluda JM, et al "The National Cancer Institute phase I study of 2',3'-dideoxyinosine administration in adults with AIDS-related complex: analysis of activity and toxicity profiles." Rev Infect Dis 12 (1990): s522-33
- Pike IM, Nicaise C "The didanosine Expanded Access Program: safety analysis." Clin Infect Dis 16 (1993): S63-8
- Lai KK, Gang DL, Zawacki JK, Cooley TP "Fulminant hepatic failure associated with 2',3'-dideoxyinosine (ddI)." Ann Intern Med 115 (1991): 283-4
- Shriner K, Goetz MB "Severe hepatoxicity in a patient receiving both acetaminophen and zidovudine." Am J Med 93 (1992): 94-6
- Gradon JD, Chapnick EK, Sepkowitz DV "Zidovudine-induced hepatitis." J Intern Med 231 (1992): 317-8
- Pai VB, Koranyi K, Nahata MC "Acute hepatitis and bleeding possibly induced by zidovudine and ritonavir in an infant with HIV infection." Pharmacotherapy 20 (2000): 1135-40
- Boubaker K, Flepp M, Sudre P, et al. "Hyperlactatemia and Antiretroviral Therapy: The Swiss HIV Cohort Study." Clin Infect Dis 33 (2001): 1931-7
- Miller KD, Cameron M, Wood LV, Dalakas MC, Kovacs JA "Lactic acidosis and hepatic steatosis associated with use of stavudine: report of four cases." Ann Intern Med 133 (2000): 192-6
- "Product Information. HIVID (zalcitabine)." Roche Laboratories, Nutley, NJ.
- Kronenberg A, Riehle HM, Gunthard HF "Liver failure after long-term nucleoside antiretroviral therapy." Lancet 358 (2001): 759-601
- Dubin G, Braffman MN "Zidovudine-induced hepatotoxicity." Ann Intern Med 110 (1989): 85-6
- "Product Information. Videx (didanosine)." Bristol-Myers Squibb, Princeton, NJ.
- Shintaku M, Nasu K, Shimizu T "Fulminant hepatic failure in an AIDS patient: possible zidovudine- induced hepatotoxicity." Am J Gastroenterol 88 (1993): 464-6
- Lonergan JT, Behling C, Pfander H, Hassanein TI, Mathews WC "Hyperlactatemia and hepatic abnormalities in 10 human immunodeficiency virus-infected patients receiving nucleoside analogue combination regimens." Clin Infect Dis 31 (2000): 162-6
- Coghlan ME, Sommadossi JP, Jhala NC, Many WJ, Saag MS, Johnson VA "Symptomatic lactic acidosis in hospitalized antiretroviral-treated patients with human immunodeficiency virus infection: a report of 12 cases." Clin Infect Dis 33 (2001): 1914-21
- "Product Information. Ziagen (abacavir)." Glaxo Wellcome, Research Triangle Pk, NC.
- Lhouri S, Cushing H "Lactic acidosis secondary to nucleoside analog antiretroviral therapy." Infect Med 17 (2000): 547-54
Tenofovir (Includes Genvoya) ↔ Renal Dysfunction
Severe Potential Hazard, High plausibility
Applies to: Renal Dysfunction
Tenofovir is primarily eliminated by the kidney via glomerular filtration and active tubular secretion. Renal impairment, including acute renal failure and Fanconi syndrome, has been reported with tenofovir use. Close monitoring of renal function and lengthening the dosing interval are recommended for patients with creatinine clearance less than 50 mL/min. Creatinine clearance should be calculated in all patients before starting tenofovir treatment and during treatment when clinically appropriate. Routine monitoring of serum creatinine and phosphorus is recommended for patients at risk of or with a history of renal dysfunction. Safety and effectiveness have not been evaluated in patients with renal insufficiency using dose adjustments; therefore, the benefit of tenofovir treatment should be weighed against the risk of renal toxicity. Tenofovir should be avoided in patients who are currently using or have recently used nephrotoxic drugs.
References
- "Product Information. Viread (tenofovir)." Gilead Sciences, Foster City, CA.
Cobicistat (Includes Genvoya) ↔ Creatinine Clearance
Moderate Potential Hazard, Moderate plausibility
Applies to: Renal Dysfunction
Cobicistat has shown to decrease creatinine clearance without affecting actual renal glomerular function and no dose adjustment is required in patients with renal impairment, including those with severe renal impairment. However, this effect should be considered when interpreting changes in estimated creatinine clearance in patients initiating cobicistat when there is presence of renal impairment or in patients receiving other drugs that need to be monitored with estimated creatinine clearance. Patients who experience a confirmed increase of serum creatinine of 0.4 mg/dL from baseline should be closely monitored for renal safety.
Emtricitabine (Includes Genvoya) ↔ Hemodialysis
Moderate Potential Hazard, High plausibility
Applies to: hemodialysis
Emtricitabine is removed by hemodialysis. Following an emtricitabine dose administered 1.5 hours before the hemodialysis session, approximately 30% of the dose was removed over three hours of hemodialysis (blood flow rate of 400 mL/min and a dialysate flow rate of 600 mL/min). Emtricitabine should be administered after hemodialysis.
References
- "Product Information. Emtriva (emtricitabine)." Gilead Sciences, Foster City, CA.
Emtricitabine (Includes Genvoya) ↔ Renal Dysfunction
Moderate Potential Hazard, High plausibility
Applies to: Renal Dysfunction
Emtricitabine is primarily eliminated by the kidney. Compared to patients with normal renal function (CrCl above 80 mL/min), peak plasma concentration (Cmax) and systemic exposure (AUC) of emtricitabine increased by 45% and 113%, respectively, in patients with moderate renal dysfunction (CrCl 30 to 49 mL/min), and 27% and 186%, respectively, in patients with severe renal dysfunction (CrCl below 30 mL/min). Systemic exposure was increased even further in patients with end-stage renal disease managed on dialysis. These patients had an approximately 3.5-fold increase in emtricitabine AUC compared to patients with normal renal function. Renal clearance of emtricitabine decreased by 68% and 86%, respectively, in patients with moderate and severe renal dysfunction. Dosage adjustment of emtricitabine is recommended for patients with CrCl below 50 mL/min, including patients on dialysis, in accordance with the manufacturer's product labeling. Clinical response to treatment and renal function should be closely monitored.
References
- "Product Information. Emtriva (emtricitabine)." Gilead Sciences, Foster City, CA.
Tenofovir (Includes Genvoya) ↔ Bone Toxicity
Moderate Potential Hazard, Moderate plausibility
Applies to: Osteoporosis, Vitamin D Deficiency
Osteomalacia and reduced bone mineral density have been reported in animal toxicology studies involving tenofovir exposures 6- to 12-fold those observed in humans. The mechanism of bone toxicity has not been established, and it is not known if long-term use of tenofovir disoproxil fumarate will cause bone abnormalities in humans.
References
- "Product Information. Viread (tenofovir)." Gilead Sciences, Foster City, CA.
Tenofovir (Includes Genvoya) ↔ Liver Disease
Minor Potential Hazard, Low plausibility
Applies to: Liver Disease
There are no data concerning the use of tenofovir disoproxil fumarate in patients with hepatic impairment. Tenofovir and tenofovir disoproxil are not metabolized by liver enzymes. However, since tenofovir is not entirely eliminated by the kidney (70% to 80%), tenofovir pharmacokinetics may be altered in patients with impaired hepatic function.
References
- "Product Information. Viread (tenofovir)." Gilead Sciences, Foster City, CA.
Genvoya (cobicistat / elvitegravir / emtricitabine / tenofovir alafenamide) drug Interactions
There are 865 drug interactions with Genvoya (cobicistat / elvitegravir / emtricitabine / tenofovir alafenamide)
Genvoya (cobicistat / elvitegravir / emtricitabine / tenofovir alafenamide) alcohol/food Interactions
There are 2 alcohol/food interactions with Genvoya (cobicistat / elvitegravir / emtricitabine / tenofovir alafenamide)
See Also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No information available. |
Do not stop taking any medications without consulting your healthcare provider.
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