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Drug Interactions between apalutamide and atazanavir / cobicistat

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

cobicistat apalutamide

Applies to: atazanavir / cobicistat and apalutamide

Consumer information for this interaction is not currently available.

CONTRAINDICATED: Coadministration of cobicistat with a drug that is both a substrate as well as a potent inducer of CYP450 3A4 may result in significantly decreased plasma concentrations of cobicistat and significantly increased concentrations of the other drug. Cobicistat is a substrate and a potent inhibitor of CYP450 3A4. In a study of 12 healthy volunteers, coadministration of the potent CYP450 3A4 inducer carbamazepine (200 mg twice daily) with cobicistat-elvitegravir (150 mg-150 mg once a day) reduced the cobicistat systemic exposure (AUC) and peak plasma concentration (Cmax) by 84% and 72%, respectively, and the elvitegravir AUC and Cmax by 69% and 45%, respectively. In addition, the AUC and Cmax of carbamazepine increased by 43% and 40%, respectively, due to inhibition of the CYP450 3A4-mediated metabolism by cobicistat.

MANAGEMENT: Given the risk of reduced viral susceptibility and resistance development associated with subtherapeutic drug levels along with the risk of serious and/or life-threatening adverse effects associated with elevated plasma levels, the concomitant use of antiretroviral regimens containing cobicistat with potent CYP450 3A4 inducers that are also sensitive CYP450 3A4 substrates is considered contraindicated.

Moderate

atazanavir apalutamide

Applies to: atazanavir / cobicistat and apalutamide

Apalutamide may reduce the blood levels of atazanavir, which may make the medication less effective in treating HIV infection in some cases. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Contact your doctor if your condition worsens or you develop new infections during treatment with these medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Drug and food interactions

Moderate

atazanavir food

Applies to: atazanavir / cobicistat

Food can enhance the levels of atazanavir in your body. To ensure maximal oral absorption, atazanavir should be administered with or immediately after a meal. This will make it easier for your body to absorb the medication.

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor 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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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