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Drug Interactions between atazanavir / cobicistat and mexiletine

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

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Interactions between your drugs

Moderate

mexiletine cobicistat

Applies to: mexiletine and atazanavir / cobicistat

MONITOR: Coadministration with cobicistat may increase the plasma concentrations of mexiletine. The proposed mechanism involves cobicistat inhibition of CYP450 2D6-mediated metabolism of mexiletine. The interaction has not been specifically studied, but could conceivably lead to serious and/or life-threatening reactions including cardiac arrhythmias and other toxicities if levels are significantly increased.

MANAGEMENT: Caution is advised if cobicistat must be used concomitantly with mexiletine. Pharmacologic response and plasma mexiletine levels should be monitored more closely whenever cobicistat is added to or withdrawn from therapy, and the mexiletine dosage adjusted as necessary.

References (3)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. (2012) "Product Information. Stribild (cobicistat/elvitegravir/emtricitabine/tenofovir)." Gilead Sciences
  3. (2018) "Product Information. Symtuza (cobicistat/darunavir/emtricitabine/tenofovir)." Janssen Pharmaceuticals

Drug and food interactions

Moderate

atazanavir food

Applies to: atazanavir / cobicistat

ADJUST DOSING INTERVAL: Administration of atazanavir with food enhances oral bioavailability and reduces pharmacokinetic variability. According to the manufacturer, administration with a light meal increased the peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of a single 400 mg dose of atazanavir by 57% and 70%, respectively, relative to the fasting state. Administration with a high-fat meal resulted in a mean increase of 35% in atazanavir AUC and no change in Cmax compared to fasting. The coefficient of variation of AUC and Cmax decreased by approximately one-half when given with either a light or high-fat meal compared to the fasting state.

MANAGEMENT: To ensure maximal oral absorption, atazanavir should be administered with or immediately after a meal.

References (1)
  1. (2003) "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb

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.

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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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