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Interactions between Certavite and Elvitegravir

1 drug interaction and 3 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

multivitamins with minerals elvitegravir

Applies to: Certavite (multivitamin with minerals) and elvitegravir
Adjust dosing interval

The concomitant use of antacids or oral products containing polyvalent cations (e.g., Mg, Al, Ca, Fe, Zn) may significantly decrease the plasma concentrations of elvitegravir. According to the elvitegravir manufacturer, the mechanism of the interaction may be related to local complexation in the gastrointestinal tract and not to changes in gastric pH. When 20 mL of an antacid containing magnesium and aluminum was given 2 hours before a 50 mg dose of elvitegravir with ritonavir (100 mg pharmacokinetic booster dose) to 11 study subjects, mean elvitegravir peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Cmin) were reduced by 18%, 15%, and 10%, respectively. When the antacid was given 2 hours after elvitegravir to 10 study subjects, the mean elvitegravir Cmax, AUC, and Cmin decreased by approximately 20% each. When the antacid was given simultaneously with elvitegravir to 13 study subjects, the mean elvitegravir Cmax, AUC, and Cmin decreased by approximately 47%, 45%, and 41%, respectively. In contrast, when the antacid was given 4 hours before or 4 hours after elvitegravir, no significant differences were observed in elvitegravir pharmacokinetics compared to the administration of elvitegravir alone. The interaction has not been studied with other polyvalent cation-containing products, but they are expected to decrease elvitegravir plasma concentrations as well.

Management

Antacid and oral products containing polyvalent cations should be administered at least 2 hours before or 2 hours after the elvitegravir dose. Some experts recommend an interval of at least 4 hours. Alternatively, H2-receptor antagonists or proton pump inhibitors may be considered instead of antacids, with no dosage adjustment needed.

References (4)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Cerner Multum, Inc. "Australian Product Information."
  3. (2012) "Product Information. Stribild (cobicistat/elvitegravir/emtricitabine/tenofovir)." Gilead Sciences
  4. (2015) "Product Information. Genvoya (cobicistat/elvitegravir/emtricitabine/tenofovir)." Gilead Sciences

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

elvitegravir Food/Lifestyle

Applies to: elvitegravir
Adjust dosing interval

Food enhances the oral bioavailabilities of both elvitegravir and tenofovir. When a single dose of cobicistat/elvitegravir/emtricitabine/tenofovir (trade name Stribild) was given with a light meal (approximately 373 kcal; 20% fat), mean elvitegravir and tenofovir systemic exposures (AUCs) increased by 34% and 24%, respectively, relative to fasting conditions. When administered with a high-fat meal (approximately 800 kcal; 50% fat), the mean AUC of elvitegravir and tenofovir increased by 87% and 23%, respectively, relative to fasting conditions. The alterations in mean AUCs of cobicistat and emtricitabine were not clinically significant with either the light or high-fat meal.

Management

Cobicistat/elvitegravir/emtricitabine/tenofovir as a fixed-dose preparation should be administered once daily with food. Elvitegravir as a single-ingredient preparation should also be administered once daily with food.

References (2)
  1. (2012) "Product Information. Stribild (cobicistat/elvitegravir/emtricitabine/tenofovir)." Gilead Sciences
  2. (2014) "Product Information. Vitekta (elvitegravir)." Gilead Sciences

Disease interactions

2 potential interactions Applies to: 2 conditions, including Liver Disease and Renal Dysfunction.

Liver Disease

Major:

elvitegravir

Elvitegravir has a major potential interaction with Liver Disease.

The use of elvitegravir is not recommended for use in patients with severe hepatic impairment (Child-Pugh Class C). No dosage adjustment is required in patients with mild (Child-Pugh Class A) or moderate (Child-Pugh Class B) hepatic impairment.

Renal Dysfunction

Major:

elvitegravir

Elvitegravir has a major potential interaction with Renal Dysfunction.

The use of elvitegravir is not recommended in patients with severe renal impairment (estimated creatinine clearance below 30 mL per minute). No dosage adjustment is recommended in patients with estimated creatinine clearance greater than or equal to 30 mL per minute.

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More resources

Certavite

A total of 112 drugs are known to interact with Certavite.

elvitegravir

A total of 99 drugs are known to interact with elvitegravir.

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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