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Drug Interactions between Clotrimazole Troche and cobicistat

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

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Moderate

clotrimazole cobicistat

Applies to: Clotrimazole Troche (clotrimazole) and cobicistat

MONITOR: Coadministration of an azole antifungal agent with cobicistat and elvitegravir may result in increased plasma concentrations of all three drugs. The mechanism may involve both competitive and noncompetitive inhibition of CYP450 3A4, since these drugs are all substrates as well as inhibitors of the isoenzyme. When ketoconazole 200 mg twice daily was given with elvitegravir 150 mg once daily plus ritonavir (100 mg/day pharmacokinetic booster dose), elvitegravir mean peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Cmin) increased by approximately 17%, 48% and 67%, respectively. The pharmacokinetics of ketoconazole were not reported. Clinically, high plasma levels of an azole antifungal agent may increase the risk of QT interval prolongation and torsade de pointes arrhythmia.

MANAGEMENT: Caution is advised if azole antifungal agents are used in combination with cobicistat and elvitegravir. Dosage adjustments may be required. According to the product information for cobicistat, the maximum daily dosage of ketoconazole or itraconazole should not exceed 200 mg/day. An assessment of benefit-to-risk ratio is recommended to justify the use of voriconazole with cobicistat and elvitegravir.

References

  1. (2012) "Product Information. Stribild (cobicistat/elvitegravir/emtricitabine/tenofov)." Gilead Sciences

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

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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