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Drug Interactions between cobicistat and voriconazole

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

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Interactions between your drugs

Moderate

voriconazole cobicistat

Applies to: voriconazole 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)
  1. (2012) "Product Information. Stribild (cobicistat/elvitegravir/emtricitabine/tenofovir)." Gilead Sciences

Drug and food interactions

Moderate

voriconazole food

Applies to: voriconazole

ADJUST DOSING INTERVAL: Food reduces the oral absorption and bioavailability of voriconazole. According to the product labeling, administration of multiple doses of voriconazole with high-fat meals decreased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) by 34% and 24%, respectively, when the drug is administered as a tablet, and by 58% and 37%, respectively, when administered as the oral suspension.

MANAGEMENT: To ensure maximal oral absorption, voriconazole tablets and oral suspension should be taken at least one hour before or after a meal.

References (2)
  1. (2002) "Product Information. VFEND (voriconazole)." Pfizer U.S. Pharmaceuticals
  2. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67

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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