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Drug Interactions between elvitegravir and Mycobutin

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

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Interactions between your drugs

Major

rifabutin elvitegravir

Applies to: Mycobutin (rifabutin) and elvitegravir

GENERALLY AVOID: Coadministration with rifabutin may significantly decrease the plasma concentrations of elvitegravir. The mechanism involves rifabutin induction of CYP450 3A4, the isoenzyme primarily responsible for the metabolic clearance of elvitegravir. When rifabutin 150 mg once every other day was given with elvitegravir 150 mg plus cobicistat 150 mg once a day to 12 study subjects, elvitegravir mean peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Cmin) decreased by approximately 9%, 21% and 67%, respectively. At the same time, the mean Cmax, AUC and Cmin of 25-O-desacetylrifabutin, the active metabolite of rifabutin, increased by 4.84-, 6.25- and 4.94-fold, respectively, compared to administration of rifabutin 300 mg once daily. High plasma levels of 25-O-desacetylrifabutin is associated with toxicities including leucopenia, uveitis, arthralgias, and skin discoloration.

MANAGEMENT: Given the risk of reduced viral susceptibility and resistance development associated with subtherapeutic drug levels, concomitant use of elvitegravir with rifabutin should generally be avoided.

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

Drug and food interactions

Moderate

elvitegravir food

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/tenofov)." Gilead Sciences
  2. (2014) "Product Information. Vitekta (elvitegravir)." Gilead Sciences

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

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