Drug Interaction Report

MONITOR: Orlistat may theoretically reduce the gastrointestinal absorption and therapeutic efficacy of antiretroviral agents. The mechanism may involve retention of lipophilic medicines in the gastrointestinal tract or reduced gastrointestinal tract transit time. Data have been reported for efavirenz and lopinavir. Other antiretroviral agents may also be affected.

MANAGEMENT: The potential reduction in antiretroviral efficacy should be considered before initiating treatment with orlistat. Patients who take antiretroviral medications should be advised to consult their physician before using the non-prescription brand of orlistat.

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.