Drug Interaction Report

GENERALLY AVOID: Coadministration with moderate or weak inducers of CYP450 3A4 may reduce the plasma concentrations of cobicistat, which is primarily metabolized by the isoenzyme. The clinical significance is unknown.

MANAGEMENT: Given the risk of reduced viral susceptibility and resistance development associated with subtherapeutic antiretroviral drug levels, concomitant use of antiretroviral regimens containing cobicistat with these inducers should be avoided. Alternative treatment combinations that do not include metabolic inducers should be considered whenever possible. If concomitant use is required, close clinical and laboratory monitoring of antiretroviral response is recommended.

Administration with food may delay the absorption of modafinil (the racemate) and armodafinil (the R-enantiomer) without significantly affecting their overall bioavailability. According to the product labeling, modafinil's absorption may be delayed by approximately one hour if taken with food. Similarly, the time to reach peak plasma concentration (Tmax) of armodafinil may be delayed by approximately 2 to 4 hours in the fed state.