Indications
Cobicistat is a pharmacokinetic enhancer (booster) used in HIV-1 treatment. It has no activity against HIV itself; it is combined with certain HIV medicines, mainly Darunavir or Atazanavir (and in some combinations Elvitegravir), to raise and prolong their levels in the blood so they work better with once-daily dosing. It is always part of combination antiretroviral therapy.
How It Works
Cobicistat blocks CYP3A, a liver and gut enzyme that breaks down many medicines. By slowing the breakdown of the HIV medicine it is paired with, it keeps that medicine at effective levels for longer, so fewer doses are needed and the virus is better controlled.
Dosage and Administration
Take exactly as prescribed by your HIV specialist. It is usually taken as 150 mg once a day, at the same time as the HIV medicine it boosts (often in one combined tablet), with food. Do not stop or skip doses, as this can allow HIV to become resistant.
Interactions
Because it blocks CYP3A, Cobicistat interacts with many medicines. It must not be taken with Rifampicin, St John’s Wort, Simvastatin, Lovastatin, Amiodarone, Dronedarone, Quinidine, Ergotamine, oral Midazolam, Triazolam, Pimozide, Lurasidone, Alfuzosin, Ranolazine, Colchicine in kidney or liver impairment, Sildenafil for lung blood pressure, Carbamazepine, Phenytoin or Phenobarbital. It raises levels of inhaled or injected steroids such as Fluticasone, some statins, blood thinners, erectile dysfunction medicines and some heart medicines. It is not used together with Ritonavir. Always check every new medicine with your doctor or pharmacist.
Contraindications
Do not take if you are allergic to Cobicistat, or with any of the medicines that must not be combined with it.
Side Effects
Common side effects include nausea, diarrhoea, headache, rash and tiredness. It can raise blood creatinine (a kidney test) slightly without truly harming the kidneys, but kidney problems can occur, especially with Tenofovir disoproxil.
Get urgent medical help if you have a severe or blistering rash, swelling of the face or throat, difficulty breathing, yellowing of the skin or eyes, or signs of kidney problems such as much less urine or swelling of the legs.
Pregnancy and Lactation
Cobicistat-boosted regimens are not recommended during pregnancy because levels of the boosted medicines fall too low in the second and third trimesters; your doctor will choose a suitable regimen. Breastfeeding advice for mothers living with HIV depends on local guidance; discuss with your HIV doctor.
Precautions and Warnings
Kidney function is checked before and during treatment. Tell your doctor about kidney or liver disease. When the immune system recovers, hidden infections can flare up; report new symptoms. Use condoms, as HIV can still be passed on if the virus is not suppressed.
Overdose
There is limited experience with overdose. Seek medical help; treatment is supportive.
Therapeutic Class
Pharmacokinetic enhancer (CYP3A inhibitor) used with antiretrovirals.
Storage
Store below 30°C in a dry place, away from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.