2016
DOI: 10.1002/phar.1752
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Cobicistat Significantly Increases Tacrolimus Serum Concentrations in a Renal Transplant Recipient with Human Immunodeficiency Virus Infection

Abstract: Cobicistat is a pharmacokinetic booster in several fixed-dose combination products for treatment of human immunodeficiency virus (HIV) infection. As a potent inhibitor of cytochrome P450 (CYP) 3A enzymes, significant drug-drug interactions are expected between cobicistat and medications that are metabolized primarily through the CYP3A pathway, including calcineurin inhibitors (e.g., tacrolimus and cyclosporine). We describe a case of tacrolimus toxicity due to supratherapeutic tacrolimus concentrations when St… Show more

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Cited by 23 publications
(15 citation statements)
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“…34 Several cases of significantly elevated tacrolimus concentrations and toxicity have been reported in HIV-infected renal transplant patients following coadministration of elvitegravir/cobicistat and tacrolimus. 3537 Extensive bruising and elevated rivaroxaban concentrations were observed in a patient on elvitegravir/cobicistat, 38 while severe acute leg ischemia occurred following ingestion of an ergotamine-containing preparation by a patient on elvitegravir/cobicistat. 39 Of note, while ergot alkaloids, fluticasone and tacrolimus are mentioned in the product monographs for elvitegravir/cobicistat, vinblastine and rivaroxaban are not.…”
Section: Drug Interaction Studies (Non-antiretrovirals): Cobicistat Vmentioning
confidence: 99%
“…34 Several cases of significantly elevated tacrolimus concentrations and toxicity have been reported in HIV-infected renal transplant patients following coadministration of elvitegravir/cobicistat and tacrolimus. 3537 Extensive bruising and elevated rivaroxaban concentrations were observed in a patient on elvitegravir/cobicistat, 38 while severe acute leg ischemia occurred following ingestion of an ergotamine-containing preparation by a patient on elvitegravir/cobicistat. 39 Of note, while ergot alkaloids, fluticasone and tacrolimus are mentioned in the product monographs for elvitegravir/cobicistat, vinblastine and rivaroxaban are not.…”
Section: Drug Interaction Studies (Non-antiretrovirals): Cobicistat Vmentioning
confidence: 99%
“…Thus, concurrent use of PIs and CNIs in HIV‐positive KT recipients requires close monitoring and dose titration, and is best avoided if possible . The newer pharmaco‐enhancer cobicistat, which is used as an alternative boosting agent for several PIs, appears to have a similar effect on CNI exposure, although there is less experience with this combination …”
Section: Antiretroviral Therapymentioning
confidence: 99%
“…Patients 6 and 10 experienced increased serum creatinine concentrations (from 1.3 to 1.8 mg/dL and from minimal dependence on CYP3A-mediated metabolism, high potency and high genetic barrier [3,4]. However, data on the use of dolutegravir in real-life transplant settings are limited and exclusively involve kidney transplant recipients [5][6][7][8][9]. Here, we sought to describe the use of dolutegravir-based maintenance ART in HIV-positive liver transplant patients regularly followed in our hospital.…”
Section: Resultsmentioning
confidence: 99%