Drug interactions
Aprepitant + Cobicistat
Severity: Major
Aprepitant and Cobicistat: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Cobicistat is a strong CYP3A inhibitor and can substantially increase aprepitant exposure. This may worsen aprepitant adverse effects. Aprepitant in turn may modestly raise levels of other CYP3A substrates in the regimen.
What this interaction means in plain words
Aprepitant and Cobicistat can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Aprepitant belongs to Gastrointestinal Tract; Cobicistat belongs to Miscellaneous.
Why it happens
Cobicistat strongly inhibits CYP3A4, the main enzyme clearing aprepitant.
What to do
Avoid the combination where possible, or use the single-dose aprepitant regimen with monitoring for adverse effects. Consider an alternative antiemetic such as a 5-HT3 antagonist with dexamethasone adjusted for CYP3A inhibition.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Aprepitant and Cobicistat, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 14 days on the web. No card needed.
Other interactions of Aprepitant
- Aprepitant + Lomitapide Contraindicated
- Aprepitant + Pimozide Contraindicated
- Aprepitant + Avapritinib Major
- Aprepitant + Bosutinib Major
- Aprepitant + Carbamazepine Major
- Aprepitant + Cobimetinib Major
Other interactions of Cobicistat
- Alfuzosin + Cobicistat Contraindicated
- Apalutamide + Cobicistat Contraindicated
- Cobicistat + Colchicine Contraindicated
- Cobicistat + Dronedarone Contraindicated
- Cobicistat + Eletriptan Contraindicated
- Cobicistat + Eplerenone Contraindicated
Frequently asked questions
Can I take Aprepitant with Cobicistat?
MediHelp rates the interaction as major. Aprepitant and Cobicistat can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Cobicistat is a strong CYP3A inhibitor and can substantially increase aprepitant exposure. This may worsen aprepitant adverse effects. Aprepitant in turn may modestly raise levels of other CYP3A substrates in the regimen.
How serious is the interaction between Aprepitant and Cobicistat?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible, or use the single-dose aprepitant regimen with monitoring for adverse effects. Consider an alternative antiemetic such as a 5-HT3 antagonist with dexamethasone adjusted for CYP3A inhibition.
What other medicines interact with Aprepitant?
MediHelp also lists interactions of Aprepitant with, for example, Lomitapide, Pimozide, Avapritinib. The full list is on the Aprepitant page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
