Drug interactions
Azithromycin + Cobicistat
Severity: Moderate
Azithromycin and Cobicistat: moderate 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 CYP3A4 and P-glycoprotein inhibitor and may increase azithromycin exposure. Azithromycin is only minimally CYP3A4-metabolized, so the effect is probably modest, though higher levels could add to QT or gastrointestinal effects.
What this interaction means in plain words
Azithromycin and Cobicistat can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Azithromycin belongs to Anti Bacterial; Cobicistat belongs to Miscellaneous.
Why it happens
Cobicistat inhibits P-glycoprotein and CYP3A4, potentially increasing azithromycin absorption and exposure.
What to do
Monitor for gastrointestinal adverse effects, hearing changes, and QT prolongation, particularly when the regimen also includes atazanavir. Consider an alternative antibiotic in patients with QT risk factors.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Azithromycin
- Azithromycin + Cisapride Contraindicated
- Azithromycin + Domperidone Contraindicated
- Azithromycin + Dronedarone Contraindicated
- Azithromycin + Pimozide Contraindicated
- Azithromycin + Piperaquine Contraindicated
- Azithromycin + Thioridazine Contraindicated
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 Azithromycin with Cobicistat?
MediHelp rates the interaction as moderate. Azithromycin and Cobicistat can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Cobicistat is a strong CYP3A4 and P-glycoprotein inhibitor and may increase azithromycin exposure. Azithromycin is only minimally CYP3A4-metabolized, so the effect is probably modest, though higher levels could add to QT or gastrointestinal effects.
How serious is the interaction between Azithromycin and Cobicistat?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for gastrointestinal adverse effects, hearing changes, and QT prolongation, particularly when the regimen also includes atazanavir. Consider an alternative antibiotic in patients with QT risk factors.
What other medicines interact with Azithromycin?
MediHelp also lists interactions of Azithromycin with, for example, Cisapride, Domperidone, Dronedarone. The full list is on the Azithromycin page.
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