Drug interactions
Bosentan + Cobicistat
Severity: Major
Bosentan and Cobicistat: major interaction.
Last updated Sources: US FDA label
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 markedly raise bosentan exposure. This increases the risk of hypotension, edema and liver injury.
What this interaction means in plain words
Bosentan 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.
Bosentan belongs to Miscellaneous; Cobicistat belongs to Miscellaneous.
Why it happens
Inhibition of CYP3A4 (and likely OATP transport) by cobicistat reduces bosentan clearance.
What to do
In patients established on bosentan, stop it at least 36 hours before starting cobicistat and restart at a reduced dose of 62.5 mg once daily or every other day after about 10 days. Monitor liver enzymes and blood pressure.
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?
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References
Other interactions of Bosentan
- Bosentan + Cyclosporin Contraindicated
- Bosentan + Glibenclamide Contraindicated
- Bosentan + Glyburide-metformin Contraindicated
- Bosentan + Lonafarnib Contraindicated
- Bosentan + Sparsentan Contraindicated
- Artemether / lumefantrine + Bosentan 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 Bosentan with Cobicistat?
MediHelp rates the interaction as major. Bosentan 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 markedly raise bosentan exposure. This increases the risk of hypotension, edema and liver injury.
How serious is the interaction between Bosentan 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: In patients established on bosentan, stop it at least 36 hours before starting cobicistat and restart at a reduced dose of 62.5 mg once daily or every other day after about 10 days. Monitor liver enzymes and blood pressure.
What other medicines interact with Bosentan?
MediHelp also lists interactions of Bosentan with, for example, Cyclosporin, Glibenclamide, Glyburide-metformin. The full list is on the Bosentan page.
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