Drug interactions
Bosentan + Elvitegravir / cobicistat / emtricitabine / tenofovir df
Severity: Major
Bosentan and Elvitegravir / cobicistat / emtricitabine / tenofovir df: 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 inhibits CYP3A4 and can raise bosentan levels, while bosentan induction may lower elvitegravir and cobicistat exposure. The net effects raise both bosentan toxicity (including hepatotoxicity) and risk of virologic failure.
What this interaction means in plain words
Bosentan and Elvitegravir / cobicistat / emtricitabine / tenofovir df 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.
Why it happens
Opposing CYP3A4 effects: cobicistat inhibition of bosentan metabolism and bosentan induction of elvitegravir and cobicistat metabolism.
What to do
Avoid starting bosentan in patients on cobicistat unless benefits outweigh risks; if used, monitor liver enzymes, blood pressure and HIV viral load closely, and consider an alternative regimen.
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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Other interactions of Bosentan
- Bosentan + Cyclosporin Contraindicated
- Bosentan + Glibenclamide Contraindicated
- Bosentan + Glyburide-metformin Contraindicated
- Bosentan + Lonafarnib Contraindicated
- Bosentan + Sparsentan Contraindicated
- Artemether / lumefantrine + Bosentan Major
Frequently asked questions
Can I take Bosentan with Elvitegravir / cobicistat / emtricitabine / tenofovir df?
MediHelp rates the interaction as major. Bosentan and Elvitegravir / cobicistat / emtricitabine / tenofovir df 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 inhibits CYP3A4 and can raise bosentan levels, while bosentan induction may lower elvitegravir and cobicistat exposure. The net effects raise both bosentan toxicity (including hepatotoxicity) and risk of virologic failure.
How serious is the interaction between Bosentan and Elvitegravir / cobicistat / emtricitabine / tenofovir df?
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 starting bosentan in patients on cobicistat unless benefits outweigh risks; if used, monitor liver enzymes, blood pressure and HIV viral load closely, and consider an alternative regimen.
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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