Drug interactions
Bosentan + Elvitegravir
Severity: Major
Bosentan and Elvitegravir: 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
Elvitegravir is given with cobicistat, a strong CYP3A inhibitor that raises bosentan exposure. Bosentan may also lower elvitegravir levels through induction, risking virologic failure.
What this interaction means in plain words
Bosentan and Elvitegravir 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
Cobicistat inhibits CYP3A4 clearance of bosentan while bosentan induces CYP3A4, reducing elvitegravir levels.
What to do
Avoid if possible; if bosentan must be used with boosted elvitegravir, follow the bosentan washout and low-dose restart schedule and monitor liver enzymes and HIV viral load.
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
Frequently asked questions
Can I take Bosentan with Elvitegravir?
MediHelp rates the interaction as major. Bosentan and Elvitegravir 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. Elvitegravir is given with cobicistat, a strong CYP3A inhibitor that raises bosentan exposure. Bosentan may also lower elvitegravir levels through induction, risking virologic failure.
How serious is the interaction between Bosentan and Elvitegravir?
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 if possible; if bosentan must be used with boosted elvitegravir, follow the bosentan washout and low-dose restart schedule and monitor liver enzymes and HIV viral load.
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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