Drug interactions
Brexpiprazole + Cobicistat
Severity: Major
Brexpiprazole 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 CYP3A4 inhibitor and also inhibits CYP2D6, so it blocks both main elimination pathways of brexpiprazole. Exposure can rise substantially, with more akathisia, sedation and hypotension.
What this interaction means in plain words
Brexpiprazole 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.
Brexpiprazole belongs to Central Nervous System; Cobicistat belongs to Miscellaneous.
Why it happens
Cobicistat inhibits CYP3A4 and CYP2D6, reducing brexpiprazole metabolism.
What to do
Reduce the brexpiprazole dose to half, or to a quarter given the dual-pathway inhibition. Monitor for adverse effects.
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 Brexpiprazole
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 Brexpiprazole with Cobicistat?
MediHelp rates the interaction as major. Brexpiprazole 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 CYP3A4 inhibitor and also inhibits CYP2D6, so it blocks both main elimination pathways of brexpiprazole. Exposure can rise substantially, with more akathisia, sedation and hypotension.
How serious is the interaction between Brexpiprazole 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: Reduce the brexpiprazole dose to half, or to a quarter given the dual-pathway inhibition. Monitor for adverse effects.
What other medicines interact with Brexpiprazole?
MediHelp also lists interactions of Brexpiprazole with, for example, Alfentanil, Amisulpride, Apalutamide. The full list is on the Brexpiprazole page.
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