Drug interactions
Brexpiprazole + Elvitegravir / cobicistat / emtricitabine / tenofovir df
Severity: Major
Brexpiprazole and Elvitegravir / cobicistat / emtricitabine / tenofovir df: 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
The cobicistat component strongly inhibits CYP3A4 and also inhibits CYP2D6, raising brexpiprazole exposure. Adverse effects such as akathisia, sedation and hypotension may increase.
What this interaction means in plain words
Brexpiprazole 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
Cobicistat inhibits CYP3A4 and CYP2D6, reducing brexpiprazole metabolism.
What to do
Reduce the brexpiprazole dose to half, or to a quarter if a CYP2D6 inhibitor is also used. 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
Frequently asked questions
Can I take Brexpiprazole with Elvitegravir / cobicistat / emtricitabine / tenofovir df?
MediHelp rates the interaction as major. Brexpiprazole 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. The cobicistat component strongly inhibits CYP3A4 and also inhibits CYP2D6, raising brexpiprazole exposure. Adverse effects such as akathisia, sedation and hypotension may increase.
How serious is the interaction between Brexpiprazole 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: Reduce the brexpiprazole dose to half, or to a quarter if a CYP2D6 inhibitor is also used. 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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