Drug interactions
Clomipramine + Cobicistat
Severity: Major
Clomipramine and Cobicistat: 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 is a strong CYP3A inhibitor and also inhibits CYP2D6, both of which participate in clomipramine metabolism. Higher tricyclic concentrations can cause anticholinergic effects, sedation, seizures and cardiac conduction abnormalities.
What this interaction means in plain words
Clomipramine 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.
Clomipramine belongs to Central Nervous System; Cobicistat belongs to Miscellaneous.
Why it happens
Inhibition of CYP2D6 and CYP3A-mediated clomipramine metabolism by cobicistat.
What to do
Start clomipramine at the lowest dose and titrate slowly, monitoring clinical response and tolerability. Obtain an ECG and consider plasma level monitoring if higher doses are needed.
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 Clomipramine
- Arsenic trioxide + Clomipramine Contraindicated
- Clomipramine + Dofetilide Contraindicated
- Clomipramine + Droperidol Contraindicated
- Clomipramine + Isocarboxazid Contraindicated
- Clomipramine + Methylene blue Contraindicated
- Clomipramine + Pentamidine Contraindicated
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 Clomipramine with Cobicistat?
MediHelp rates the interaction as major. Clomipramine 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 also inhibits CYP2D6, both of which participate in clomipramine metabolism. Higher tricyclic concentrations can cause anticholinergic effects, sedation, seizures and cardiac conduction abnormalities.
How serious is the interaction between Clomipramine 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: Start clomipramine at the lowest dose and titrate slowly, monitoring clinical response and tolerability. Obtain an ECG and consider plasma level monitoring if higher doses are needed.
What other medicines interact with Clomipramine?
MediHelp also lists interactions of Clomipramine with, for example, Arsenic trioxide, Dofetilide, Droperidol. The full list is on the Clomipramine page.
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