Drug interactions
Cobicistat + Cyclosporin
Severity: Major
Cobicistat and Cyclosporin: 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 potent CYP3A inhibitor and also inhibits P-gp, which can substantially increase cyclosporine concentrations. This raises the risk of nephrotoxicity, hypertension and neurotoxicity.
What this interaction means in plain words
Cobicistat and Cyclosporin 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 belongs to Miscellaneous; Cyclosporin belongs to Miscellaneous.
Why it happens
Inhibition of CYP3A4 and P-glycoprotein by cobicistat reduces cyclosporine clearance.
What to do
Reduce the cyclosporine dose when starting cobicistat and monitor trough levels and renal function closely. Readjust when cobicistat is stopped.
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 Cyclosporin
- Adenovirus types 4 and 7 live + Cyclosporin Contraindicated
- Aliskiren + Cyclosporin Contraindicated
- Bcg vaccine live + Cyclosporin Contraindicated
- Bosentan + Cyclosporin Contraindicated
- Cidofovir + Cyclosporin Contraindicated
- Cyclosporin + Dengue vaccine 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 Cobicistat with Cyclosporin?
MediHelp rates the interaction as major. Cobicistat and Cyclosporin 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 potent CYP3A inhibitor and also inhibits P-gp, which can substantially increase cyclosporine concentrations. This raises the risk of nephrotoxicity, hypertension and neurotoxicity.
How serious is the interaction between Cobicistat and Cyclosporin?
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 cyclosporine dose when starting cobicistat and monitor trough levels and renal function closely. Readjust when cobicistat is stopped.
What other medicines interact with Cyclosporin?
MediHelp also lists interactions of Cyclosporin with, for example, Adenovirus types 4 and 7 live, Aliskiren, Bcg vaccine live. The full list is on the Cyclosporin page.
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