Drug interactions
Cobicistat + Dexamethasone
Severity: Major
Cobicistat and Dexamethasone: 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 inhibits CYP3A and can raise dexamethasone exposure, increasing risk of systemic corticosteroid effects such as adrenal suppression and Cushing syndrome. Dexamethasone may in turn induce CYP3A4 and lower cobicistat and boosted antiretroviral levels, risking virologic failure.
What this interaction means in plain words
Cobicistat and Dexamethasone 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; Dexamethasone belongs to Endocrine.
Why it happens
Cobicistat inhibits CYP3A4 metabolism of dexamethasone while dexamethasone induces CYP3A4, lowering cobicistat and the boosted drug.
What to do
Avoid long-term systemic dexamethasone with cobicistat-boosted regimens; consider an alternative such as beclomethasone or prednisolone. If short-term use is needed, monitor HIV viral load and corticosteroid 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 Dexamethasone
- Bcg vaccine live + Dexamethasone Contraindicated
- Dexamethasone + Mifepristone Contraindicated
- Dexamethasone + Rilpivirine Contraindicated
- Dexamethasone + Smallpox vaccine live Contraindicated
- Dexamethasone + Varicella virus vaccine live Contraindicated
- Dexamethasone + Yellow fever 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 Dexamethasone?
MediHelp rates the interaction as major. Cobicistat and Dexamethasone 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 inhibits CYP3A and can raise dexamethasone exposure, increasing risk of systemic corticosteroid effects such as adrenal suppression and Cushing syndrome. Dexamethasone may in turn induce CYP3A4 and lower cobicistat and boosted antiretroviral levels, risking virologic failure.
How serious is the interaction between Cobicistat and Dexamethasone?
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 long-term systemic dexamethasone with cobicistat-boosted regimens; consider an alternative such as beclomethasone or prednisolone. If short-term use is needed, monitor HIV viral load and corticosteroid adverse effects.
What other medicines interact with Dexamethasone?
MediHelp also lists interactions of Dexamethasone with, for example, Bcg vaccine live, Mifepristone, Rilpivirine. The full list is on the Dexamethasone page.
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