Drug interactions
Cobicistat + Fluticasone-vilanterol
Severity: Major
Cobicistat and Fluticasone-vilanterol: 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 increases systemic exposure to inhaled fluticasone furoate and vilanterol. This can lead to adrenal suppression and Cushing's syndrome from the steroid and to tachycardia, tremor and hypokalemia from the beta-agonist.
What this interaction means in plain words
Cobicistat and Fluticasone-vilanterol 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; Fluticasone-vilanterol belongs to Respiratory.
Why it happens
Strong CYP3A inhibition (and P-gp effects) reducing clearance of fluticasone furoate and vilanterol.
What to do
Avoid concurrent use; choose an alternative inhaled corticosteroid less dependent on CYP3A such as beclomethasone. If unavoidable, monitor for cardiovascular 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 Fluticasone-vilanterol
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 Fluticasone-vilanterol?
MediHelp rates the interaction as major. Cobicistat and Fluticasone-vilanterol 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 increases systemic exposure to inhaled fluticasone furoate and vilanterol. This can lead to adrenal suppression and Cushing's syndrome from the steroid and to tachycardia, tremor and hypokalemia from the beta-agonist.
How serious is the interaction between Cobicistat and Fluticasone-vilanterol?
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 concurrent use; choose an alternative inhaled corticosteroid less dependent on CYP3A such as beclomethasone. If unavoidable, monitor for cardiovascular and corticosteroid adverse effects.
What other medicines interact with Fluticasone-vilanterol?
MediHelp also lists interactions of Fluticasone-vilanterol with, for example, Adagrasib, Amiodarone, Amisulpride. The full list is on the Fluticasone-vilanterol page.
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