Drug interactions
Cobicistat + Fluvoxamine
Severity: Moderate
Cobicistat and Fluvoxamine: moderate 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 CYP3A4 and CYP2D6 inhibitor and can raise levels of SSRI antidepressants that rely on these pathways. Fluvoxamine is cleared largely through CYP2D6 and CYP1A2, so its exposure may increase, which could heighten serotonergic and other adverse effects.
What this interaction means in plain words
Cobicistat and Fluvoxamine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Cobicistat belongs to Miscellaneous; Fluvoxamine belongs to Central Nervous System.
Why it happens
Cobicistat inhibits CYP2D6 and CYP3A4, potentially reducing fluvoxamine clearance.
What to do
Titrate fluvoxamine cautiously from the lowest feasible dose and monitor for adverse effects such as nausea, sedation and serotonergic symptoms.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Fluvoxamine
- Agomelatine + Fluvoxamine Contraindicated
- Alosetron + Fluvoxamine Contraindicated
- Fezolinetant + Fluvoxamine Contraindicated
- Fluvoxamine + Isocarboxazid Contraindicated
- Fluvoxamine + Mavacamten Contraindicated
- Fluvoxamine + Methylene blue 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 Fluvoxamine?
MediHelp rates the interaction as moderate. Cobicistat and Fluvoxamine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Cobicistat is a strong CYP3A4 and CYP2D6 inhibitor and can raise levels of SSRI antidepressants that rely on these pathways. Fluvoxamine is cleared largely through CYP2D6 and CYP1A2, so its exposure may increase, which could heighten serotonergic and other adverse effects.
How serious is the interaction between Cobicistat and Fluvoxamine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Titrate fluvoxamine cautiously from the lowest feasible dose and monitor for adverse effects such as nausea, sedation and serotonergic symptoms.
What other medicines interact with Fluvoxamine?
MediHelp also lists interactions of Fluvoxamine with, for example, Agomelatine, Alosetron, Fezolinetant. The full list is on the Fluvoxamine page.
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