Drug interactions
Cobicistat + Ifosfamide
Severity: Moderate
Cobicistat and Ifosfamide: 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
Ifosfamide is a prodrug activated mainly by CYP3A4 and CYP2B6, and the same CYP3A4 pathway also forms the neurotoxic metabolite chloroacetaldehyde. Cobicistat, a strong CYP3A4 inhibitor, may reduce activation and so lessen antitumour effect, while shifting metabolism in ways that are hard to predict. The net clinical effect on efficacy and toxicity is uncertain.
What this interaction means in plain words
Cobicistat and Ifosfamide 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; Ifosfamide belongs to Oncology.
Why it happens
Cobicistat inhibits CYP3A4-mediated bioactivation and N-dechloroethylation of ifosfamide.
What to do
Where possible, choose an antiretroviral regimen without a pharmacokinetic booster during ifosfamide courses. If coadministration is unavoidable, monitor for reduced response and for neurotoxicity and nephrotoxicity.
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 Ifosfamide
- Adenovirus types 4 and 7 live + Ifosfamide Contraindicated
- Ifosfamide + Measles mumps and rubella vaccine Contraindicated
- Ifosfamide + Measles mumps and rubella vaccine live Contraindicated
- Ifosfamide + Measles mumps rubella and varicella vaccine live Contraindicated
- Ifosfamide + Measles vaccine Contraindicated
- Ifosfamide + Rotavirus oral vaccine live 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 Ifosfamide?
MediHelp rates the interaction as moderate. Cobicistat and Ifosfamide 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. Ifosfamide is a prodrug activated mainly by CYP3A4 and CYP2B6, and the same CYP3A4 pathway also forms the neurotoxic metabolite chloroacetaldehyde. Cobicistat, a strong CYP3A4 inhibitor, may reduce activation and so lessen antitumour effect, while shifting metabolism in ways that are hard to predict. The net clinical effect on efficacy and toxicity is uncertain.
How serious is the interaction between Cobicistat and Ifosfamide?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Where possible, choose an antiretroviral regimen without a pharmacokinetic booster during ifosfamide courses. If coadministration is unavoidable, monitor for reduced response and for neurotoxicity and nephrotoxicity.
What other medicines interact with Ifosfamide?
MediHelp also lists interactions of Ifosfamide with, for example, Adenovirus types 4 and 7 live, Measles mumps and rubella vaccine, Measles mumps and rubella vaccine live. The full list is on the Ifosfamide page.
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