Drug interactions
Cobicistat + Imipramine
Severity: Major
Cobicistat and Imipramine: 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 strong CYP3A4 and CYP2D6 inhibitor that can substantially raise tricyclic concentrations. This may increase the risk of anticholinergic effects, sedation, hypotension and arrhythmias.
What this interaction means in plain words
Cobicistat and Imipramine 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; Imipramine belongs to Central Nervous System.
Why it happens
Cobicistat inhibits CYP2D6 and CYP3A4, reducing imipramine and desipramine metabolism.
What to do
Start imipramine at the lowest dose and titrate slowly to response. Monitor for TCA toxicity, check an ECG and consider serum drug levels.
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 Imipramine
- Dronedarone + Imipramine Contraindicated
- Imipramine + Isocarboxazid Contraindicated
- Imipramine + Phenelzine Contraindicated
- Imipramine + Pimozide Contraindicated
- Imipramine + Rasagiline Contraindicated
- Imipramine + Safinamide 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 Imipramine?
MediHelp rates the interaction as major. Cobicistat and Imipramine 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 strong CYP3A4 and CYP2D6 inhibitor that can substantially raise tricyclic concentrations. This may increase the risk of anticholinergic effects, sedation, hypotension and arrhythmias.
How serious is the interaction between Cobicistat and Imipramine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Start imipramine at the lowest dose and titrate slowly to response. Monitor for TCA toxicity, check an ECG and consider serum drug levels.
What other medicines interact with Imipramine?
MediHelp also lists interactions of Imipramine with, for example, Dronedarone, Isocarboxazid, Phenelzine. The full list is on the Imipramine page.
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