Drug interactions
Cobicistat + Lorlatinib
Severity: Major
Cobicistat and Lorlatinib: 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 CYP3A inhibitor and raises lorlatinib concentrations, increasing the risk of hyperlipidemia, CNS effects and hepatotoxicity. Lorlatinib, a CYP3A inducer, may in turn lower cobicistat exposure and weaken its boosting effect on the partner antiretrovirals.
What this interaction means in plain words
Cobicistat and Lorlatinib 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; Lorlatinib belongs to Oncology.
Why it happens
Cobicistat inhibits CYP3A4 and reduces lorlatinib clearance, while lorlatinib induces CYP3A and may reduce cobicistat levels.
What to do
Avoid the combination. If unavoidable, reduce the lorlatinib dose per labeling for strong CYP3A inhibitors and monitor lipids, liver tests, and HIV virologic response.
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 Lorlatinib
- Amobarbital + Lorlatinib Contraindicated
- Apalutamide + Lorlatinib Contraindicated
- Butabarbital + Lorlatinib Contraindicated
- Carbamazepine + Lorlatinib Contraindicated
- Enzalutamide + Lorlatinib Contraindicated
- Fosphenytoin + Lorlatinib 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 Lorlatinib?
MediHelp rates the interaction as major. Cobicistat and Lorlatinib 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 CYP3A inhibitor and raises lorlatinib concentrations, increasing the risk of hyperlipidemia, CNS effects and hepatotoxicity. Lorlatinib, a CYP3A inducer, may in turn lower cobicistat exposure and weaken its boosting effect on the partner antiretrovirals.
How serious is the interaction between Cobicistat and Lorlatinib?
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 the combination. If unavoidable, reduce the lorlatinib dose per labeling for strong CYP3A inhibitors and monitor lipids, liver tests, and HIV virologic response.
What other medicines interact with Lorlatinib?
MediHelp also lists interactions of Lorlatinib with, for example, Amobarbital, Apalutamide, Butabarbital. The full list is on the Lorlatinib page.
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