Drug interactions
Cobicistat + Salmeterol
Severity: Major
Cobicistat and Salmeterol: 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 inhibitor and markedly increases salmeterol exposure. This raises the risk of QT prolongation, palpitations and sinus tachycardia.
What this interaction means in plain words
Cobicistat and Salmeterol 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; Salmeterol belongs to Respiratory.
Why it happens
Strong CYP3A4 inhibition by cobicistat reduces the first-pass and systemic metabolism of salmeterol.
What to do
Avoid the combination and use an alternative long-acting bronchodilator such as formoterol. If it cannot be avoided, monitor ECG and heart rate closely.
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 Salmeterol
- Ritonavir + Salmeterol Contraindicated
- Salmeterol + Saquinavir Contraindicated
- Amitriptyline + Salmeterol Major
- Arformoterol + Salmeterol Major
- Atazanavir + Salmeterol Major
- Budesonide-formoterol + Salmeterol Major
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 Salmeterol?
MediHelp rates the interaction as major. Cobicistat and Salmeterol 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 inhibitor and markedly increases salmeterol exposure. This raises the risk of QT prolongation, palpitations and sinus tachycardia.
How serious is the interaction between Cobicistat and Salmeterol?
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 and use an alternative long-acting bronchodilator such as formoterol. If it cannot be avoided, monitor ECG and heart rate closely.
What other medicines interact with Salmeterol?
MediHelp also lists interactions of Salmeterol with, for example, Ritonavir, Saquinavir, Amitriptyline. The full list is on the Salmeterol page.
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