Drug interactions
Elvitegravir / cobicistat / emtricitabine / tenofovir df + Irinotecan
Severity: Major
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Irinotecan: major 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 inhibits CYP3A4 and can raise exposure to irinotecan and its active metabolite SN-38, increasing the risk of severe neutropenia and diarrhea. The combination is not an absolute labeled contraindication but carries substantial toxicity risk.
What this interaction means in plain words
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Irinotecan 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.
Why it happens
Cobicistat inhibits CYP3A4 (and possibly transporters such as P-gp and UGT1A1 pathways), reducing irinotecan clearance.
What to do
Avoid if possible by using a non-boosted antiretroviral regimen during irinotecan therapy. If unavoidable, monitor blood counts and diarrhea closely and consider irinotecan dose reduction.
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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Other interactions of Irinotecan
- Clozapine + Irinotecan Contraindicated
- Irinotecan + Sacituzumab govitecan Contraindicated
- Adenovirus types 4 and 7 live + Irinotecan Major
- Apalutamide + Irinotecan Major
- Atazanavir + Irinotecan Major
- Carbamazepine + Irinotecan Major
Frequently asked questions
Can I take Elvitegravir / cobicistat / emtricitabine / tenofovir df with Irinotecan?
MediHelp rates the interaction as major. Elvitegravir / cobicistat / emtricitabine / tenofovir df and Irinotecan 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 inhibits CYP3A4 and can raise exposure to irinotecan and its active metabolite SN-38, increasing the risk of severe neutropenia and diarrhea. The combination is not an absolute labeled contraindication but carries substantial toxicity risk.
How serious is the interaction between Elvitegravir / cobicistat / emtricitabine / tenofovir df and Irinotecan?
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 if possible by using a non-boosted antiretroviral regimen during irinotecan therapy. If unavoidable, monitor blood counts and diarrhea closely and consider irinotecan dose reduction.
What other medicines interact with Irinotecan?
MediHelp also lists interactions of Irinotecan with, for example, Clozapine, Sacituzumab govitecan, Adenovirus types 4 and 7 live. The full list is on the Irinotecan page.
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