Drug interactions
Elvitegravir / cobicistat / emtricitabine / tenofovir df + Isosorbide dinitrate
Severity: Moderate
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Isosorbide dinitrate: 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
Cobicistat inhibits CYP3A4 and can raise nitrate exposure, which may amplify vasodilation and hypotension. Isosorbide dinitrate is not highly dependent on CYP3A4 for clearance, and the clinical effect is generally modest and manageable rather than a true contraindication.
What this interaction means in plain words
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Isosorbide dinitrate 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.
Why it happens
Cobicistat inhibits CYP3A4 and may modestly reduce nitrate metabolism, adding to pharmacodynamic vasodilation.
What to do
Monitor blood pressure and symptoms of hypotension such as dizziness when starting or stopping the combination. Reduce the nitrate dose if hypotension occurs.
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 Isosorbide dinitrate
- Avanafil + Isosorbide dinitrate Contraindicated
- Isosorbide dinitrate + Riociguat Contraindicated
- Isosorbide dinitrate + Sildenafil Contraindicated
- Isosorbide dinitrate + Tadalafil Contraindicated
- Isosorbide dinitrate + Vardenafil Contraindicated
- Ergotamine + Isosorbide dinitrate Major
Frequently asked questions
Can I take Elvitegravir / cobicistat / emtricitabine / tenofovir df with Isosorbide dinitrate?
MediHelp rates the interaction as moderate. Elvitegravir / cobicistat / emtricitabine / tenofovir df and Isosorbide dinitrate 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 inhibits CYP3A4 and can raise nitrate exposure, which may amplify vasodilation and hypotension. Isosorbide dinitrate is not highly dependent on CYP3A4 for clearance, and the clinical effect is generally modest and manageable rather than a true contraindication.
How serious is the interaction between Elvitegravir / cobicistat / emtricitabine / tenofovir df and Isosorbide dinitrate?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor blood pressure and symptoms of hypotension such as dizziness when starting or stopping the combination. Reduce the nitrate dose if hypotension occurs.
What other medicines interact with Isosorbide dinitrate?
MediHelp also lists interactions of Isosorbide dinitrate with, for example, Avanafil, Riociguat, Sildenafil. The full list is on the Isosorbide dinitrate page.
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