Drug interactions
Elvitegravir / cobicistat / emtricitabine / tenofovir df + Itraconazole
Severity: Major
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Itraconazole: 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 is a strong CYP3A4 inhibitor and itraconazole is a CYP3A4 substrate and inhibitor, so itraconazole levels may rise. Itraconazole can in turn increase cobicistat and elvitegravir exposure, raising the risk of adverse effects.
What this interaction means in plain words
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Itraconazole 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
Mutual CYP3A4 inhibition (and P-gp) between itraconazole and cobicistat increases exposure to both.
What to do
Limit itraconazole to a low daily dose per labeling and monitor for itraconazole toxicity such as heart failure and liver injury. Consider itraconazole levels or an alternative antifungal.
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 Itraconazole
- Alfuzosin + Itraconazole Contraindicated
- Alprazolam + Itraconazole Contraindicated
- Avanafil + Itraconazole Contraindicated
- Conivaptan + Itraconazole Contraindicated
- Dihydroergotamine intranasal + Itraconazole Contraindicated
- Dihydroergotamine + Itraconazole Contraindicated
Frequently asked questions
Can I take Elvitegravir / cobicistat / emtricitabine / tenofovir df with Itraconazole?
MediHelp rates the interaction as major. Elvitegravir / cobicistat / emtricitabine / tenofovir df and Itraconazole 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 itraconazole is a CYP3A4 substrate and inhibitor, so itraconazole levels may rise. Itraconazole can in turn increase cobicistat and elvitegravir exposure, raising the risk of adverse effects.
How serious is the interaction between Elvitegravir / cobicistat / emtricitabine / tenofovir df and Itraconazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Limit itraconazole to a low daily dose per labeling and monitor for itraconazole toxicity such as heart failure and liver injury. Consider itraconazole levels or an alternative antifungal.
What other medicines interact with Itraconazole?
MediHelp also lists interactions of Itraconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Itraconazole page.
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