Drug interactions
Elvitegravir / cobicistat / emtricitabine / tenofovir df + Metformin-repaglinide
Severity: Major
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Metformin-repaglinide: 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 strongly inhibits CYP3A4, and repaglinide is metabolized by CYP2C8 and CYP3A4, so repaglinide exposure may rise and cause hypoglycemia. Cobicistat also inhibits renal transporters (MATE1) and can raise metformin concentrations, and tenofovir adds renal risk.
What this interaction means in plain words
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Metformin-repaglinide 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 MATE1/OCT2-mediated renal tubular secretion, increasing repaglinide and metformin exposure.
What to do
Monitor blood glucose closely and reduce the repaglinide dose or choose an alternative agent if hypoglycemia occurs. Monitor renal function and for metformin adverse effects, adjusting the metformin dose as needed.
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 Metformin-repaglinide
Frequently asked questions
Can I take Elvitegravir / cobicistat / emtricitabine / tenofovir df with Metformin-repaglinide?
MediHelp rates the interaction as major. Elvitegravir / cobicistat / emtricitabine / tenofovir df and Metformin-repaglinide 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 strongly inhibits CYP3A4, and repaglinide is metabolized by CYP2C8 and CYP3A4, so repaglinide exposure may rise and cause hypoglycemia. Cobicistat also inhibits renal transporters (MATE1) and can raise metformin concentrations, and tenofovir adds renal risk.
How serious is the interaction between Elvitegravir / cobicistat / emtricitabine / tenofovir df and Metformin-repaglinide?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor blood glucose closely and reduce the repaglinide dose or choose an alternative agent if hypoglycemia occurs. Monitor renal function and for metformin adverse effects, adjusting the metformin dose as needed.
What other medicines interact with Metformin-repaglinide?
MediHelp also lists interactions of Metformin-repaglinide with, for example, Gemfibrozil, Apalutamide, Clarithromycin. The full list is on the Metformin-repaglinide page.
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