Drug interactions
Elvitegravir / cobicistat / emtricitabine / tenofovir df + Mexiletine
Severity: Major
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Mexiletine: 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 CYP2D6 and CYP3A4, which can raise mexiletine concentrations. Mexiletine has a narrow therapeutic index and elevated levels can cause neurotoxicity and arrhythmias.
What this interaction means in plain words
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Mexiletine 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 CYP2D6-mediated metabolism of mexiletine.
What to do
Avoid the combination where possible or reduce the mexiletine dose, with close clinical and ECG monitoring and mexiletine level checks if available.
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 Mexiletine
- Fezolinetant + Mexiletine Contraindicated
- Mexiletine + Pimozide Contraindicated
- Alosetron + Mexiletine Major
- Amiodarone + Mexiletine Major
- Clozapine + Mexiletine Major
- Cobicistat + Mexiletine Major
Frequently asked questions
Can I take Elvitegravir / cobicistat / emtricitabine / tenofovir df with Mexiletine?
MediHelp rates the interaction as major. Elvitegravir / cobicistat / emtricitabine / tenofovir df and Mexiletine 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 CYP2D6 and CYP3A4, which can raise mexiletine concentrations. Mexiletine has a narrow therapeutic index and elevated levels can cause neurotoxicity and arrhythmias.
How serious is the interaction between Elvitegravir / cobicistat / emtricitabine / tenofovir df and Mexiletine?
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 where possible or reduce the mexiletine dose, with close clinical and ECG monitoring and mexiletine level checks if available.
What other medicines interact with Mexiletine?
MediHelp also lists interactions of Mexiletine with, for example, Fezolinetant, Pimozide, Alosetron. The full list is on the Mexiletine page.
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