Drug interactions
Elvitegravir / cobicistat / emtricitabine / tenofovir df + Pimavanserin
Severity: Major
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Pimavanserin: 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
The cobicistat in this combination is a strong CYP3A4 inhibitor and can substantially raise pimavanserin exposure. This increases the risk of QT prolongation and other dose-related effects.
What this interaction means in plain words
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Pimavanserin 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, reducing the metabolism of pimavanserin.
What to do
Reduce the pimavanserin dose to 17 mg daily while the regimen is used. Monitor the ECG in patients with additional QT risks.
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 Pimavanserin
- Lefamulin + Pimavanserin Contraindicated
- Pimavanserin + Pimozide Contraindicated
- Pimavanserin + Vandetanib Contraindicated
- Adagrasib + Pimavanserin Major
- Amiodarone + Pimavanserin Major
- Amisulpride + Pimavanserin Major
Frequently asked questions
Can I take Elvitegravir / cobicistat / emtricitabine / tenofovir df with Pimavanserin?
MediHelp rates the interaction as major. Elvitegravir / cobicistat / emtricitabine / tenofovir df and Pimavanserin 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. The cobicistat in this combination is a strong CYP3A4 inhibitor and can substantially raise pimavanserin exposure. This increases the risk of QT prolongation and other dose-related effects.
How serious is the interaction between Elvitegravir / cobicistat / emtricitabine / tenofovir df and Pimavanserin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reduce the pimavanserin dose to 17 mg daily while the regimen is used. Monitor the ECG in patients with additional QT risks.
What other medicines interact with Pimavanserin?
MediHelp also lists interactions of Pimavanserin with, for example, Lefamulin, Pimozide, Vandetanib. The full list is on the Pimavanserin page.
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