Drug interactions
Elvitegravir / cobicistat / emtricitabine / tenofovir df + Verapamil
Severity: Major
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Verapamil: 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 potent CYP3A4 inhibitor and can increase verapamil exposure. This may lead to excessive hypotension, bradycardia and AV conduction delay. Verapamil may also modestly affect cobicistat-boosted regimen exposure.
What this interaction means in plain words
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Verapamil 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 P-glycoprotein), reducing verapamil clearance and increasing its concentration.
What to do
Use a reduced verapamil dose with clinical and ECG monitoring of heart rate, PR interval and blood pressure. Consider an alternative antihypertensive if bradycardia or hypotension develops.
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 Verapamil
- Dofetilide + Verapamil Contraindicated
- Flibanserin + Verapamil Contraindicated
- Lomitapide + Verapamil Contraindicated
- Lonafarnib + Verapamil Contraindicated
- Pimozide + Verapamil Contraindicated
- Acebutolol + Verapamil Major
Frequently asked questions
Can I take Elvitegravir / cobicistat / emtricitabine / tenofovir df with Verapamil?
MediHelp rates the interaction as major. Elvitegravir / cobicistat / emtricitabine / tenofovir df and Verapamil 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 potent CYP3A4 inhibitor and can increase verapamil exposure. This may lead to excessive hypotension, bradycardia and AV conduction delay. Verapamil may also modestly affect cobicistat-boosted regimen exposure.
How serious is the interaction between Elvitegravir / cobicistat / emtricitabine / tenofovir df and Verapamil?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use a reduced verapamil dose with clinical and ECG monitoring of heart rate, PR interval and blood pressure. Consider an alternative antihypertensive if bradycardia or hypotension develops.
What other medicines interact with Verapamil?
MediHelp also lists interactions of Verapamil with, for example, Dofetilide, Flibanserin, Lomitapide. The full list is on the Verapamil page.
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