Date of report 16 May 2019
Reported case interaction between
Cobicistat and Paliperidone
Cobicistat and Paliperidone
Drugs suspected to be involved in the DDI
Complete list of drugs taken by the patient
paliperidone, valproic acid, cyanocobalamin, lorazepam, estradiol
Clinical case description
38 year-old transgender woman with diagnosis of maniac-depressive syndrome. HIV infection diagnosed in 2008. cART was started in April 2011 in context of cerebral toxoplasmosis. She had a new maniac episode requiring hospital admission, and she received therapy with paliperidone (loading doses of 150 and 100 mg IM, followed by a maintenance dose of 50 mg IM). A new cART regimen was started and, given prior history of multiple virological failures and ARV resistance, a PI/c was required. She initiated tenofovir alafenamide, emtricitabine, darunavir cobicistat and rilpivirine. Although darunavir/cobicistat could potentially increase paliperidone levels. No unwanted outcome was observed.
Clinical Outcome
Editorial Comment
Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Darunavir/cobicistat could potentially increase paliperidone concentrations by inhibiting CYP3A4 . Despite loading doses of paliperidone in this case, no negative clinical outcome was observed and clinical response was appropriate and fast, suggesting that full dose of this drug can be used safely.
University of Liverpool Recommendation
Potential interaction likely to be of weak intensity. Additional action/monitoring or dosage adjustment is unlikely to be required