Date of report: 16 May 2019
Reported case interaction between
Cobicistat and Paliperidone
Cobicistat and Paliperidone
Drugs suspected to be involved in the DDI
Drug A
Cobicistat
(Perpetrator)
Daily Dose
150
(mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
March 28, 2019
End date
Ongoing
Drug B
Paliperidone
(Victim)
Daily Dose
50
(mg)
Dose adjustment performed
No
Administration Route
Intramuscular
Start date
March 29, 2019
End date
Ongoing
Complete list of drugs taken by the patient
Antiretroviral treatment
Darunavir/Cobicistat
Rilpivirine/Emtricitabine/Tenofovir-AF
Complete list of all comedications taken by the patient, included that involved in the DDI
paliperidone, valproic acid, cyanocobalamin, lorazepam, estradiol
Clinical case description
Gender
Transgender
Age
38
eGFR (mL/min)
>60
Liver function impairment
No
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.
Outcome
No unwanted 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.