Date of report 22 Jun 2020
Reported case interaction between
Cobicistat and Aripiprazole
Cobicistat and Aripiprazole
Drugs suspected to be involved in the DDI
Complete list of drugs taken by the patient
Clinical case description
21-year-old HIV positive patient, known for ilicit substance abuse and recent HIV infection. Clinical history relevant for chronic psychotic disorder (poorly characterized) treated with aripiprazole 10mg/d orally since 2017. Following HIV diagnosis, he initiated FTC/TAF + RAL to avoid drug-drug-interactions, but later genotype showed resistance mutations for RAL (163K substitution in 98% of the sequences). ARV regimen was changed to DRV/c/FTC/TAF in November 2018, and the dose of aripiprazole was reduced to 5mg/d. Clinical response continued to be adequate and no side effects were observed. VL became undetectable afetr 3 months of follow-up. Aripiprazole is metabolized by CYP3A4 and CYP2D6. Darunavir/cobicistat could potentially increase aripiprazole concentrations, but no adverse effects were observed in our patient with dose modification (10 mg to 5mg) when cobicistat was introduced.
Clinical Outcome
Editorial Comment
Aripiprazole is metabolized by CYP3A4 and CYP2D6. Darunavir/cobicistat could potentially increase aripiprazole concentrations. The European product label for aripiprazole advises reducing the aripiprazole dose to approximately one-half of its prescribed dose when given with potent inhibitors of CYP3A4, as in this case.
University of Liverpool Recommendation
Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration