Date of report 22 Jun 2020
Reported case interaction between
Cobicistat and Clorazepate
Cobicistat and Clorazepate
Drugs suspected to be involved in the DDI
Complete list of drugs taken by the patient
Clorazepate
Clinical case description
50 years old woman diagnosed with HIV in 1997. She had been receiving ART with abacavir, lamivudine and nevirapine maintaining undetectable plasma viral load until September 2019 when she stopped ART during 2 months. In November 2019 ART was reinitiated with FTC/TAF + RAL but it was switched to DRV/c/FTC/TAF because of poor adherence. She was also receiving clorazepate because of a chronic anxiety disorder. Clorazepate is converted to nordiazepam which is then metabolized to oxazepam by CYP3A4. Despite nordiazepam plasma concentrations are expected to be increased in combination with a strong inhibitor of CYP3A4 like cobicistat, no adverse events were observed.
Clinical Outcome
Editorial Comment
Darunavir/c is expected to increase nordiazepam exposure due to CYP3A4 Inhibition. Development of adverse effects as a consequence of drug-drug interaction is likely to vary from one person to the other.
University of Liverpool Recommendation
Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration