Date of report 20 Jul 2020
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, TMP-SMX prophylaxis, Olanzapine, Liposomal doxorubicin, Fluconazole
Clinical case description
60 year-old male patient, recently diagnosed of HIV infection due to cutaneous and visceral (digestive, ocular, laryngeal and bronchial) Kaposi sarcoma (KS). Past clinical history was relevant for schizophrenia with poor adherence to psychiatric oral medication. He started on ART (DRV/c/FTC-TAF) in the frame of a clinical trial and received liposomal doxorubicin for KS and oral olanzapine and paliperidone for his psychiatric condition. Tolerance and response were very good, not presenting adverse events and not requiring dose adjustments (he was treated during hospitalization with a paliperidone dose of 6mg/d). Given the good tolerance presented and his past bad adherence to oral therapy in the past, IM paliperidone wasconsidered to be continued after discharge. He also received fluconazole due to oral candidiasis. Clinical response was good for all the clinical conditions.
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, although to a limited extent. Usual dose for paliperidone in this indication ranges between 3-12 mg/d, and the patient received 6mg/d, as explained. The lack of negative clinical outcome and the favourable clinical response seen in this patient suggest that full dose of paliperidone can be used safely with darunavir/cobicistat
University of Liverpool Recommendation
Potential interaction likely to be of weak intensity. Additional action/monitoring or dosage adjustment is unlikely to be required