Date of report 16 Apr 2021
Reported case interaction between
Cobicistat and Nebivolol
Cobicistat and Nebivolol
Drugs suspected to be involved in the DDI
Complete list of drugs taken by the patient
Nebivolol, hydrochlorothiazide,
Clinical case description
44 years-old, Caucasian, female patient. HIV-infection was diagnosed at the age of 32. Her current cART is darunavir/cobicistat plus emtricitabine/tenofovir DF. Her last HIV RNA pVL was 50 copies/ml. (January 2020). She was recently diagnosed with mild hypertension (systolic blood pressure of 155 mm Hg and diastolic pressure of 95 mm Hg). Patients is non-smoker, BMI 26 kg/m2. Her cardiologist introduced the following antihypertensive drugs: 5 mg nebivolol plus 12,5 mg hydrochlorothiazide (single tablet regimen) once daily. The patient felt dizziness, flushing, palpitations, irregular heart rate and hypotension. These side effects disappeared soon after replacing nebivolol by enalapril 20 mg qd.
Clinical Outcome
Drug Interaction Probability Scale (DIPS)
Editorial Comment
This is a potential weak interaction. Nebivolol metabolism involves CYP2D6, and darunavir/cobicistat could potentially increase nebivolol concentrations (darunavir/cobicistat is a weak inhibitor of CYP2D6). Although to limited extent, such an increase in nebivolol concentrations could lead to the development of adverse effects in some predisposed patients.
University of Liverpool Recommendation
Potential interaction likely to be of weak intensity. Additional action/monitoring or dosage adjustment is unlikely to be required