Date of report 16 Jul 2024
Reported case interaction between
Cobicistat and Drospirenone
Cobicistat and Drospirenone
Drugs suspected to be involved in the DDI
Complete list of drugs taken by the patient
Drospirenone 4mg/d
Citalopram 10mg/d
Clinical case description
A female patient with HIV had a history of poor adherence to ART, leading to a switch from RPV/FTC/TAF to DRVc/FTC/TAF in 2020. She had a medical history of depression, for which she was on citalopram therapy, and ovarian cysts. For the latter, her gynecologist prescribed drospirenone without checking for potentially relevant drug-drug interactions (DDIs). Despite not experiencing any adverse events (which may be more frequent due to increased exposure to drospirenone), at her next visit with her HIV doctor, ART was modified to BIC/FTC/TAF.
Most guidelines recommend removing PK enhancers whenever possible to avoid risky DDIs with drugs that may be prescribed by other healthcare professionals.
Clinical Outcome
Editorial Comment
Cobicistat is a potent inhibitor of CYP3A4 which is involved in drospirenone metabolism. Drospirenone AUC increased by 58% when a combined oral contraceptive containing drospirenone and ethinylestradiol was coadministered with darunavir/cobicistat. When darunavir/cobicistat is coadministered with a drospirenone-containing product, clinical monitoring is recommended due to the potential for hyperkalaemia.
University of Liverpool Recommendation
Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration