Pharmacokinetic enhancer (booster) for antiretroviral therapy×Selective immunosuppressant, mTOR inhibitor
Mechanism
Sirolimus is a CYP3A4 sensitive substrate, P-gp substrate, NTI. Cobicistat raises concentration 10+ fold with severe toxicity: nephrotoxicity, hepatotoxicity, cytopenia.
Symptoms
Rising creatinine, thrombocytopenia, hepatitis within days.
Management
Combination contraindicated. For HIV in transplant patient – regimen without cobicistat.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.