CriticalPharmacokinetic enhancer (booster) for antiretroviral therapy×Selective immunosuppressant, mTOR inhibitor
Updated · Methodology
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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- EMA: Tybost (cobicistat) Summary of Product Characteristics (2024)– EMA EPAR Tybost
- EMA: Ficha técnica: Sirolimús (EU/1/01/171), sección 4.5 (2026)– EMA SmPC vía AEMPS CIMA, nº 01171013 (EU/1/01/171), sección 4.5, consultado 10/2026