Alyq and Cobicistat

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Talk to your doctor before using tadalafil together with cobicistat. Combining these medications may significantly increase the blood levels and effects of tadalafil. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your condition changes or you experience nausea, shortness of breath, dizziness, lightheadedness, fainting, visual disturbances, ringing in the ears, vision or hearing loss, chest pain or tightness, irregular heartbeat, and/or priapism (prolonged and painful erection unrelated to sexual activity), as these may be signs and symptoms of excessive tadalafil levels. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

ADJUST DOSE: Coadministration with the pharmacokinetic booster cobicistat may increase the plasma concentrations of tadalafil. The mechanism is cobicistat inhibition of tadalafil metabolism via CYP450 3A4. The interaction has not been studied with cobicistat, but has been reported with ritonavir, a pharmacokinetic booster with a similar metabolic profile to cobicistat. In study subjects, administration of a single 20 mg dose of tadalafil during treatment with ritonavir 500 mg or 600 mg twice daily at steady state resulted in a 30% reduction in tadalafil peak plasma concentration (Cmax) and 32% increase in systemic exposure (AUC) compared to tadalafil administered alone. Administration of the same dose of tadalafil in combination with ritonavir 200 mg twice a day was associated with a 124% increase in tadalafil AUC and no change in Cmax. The pharmacokinetics of tadalafil in the treatment of pulmonary arterial hypertension (PAH) have been studied in the presence of tipranavir/ritonavir. Tadalafil concentrations increased when coadministered with the first dose of tipranavir/ritonavir, but not with tipranavir/ritonavir at steady-state. This would suggest that the initial inhibitory effect of ritonavir on CYP450 3A4 may be mitigated by a more slowly evolving induction effect so that after about one week of ritonavir administered twice daily, the exposure to tadalafil is similar in the presence and absence of ritonavir.

MANAGEMENT: Caution is advised if tadalafil is administered in combination with cobicistat. For the treatment of erectile dysfunction, the dosage of tadalafil should not exceed 10 mg once every 72 hours when used on an as-needed basis. When given for once-daily use in the treatment of erectile dysfunction or benign prostatic hyperplasia, the maximum recommended dose is 2.5 mg. For the treatment of pulmonary arterial hypertension, tadalafil should be started at 20 mg once daily in patients who have been receiving cobicistat for at least one week. The dosage may be increased to 40 mg once daily based upon individual tolerability. The use of tadalafil for PAH should be avoided during the initiation of cobicistat-containing antiretroviral therapy. The manufacturers recommend that tadalafil be discontinued at least 24 hours prior to initiating the cobicistat regimen. After at least one week, tadalafil may be resumed at 20 mg once daily, and the dosage increased to 40 mg once daily based upon individual tolerability. All patients treated with tadalafil should be advised to promptly notify their physician if they experience pain or tightness in the chest or jaw, irregular heartbeat, nausea, shortness of breath, visual disturbances, syncope, or prolonged erection (greater than 4 hours).

Alyq

Generic Name: tadalafil

Brand name: Adcirca, Alyq, Cialis

Synonyms: n.a.

What is Alyq?

Cobicistat

Generic Name: cobicistat

Brand name: Tybost

Synonyms: n.a.

What is Cobicistat?