Elvitegravir/emtricitabine/tenofovir-disoproxil-fumarate/cobicistat/sildenafil interaction
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Elvitegravir/emtricitabine/tenofovir-disoproxil-fumarate/cobicistat/sildenafil interaction
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Hypotension: case report A 57-year-old patient [sex not stated] developed hypotension following concomitant administration of elvitegravir/emtricitabine/ tenofovir-disoproxil-fumarate/cobicistat and sildenafil for HIV infection and pulmonary arterial hypertension (PAH), respectively [routes and time to reaction on set not stated]. The patient, who had HIV infection and various other co-morbidities, was hospitalised with progressive dyspnoea. The patient had been receiving elvitegravir/emtricitabine/tenofovir-disoproxil-fumarate/cobicistat 150mg/150mg/200mg/300mg daily [elvitegravir/cobicistat/emtricitabine/tenofovir disoproxyl fumarate]. At the current admission, investigations revealed PAH, and the patient started receiving sildenafil 20mg three times daily with continuation of the antiretroviral therapy. Two days later, the dose of sildenafil was decreased to 10mg three times daily in view of hypotension. The patient tolerated the therapy at the reduced dosage and was therefore discharged. Ten weeks later, following consultation with the HIV clinical pharmacist, it was discovered that the patient had developed hypotension secondary to interaction between cobicistat (a pharmacokinetic enhancers) and sildenafil. A maximum sildenafil concentration (Cmax) was noted to be within therapeutic range. The Cmax for N-desmethylsildenafil (metabolite) was 160 ng/mL. Three weeks later, the PAH worsened, and the antiretroviral regimen was switched to abacavir/dolutegravir/lamivudine. The dose of sildenafil was increased to 20mg three times daily. Two weeks later, the patient was admitted for acute respiratory failure, and the patient died. Pecora Fulco P, et al. Sildenafil Use for Pulmonary Artery Hypertension With a Cobicistat-Boosted Antiretroviral Regimen. Annals of Pharmacotherapy 54: 84-85, No. 1, Jan 803448647 2020. Available from: URL: http://doi.org/10.1177/1060028019865542
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of an interaction between elvitegravir/emtricitabine/tenofovir-disoproxil-fumarate/cobicistat and sildenafil. The results from the WHO ADR database are pending.
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Reactions 25 Jan 2020 No. 1788
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