Liverpool HIV Interactions

Do Not Coadminister

Darunavir/cobicistat (DRV/c)

Etravirine (ETR)

Quality of Evidence: Low

Summary:

Coadministration is not recommended. Coadministration of etravirine and darunavir/cobicistat decreased cobicistat AUC, Cmax and Cmin by 30%, 14% and 66%, respectively. Darunavir AUC and Cmax were not changed significantly but Cmin was decreased by 56%. On the other hand, darunavir/cobicistat had no significant effects on etravirine exposure. Boosting of darunavir with cobicistat is not recommended in presence of etravirine due to the marked decrease in cobicistat exposure and in darunavir Cmin. However, boosting of darunavir with ritonavir may constitute an option if darunavir has to be coadministered with etravirine.

Description:

Based on theoretical considerations etravirine is expected to decrease darunavir and/or cobicistat plasma concentrations (CYP3A induction). Co-administration of darunavir/cobicistat and etravirine is not recommended. [This recommendation is different from ritonavir-boosted darunavir. Consult the Summary of Product Characteristics for darunavir for further details.]

Rezolsta Summary of Product Characteristics, Janssen-Cilag Ltd, July 2023.

Coadministration is expected to decrease concentrations of cobicistat but the effect on darunavir is unknown. Co-administration with etravirine is not recommended because it may result in loss of therapeutic effect and development of resistance to darunavir.

Prezcobix US Prescribing Information, Janssen Pharmaceuticals Inc, March 2023.

The combination of etravirine with darunavir/cobicistat is not recommended. Co-administration of etravirine with darunavir/cobicistat has not been studied but may decrease plasma concentrations of darunavir and/or cobicistat, which may result in loss of therapeutic effect and development of resistance.

Intelence Summary of Product Characteristics, Janssen-Cilag Ltd, March 2019.

Coadministration may decrease concentrations of cobicistat but the effect on darunavir is unknown. Co-administration of etravirine with darunavir/cobicistat is not recommended because it may result in loss of therapeutic effect and development of resistance to darunavir.

Intelence US Prescribing Information, Janssen Therapeutics, July 2019.

Coadministration of darunavir/cobicistat (800/150 mg once daily) and etravirine (400 mg once daily) was studied in two cohorts of HIV-infected patients. Cobicistat AUC, Cmax and C24 decreased by 30%, 14% and 66%, respectively, in the presence of etravirine. Darunavir AUC and Cmax were unchanged by etravirine, but darunavir C24 decreased by 56% relative to darunavir/cobicistat alone (n=15). Etravirine pharmacokinetics were unchanged by darunavir/cobicistat (n=15). Boosting darunavir with ritonavir instead of with cobicistat may be preferred if darunavir is to be combined with etravirine in clinical practice.

Pharmacokinetics of darunavir/cobicistat and etravirine alone and co-administered in HIV-infected patients. Moltó J, Curran A, Miranda C, et al. J Antimicrob Chemother. 2018, epub ahead of print.

View all available interactions with Darunavir/cobicistat (DRV/c) by clicking here.