cobicistat + elvitegravir + emtricitabine + tenofovir alafenamide fumarate at a glance
Medicine class
Combination antiretroviral containing an integrase inhibitor, two reverse-transcriptase inhibitors and a pharmacokinetic enhancer.
Main use
HIV-1 infection without known relevant resistance.
Food
Take with food.
Interactions
Check all prescribed, over-the-counter and herbal products with the HIV team.
What is cobicistat + elvitegravir + emtricitabine + tenofovir alafenamide fumarate used for?
UK-licensed use:
HIV-1 infection in adults and eligible children from 2 years of age who meet the product’s weight criteria and have no known relevant resistance mutations.
How does cobicistat + elvitegravir + emtricitabine + tenofovir alafenamide fumarate work?
Elvitegravir blocks HIV integrase. Emtricitabine and tenofovir alafenamide interrupt construction of viral DNA. Cobicistat inhibits CYP3A metabolism, increasing elvitegravir exposure; it has no direct anti-HIV activity.
cobicistat + elvitegravir + emtricitabine + tenofovir alafenamide fumarate preparations and strengths
Tablet
Route: Oral
Strengths: 90 mg + 90 mg + 120 mg + 6 mg, 150 mg + 150 mg + 200 mg + 10 mg
How to take cobicistat + elvitegravir + emtricitabine + tenofovir alafenamide fumarate
Take with food. Swallow the film-coated tablet without chewing or crushing.
If swallowing is difficult, the tablet may be split and both halves swallowed immediately, one after the other.
The score line aids swallowing but does not divide the tablet into equal amounts.
cobicistat + elvitegravir + emtricitabine + tenofovir alafenamide fumarate side effects
Common or expected effects
- Nausea
- Diarrhoea, vomiting, abdominal pain or wind
- Headache or dizziness
- Abnormal dreams
- Rash
- Tiredness
Get urgent medical advice
- Swelling of the face, lips, tongue or throat
- Suicidal thoughts or attempted suicide, particularly with previous psychiatric illness
- New inflammatory or autoimmune symptoms after immune recovery
- Kidney impairment or proximal renal tubulopathy
- Severe worsening of hepatitis after stopping treatment in someone with HIV and hepatitis B
cobicistat + elvitegravir + emtricitabine + tenofovir alafenamide fumarate in pregnancy
This combination should not be started during pregnancy. Elvitegravir and cobicistat exposure falls later in pregnancy, which may cause treatment failure and increase HIV transmission risk. Pregnancy while taking it requires prompt specialist review.
cobicistat + elvitegravir + emtricitabine + tenofovir alafenamide fumarate while breastfeeding
The product information says this combination should not be used while breastfeeding. Formula feeding avoids postnatal HIV transmission, although some people with sustained viral suppression may choose supported breastfeeding with specialist monitoring and treatment review.
cobicistat + elvitegravir + emtricitabine + tenofovir alafenamide fumarate interactions
Cobicistat strongly inhibits CYP3A and several transporters, while CYP3A-inducing medicines can reduce elvitegravir exposure. A full interaction check is essential.
Carbamazepine, phenobarbital, phenytoin, rifampicin or St John’s wort
Contraindicated because they can lower elvitegravir and cobicistat exposure, risking loss of viral control and resistance.
Simvastatin, lovastatin or lomitapide
Contraindicated because cobicistat can substantially increase exposure and serious toxicity.
Dabigatran etexilate
Contraindicated because transporter inhibition may substantially increase anticoagulant exposure and bleeding risk.
Common questions about cobicistat + elvitegravir + emtricitabine + tenofovir alafenamide fumarate
Answers are fully visible for fast scanning and source review.
Why is cobicistat included?
Cobicistat blocks CYP3A metabolism and increases elvitegravir exposure. It is a pharmacokinetic enhancer rather than an antiviral agent.
Can it be used when HIV is resistant?
Its UK licence requires no known mutations associated with resistance to integrase inhibitors, emtricitabine or tenofovir. Treatment history and resistance results should be reviewed.
Why must it be taken with food?
Food increases elvitegravir exposure and supports reliable absorption.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.