Interactions with Stribild: A Look at Supplements, Alcohol, and Other Factors
Stribild, a medication used to treat HIV, can interact with a variety of other drugs, potentially leading to severe or life-threatening side effects. Here are some key interactions to be aware of:
Stribild, which consists of elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate, can interact with certain medications that affect liver enzymes or kidney function. Some of these interactions can significantly increase toxicity risk or decrease the effectiveness of Stribild or the interacting medication.
Contraindicated or Not Recommended with Stribild:
- Bepridil
- Carbamazepine
- Cisapride
- Dasabuvir
- Dronedarone
- Elbasvir
- Grazoprevir
- Levoketoconazole
- Lonafarnib
- Maraviroc
- Mavacamten
- Mesoridazine
- Paritaprevir
- Pimozide
- Piperaquine
- Posaconazole
- Ranolazine
- Ritonavir
- Saquinavir
- Sparfloxacin
- St John's Wort
- Terfenadine
- Thioridazine
- Voriconazole
- Ziprasidone
These drugs may cause serious cardiac arrhythmias, liver toxicity, or adversely affect drug levels due to CYP3A interactions induced or inhibited by cobicistat.
Other Interacting Drugs:
- Some protease inhibitors (atazanavir, darunavir, lopinavir, indinavir, nelfinavir, tipranavir)
- Certain antifungals (itraconazole, ketoconazole, posaconazole, voriconazole)
- Macrolide antibiotics (clarithromycin, erythromycin)
- Other CYP3A inhibitors or inducers (ritonavir, nirmatrelvir, paritaprevir)
Nephrotoxic Drugs:
Drugs such as Acyclovir, valacyclovir, ganciclovir, valganciclovir, aminoglycosides (e.g., gentamicin), and high-dose or multiple NSAIDs (e.g., ibuprofen, naproxen) should be used cautiously or avoided because emtricitabine and tenofovir are primarily eliminated by the kidneys.
Because cobicistat in Stribild is a strong CYP3A inhibitor, many drugs metabolized by this enzyme can interact, raising the risk for severe toxicity including cardiac arrhythmias, liver damage, and kidney injury. St John’s Wort is particularly contraindicated because it induces CYP3A and can reduce Stribild effectiveness.
It's crucial to inform your healthcare professional about all prescribed, over-the-counter, and herbal medications you take while on Stribild to avoid these severe interactions. Your doctor might adjust doses or choose alternative therapies to safely manage these interactions.
In summary, many drugs—especially CYP3A substrates with narrow therapeutic windows, nephrotoxic agents, and certain cardiac drugs—can cause severe or life-threatening side effects when combined with Stribild. Key examples are the ones listed above, notably including ritonavir, St John’s Wort, carbamazepine, cisapride, and nephrotoxic drugs like aminoglycosides and high-dose NSAIDs.
