Cobicistat and Cyclosporine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cobicistat
Cyclosporine Injection
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased cycloSPORINE exposure and an increased cobicistat exposure
Interaction Deep Dive
Use caution when administering cobicistat, a potent CYP3A4 and a P-gp inhibitor, together with cycloSPORINE, a CYP3A4 and a P-gp substrate, as this may result in increased cycloSPORINE exposure. Monitor for therapeutic3 and toxic effects of cycloSPORINE and consider consultation with a specialist if clinically indicated. If coadministration is required, initiate cycloSPORINE at a lower dose 2 or adjust cycloSPORINE dosage to achieve the desired cycloSPORINE concentrations 1. Coadministration of cobicistat (CYP3A substrate) with atazanavir or darunavir in combination with other drugs that inhibit CYP3A4, such as cycloSPORINE may further increase exposures of cobicistat, atazanavir, and darunavir 4.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of cycloSPORINE; inhibition of P-gp-mediated efflux transport of cycloSPORINE; inhibition of CYP3A4-mediated metabolism of cobicistat
Common questions
Can I take Cobicistat and Cyclosporine Injection together?
Increased cycloSPORINE exposure and an increased cobicistat exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Cobicistat and Cyclosporine Injection interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Cobicistat or Cyclosporine Injection need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (4)
- Product Information: SANDIMMUNE(R) oral capsules, oral solution, intravenous injection, cyclosporine oral capsules, oral solution, intravenous injection. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Panel on Antiretroviral Guidelines for Adults and Adolescents: Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. AIDSinfo, U.S. Department of Health and Human Services. Rockville, MD. 2013.
- Product Information: STRIBILD(R) oral tablets, elvitegravir cobicistat emtricitabine tenofovir disoproxil fumarate oral tablets. Gilead Sciences Inc (per FDA), Foster City, CA, 2021. DailyMed
- Product Information: TYBOST(R) oral tablets, cobicistat oral tablets. Gilead Sciences Inc (per FDA), Foster City, CA, 2025. DailyMed
Keep reading about Cobicistat
Keep reading about Cyclosporine Injection
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist