Indications And Dose
Pharmacokinetic enhancer used to increase the effect of atazanavir or darunavir ▶BY MOUTH ▶Adult: 150 mg once daily
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Drug reference
Pharmacokinetic enhancer used to increase the effect of atazanavir or darunavir ▶BY MOUTH ▶Adult: 150 mg once daily
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Dispense in original container (contains desiccant).
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→Appendix 1: cobicistat
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Manufacturer advises avoid unless essential. For use with darunavir, see darunavir with cobicistat p. 694 or darunavir with cobicistat, emtricitabine and tenofovir alafenamide p. 695. For use with elvitegravir, see elvitegravir with cobicistat, emtricitabine and tenofovir disoproxil p. 686 or elvitegravir with cobicistat, emtricitabine and tenofovir alafenamide p. 686.
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Manufacturer advises avoid in severe impairment—no information available.
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No dose adjustment required; inhibits tubular secretion of creatinine; when any co-administered drug requires dose adjustment based on renal function, avoid initiating cobicistat if eGFR less than 70 mL/minute/1.73 m2.
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There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 21 ▶Tybost (Gilead Sciences International Ltd) Cobicistat 150 mg Tybost 150mg tablets | 30 tablet P £21.38 Combinations available: Atazanavir with cobicistat, p. 693. Darunavir with cobicistat, p. 694. Darunavir with cobicistat, emtricitabine and tenofovir alafenamide, p. 695. Elvitegravir with cobicistat, emtricitabine and tenofovir alafenamide, p. 686. Elvitegravir with cobicistat, emtricitabine and tenofovir disoproxil, p. 686 6.6 Influenza Influenza Management Oseltamivir p. 699 and zanamivir p. 700 are most effective for the treatment of influenza if started within a few hours of the onset of symptoms; they are licensed for use within 48 hours of the first symptoms. In otherwise healthy individuals they reduce the duration of symptoms by about 1–1.5 days. Oseltamivir or zanamivir can reduce the risk of complications from influenza in the elderly and in patients with chronic disease. Oseltamivir and zanamivir are licensed for post-exposure prophylaxis of influenza when influenza is circulating in the community. Oseltamivir should be given within 48 hours of exposure to influenza while zanamivir should be given within 36 hours of exposure to influenza. However, in patients with severe influenza or in those who are immunocompromised, antivirals may still be effective after this time if viral shedding continues [unlicensed use]. Oseltamivir and zanamivir are also licensed for use in exceptional circumstances (e.g. when vaccination does not cover the infecting strain) to prevent influenza in an epidemic. There is evidence that some strains of influenza A virus have reduced susceptibility to oseltamivir, but may retain susceptibility to zanamivir. Resistance to oseltamivir may be greater in severely immunocompromised patients. Zanamivir should be reserved for patients who are severely immunocompromised, or when oseltamivir cannot be used, or when resistance to oseltamivir is suspected. For those unable to use the dry powder for inhalation, zanamivir is available as a solution that can be administered by nebuliser [unlicensed] or intravenously. Amantadine hydrochloride p. 437 is licensed for prophylaxis and treatment of influenza A but it is no longer recommended. Information on pandemic influenza, avian influenza, and swine influenza may be found at www.gov.uk/phe. Immunisation against influenza is recommended for persons at high risk, and to reduce transmission of infection. Oseltamivir in children under 1 year of age Data on the use of oseltamivir in children under 1 year of age is limited. Furthermore, oseltamivir may be ineffective in neonates because they may not be able to metabolise oseltamivir to its active form. However, oseltamivir can be used (under specialist supervision) for the treatment or post- exposure prophylaxis of influenza in children under 1 year of age. The Department of Health has advised (May 2009) that during a pandemic, treatment with oseltamivir can be overseen by healthcare professionals experienced in assessing children. ANTIVIRALS › INFLUENZA › NEURAMINIDASE INHIBITORS
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Missed doses If a dose is more than 12 hours late, the missed dose should not be taken and the next dose should be taken at the normal time.
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150 mg once daily
First-line fragment. Read the complete Indications and Dose section above.
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