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cobicistat + darunavir (G006 / Rezolsta / Prezcobix)

✓ Approved

Johnson & Johnson Services, Inc. · CYP3A4 · Small Molecule

What is cobicistat + darunavir?

cobicistat + darunavir is a small molecule developed by Johnson & Johnson Services, Inc.. It is approved for therapeutic indications via oral (po).

Drug Profile

Brand NamesG006, Rezolsta, Prezcobix
CompanyJohnson & Johnson Services, Inc.
Drug ClassSmall Molecule
Molecular TargetCYP3A4,
RouteOral (PO)
StatusApproved

Mechanism of Action

Molecular Targets

cobicistat + darunavir acts on 2 molecular targets:

CYP3A4cytochrome P450 family 3 subfamily A member 4 (CP33, HLP)
gag-pol, HIV-1 (gag-pol)
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Therapeutic Indications

cobicistat + darunavir is developed for 1 unique indication across 1 therapeutic area.

Therapeutic AreaConditionPhase
Infections and infestationsAcquired immunodeficiency syndrome✓ Approved

Related Research Articles

PubMedbioRxiv : the preprint server for biology2026-10-11

A Dynamics-Informed Machine Learning Framework for Inhibitor Optimization Against Quickly Evolving Targets to Avoid Resistance.

Intravaia Lauren E LE, Kaur Jagroop J, Shaqra Ala M AM, Henes Mina M et al.

Drug resistance often emerges through mutations that reshape protein conformational ensembles, allowing inhibitor potency to be altered without directly disrupting protein-ligand contacts. Consequently, the molecular mechanisms underlying these effects remain difficult to identify, hindering the design of inhibitors with durable potency against rapidly evolving drug targets. To address this challenge, we developed ROBUST, a physics-informed machine learning framework that integrates experimental measurements, molecular dynamics simulations, and interpretable statistical modeling to identify energetic determinants of inhibitor potency. Using HIV-1 protease as a stringent model system for drug resistance, we determined 157 new inhibition constants and integrated them with prior measurements to establish a comprehensive experimental dataset of 364 protease-inhibitor pairs. Analysis of the corresponding molecular dynamics simulations revealed a compact network of energetic interactions that quantitatively explains how resistance mutations and inhibitor modifications jointly reshape molecular recognition and inhibitor potency across the multidimensional resistance landscape. Models constructed from these energetic signatures predicted binding free energies with high accuracy (RMSE < 1 kcal mol -1 ) and successfully generalized to unseen darunavir analogs. Importantly, ROBUST accurately prioritized unseen analogs based on their potency across the variant set, demonstrating its utility for identifying compounds with improved resistance profiles. Together, these results uncover the energetic principles through which resistance mutations and inhibitor modifications alter potency and establish ROBUST as a mechanistically interpretable framework for translating these insights into resistance-aware inhibitor optimization against rapidly evolving drug targets.

PubMedBritish journal of clinical pharmacology2026-10-06

Lenacapavir initiation with concomitant primidone: A case report with therapeutic drug monitoring.

Devanathan Aaron S AS, Glowa Thomas T, Thompson Emily M EM, Saylor Amanda J AJ et al.

Lenacapavir (LEN), a first-in-class capsid inhibitor, has unique pharmacokinetics that enable twice-yearly dosing. LEN is not extensively metabolized, although it is a substrate of CYP3A4, which introduces drug-drug interactions concerns. As adoption and implementation of LEN for treatment and prevention increase, additional guidance on concomitant medications with LEN is needed. Primidone is a barbiturate type anticonvulsant medication and a moderate-to-strong inducer of CYP3A4. A primary metabolite of primidone, phenobarbital, also induces CYP3A. Consequently, the coadministration of LEN and primidone is not recommended due to the potential induction of CYP3A-mediated metabolism and resultant subtherapeutic LEN concentrations. However, the extent to which LEN concentrations may decrease alongside concomitant primidone is unknown. Herein, we describe a 67-year-old male initiating LEN following switch from a boosted darunavir regimen, alongside long-standing treatment with primidone 50 mg daily. Blood samples were collected throughout the first 6-month dosing interval. Plasma LEN concentrations were quantified using a validated liquid chromatography-tandem mass spectrometry analytical method. LEN concentrations remained above four times the protein adjusted 95% effective concentration during the measured time points. The lowest observed concentration was 24.9 ng/mL at Month 1; the highest observed was 58.3 ng/mL at Month 3. The projected 6-month concentration was 40.6 ng/mL. Observed concentrations were generally consistent with concentrations reported in prior studies in the absence of clinically-significant drug-drug interactions. Viral load measures remained undetectable throughout the dosing interval and following subsequent administrations thereafter. This case provides pharmacokinetic rationale for the coadministration of LEN with primidone and may help guide future clinical decision-making.

PubMedThe Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases2026-09-27

Persistent low-level viremia and symptomatic HIV cerebrospinal fluid escape in a person living with HIV receiving darunavir: a case report.

Suriano Enrico Stefano ES, Kuslevicius Karin K, Leal Mariana Martins Dos Santos MMDS, Relvas Luiz Fernando Degrecci LFD et al.

HIV Cerebrospinal Fluid (CSF) viral escape is a condition characterized by inadequate virological control within the CSF despite systemic antiretroviral therapy, often assessed through discordant CSF and plasma HIV viral loads. The clinical relevance of CSF viral escape remains poorly understood, but it is thought to contribute to a spectrum of neurological and neurocognitive manifestations. The present study details the case of a 51-year-old individual from São Paulo, Brazil, presenting with acute meningoencephalitis and seizures in the context of persistent low-level viremia. Differential diagnoses were considered to rule out other conditions, such as infectious and immune-related diseases, eventually leading to a diagnosis of HIV CSF viral escape, confirmed through clinical presentation and a series of diagnostic evaluations. Antiretroviral therapy was subsequently optimized to improve central nervous system penetration, resulting in clinical improvement, resolution of neurological symptoms and undetectable CSF viral load.

PubMedPharmaceutics2026-09-26

Hidden Solid-State Transformation of Darunavir in Low-Temperature Hot-Melt-Extruded Granules: Implications for Pharmacy Compounding and Routine Quality Control.

Mandrik Mark M, Makarova Veronika V, Korol Ludmila L, Sadkovskii Ivan I et al.

Background: Hot-melt extrusion (HME) is a scalable pharmaceutical technology increasingly relevant to flexible manufacturing, including small-batch production, personalized dosage-form development, and potential use in pharmacy compounding. When translated into compounding practice, however, HME introduces a risk that routine quality-control methods available in pharmacies may be insufficient to reliably assess the stability of extrusion-based preparations. Methods: Granules containing 50% (w/w) darunavir were prepared by HME at 70 and 90 °C using a previously developed polymeric premix. Samples were stored for 24 months under ambient conditions. During storage, routine quality attributes were evaluated, including appearance, particle size distribution, loss on drying, disintegration time, content uniformity, and assay. Solid-state changes were investigated using differential scanning calorimetry (DSC) and X-ray diffraction (XRD), with a reference PEG-associated darunavir sample prepared and characterized for comparative analysis. Changes in drug release and darunavir content were assessed by dissolution testing and HPLC analysis, respectively. Results: Granules produced at both extrusion temperatures retained acceptable routine quality attributes throughout the 24-month storage period. No substantial changes were detected by visual inspection, pharmacopoeial tests, or UV assay. However, DSC revealed a new thermal event after storage, while XRD showed the formation of a new crystalline phase. Comparison with the reference PEG-associated sample supported the assignment of this phase as a PEG-associated crystalline phase of darunavir. Importantly, this transformation occurred even though the routine quality attributes evaluated in pharmacy compounding practice remained unchanged. Dissolution profiles differed between samples tested immediately after preparation and after long-term storage, with a more pronounced overall difference for granules produced at 90 °C, whereas HPLC confirmed comparable darunavir content in all investigated samples. Discussion: Our results show that routine compounding quality control can meet conventional acceptance criteria while failing to detect API solid-state changes in the investigated HME-derived system. In the PEG-containing matrix, amorphous darunavir undergoes storage-induced crystallization, forming a PEG-associated crystalline phase consistent with its known affinity for polyol-containing media. Conclusions: Acceptable routine quality attributes do not necessarily reflect the solid-state stability of APIs in HME-based formulations. These results highlight the need for solid-state risk assessment when developing extrusion-based systems intended for pharmacy compounding and other personalized manufacturing models in which routine quality control may not include advanced solid-state characterization.

PubMedPharmaceuticals (Basel, Switzerland)2026-09-26

Need for Medication Review and Deprescribing in People Living with HIV: A Longitudinal Observational Study.

De Bellis Emanuela E, Donnarumma Danilo D, Pagano Annarita A, Mazza Ines I et al.

Background/Objectives: People Living with HIV (PLWH) often have comorbidities require polypharmacy, increasing the risk of adverse events (AEs) associated with drug-drug/drug-supplement interactions (DDIs/DSIs). However, DDIs and DSIs, including those involving antiretrovirals (ARVs), and their related effects have not been exhaustively assessed. This study aimed to determine, in HIV patients on HAART who are taking multiple medications, the prevalence of DDIs and DSIs involving both ARVs and non-ARV co-medications, and their clinical relevance and consequences. Methods: In this longitudinal observational study, PLWH receiving HAART were consecutively enrolled at the University Hospital of Salerno and followed up during scheduled visits. Demographic, clinical, and pharmacological data were collected. DDIs/DSIs were identified using Drugs.com, Lexicomp, and the Liverpool HIV Interaction Checker. Interactions classified as major (Drugs.com), consider therapy modification or avoid combination (Lexicomp), and do not coadminister (Liverpool) were deemed highly clinically relevant. This assessment was supplemented with review of SmPCs and the available literature. Results: Among 84 PLWH, 229 interactions were identified, and 37/229 (16.2%) were highly clinically relevant. Eight patients (9.5%) experienced AEs predicted by the tools. Four were DDIs: cobicistat/alprazolam associated with sedation and dyspnoea, rilpivirine/hydroxychloroquine with QT prolongation, bictegravir/ursodeoxycholic acid with rising viremia, and atorvastatin/fenofibrate with myalgia. Four DSIs between bictegravir and supplements containing divalent ions have been associated with increasing viremia. After medication review, alprazolam was replaced with zolpidem, rilpivirine-based HAART with bictegravir/emtricitabine/tenofovir alafenamide, and atorvastatin/fenofibrate with simvastatin/ezetimibe, and ursodeoxycholic acid and supplements were discontinued. These interventions were temporally associated with clinical improvement of interaction-related AEs and good virological control. Conclusions: This study highlights the importance of predicting DDIs/DSIs in PLWH undergoing polypharmacy. Medication review supports clinical decision-making, preventing avoidable adverse outcomes.

PubMedMetabolites2026-09-24

Determinants of Metabolic Syndrome in Virally Suppressed People Living with HIV: A Single-Center Comparative Analysis of Antiretroviral Regimens.

Biały Michał M, Inglot Małgorzata M

Background: Metabolic complications and weight gain have emerged as primary concerns among virologically suppressed and immunologically competent people living with HIV. Particularly integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF) are being connected with this issue. Objectives: This study aimed to evaluate the prevalence of metabolic syndrome (MetS) and its components within a highly homogeneous, virologically suppressed cohort, assessing the impact of antiretroviral therapy (ART) and HIV-unrelated factors. Methods: We conducted a single-center cross-sectional analysis of 93 HIV-positive patients receiving stable ART for >2 years, in Wrocław, Poland. To minimize confounding, individuals with HBV/HCV co-infections or significant alcohol use were excluded. Participants were stratified primarily by regimen, INSTI/TAF-based (n = 50) vs. PI/TAF-based (n = 28), and secondarily by the particular drugs taken. Clinical assessment included anthropometric parameters, lipid profiles, and glucose metabolism. Results: The prevalence of MetS was 10.8%. No statistically significant differences were observed in the incidence of MetS, insulin resistance, or dyslipidemia between the INSTI/TAF and PI/TAF groups. A marginally significant trend toward lower total cholesterol was identified in patients receiving dolutegravir/TAF compared to those on darunavir/TAF. Conclusions: In this stable Caucasian cohort with long-term viral suppression, we found no statistically significant differences in metabolic outcomes between modern INSTI- and PI-based regimens. However, due to the limited sample size and low statistical power, these findings do not prove clinical equivalence. Our results suggest that in particular tightly selected settings of well-controlled patients, traditional risk factors and lifestyle may remain the primary drivers of metabolic health, although modest drug-related effects cannot be ruled out.

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