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Hepatologytextbook.com

Hepatology 2013

Chapter 12: Standard Therapy of Chronic Hepatitis C Virus Infection

By Markus Cornberg, Benjamin Maasoumy, Svenja Hardtke, Kerstin Port, Michael P. Manns, Heiner


Table 11. Overview of drug interactions of HCV-PIs with frequently used co-medications.

Drug class
Suspected Effect of Co-
Recommendation for
Alternatives without
administration
Management
interactions
Analgesics
Acetylsalicylic acid
Buprenorphine
Ibuprofen
Morphine
Paracetamol Pethidine
monitoring Dose adjustments may be needed Antiarrhytmics
Atenolol
Metoprolol
close/cautious monitoring (amiodarone drug levels); Should be avoided carefully titrated, starting with the lowest dosage. Close/cautious monitoring BOC: Very close/cautious monitoring (Quinidine drug levels); Should be avoided TLV: Contraindicated BOC: Should be avoided Antibiotics
Aminoglycosides
Azithromycin
Ciprofloxacin
Linezolid
Meropenem
Moxifloxacin
Rifaximin

Streptomycin
Trimethoprim/
Sulfamethoxazole
Vancomycin
Anticoagulants
Anticonvulsants
Gabapentin
Lamotrigine
Levetiracetam
Valproate
levels May alter phenobarbital levels (TLV) Antidepressants
Clomipramine
Fluvoxamine
Imipramine
Nortriptyline
monitoring Dose adjustments may be needed monitoring Dose adjustments may be needed Antifungals
Amphotericin B
Flucytosine
Daily dose of itraconazole should not exceed 200mg/d ECG) Daily dose of ketoconazole should not exceed 200mg/d Antihypertensiv
Atenolol
Furosemide
Losartan
Metoprolol
Nebivolol
Ramipril
Spironolacton
Antimigraine
Rizatriptan
Antiprotozoals
Atovaquone
Pyrimethamine
Antipsychotics/
Olanzapine
Neuroleptics
Anxiolytics/
Lorazepam
Hypnotics/
Oxazepam
Sedatives
Parenteral: Very close monitoring; lower dosage (50%); Should be avoided Erectile
Dysfunction
dose must not exceed 25 mg every 48 hours; TLV: Should be avoided monitoring; vardenafil dose must not exceed 2.5 mg every 24 hours; TLV: Should be avoided Gastrointestinal
Esomeprazole
Omeprazole
Pantoprazole
Azathioprine
suppressants
Dose adjustments needed; Very close/cautious monitoring Statines
Use statin with least
interaction (Pravastatin)
recommended; Daily dose must not exceed of 40mg; TLV: Contraindicated Steroids
Beclometasone
adjustments; Very close/cautious monitoring; Should be avoided not reliable. Use two effective non-hormonal methods. Tamsulosin
May increase
Closer/cautious
tamsulosin levels
monitoring

Increased levels = increased cmax and/or prolonged time for elimination (AUC) References: EMA. Incivo; Summary of product characteristics. 2012:

Source: http://hepatologytextbook.com/Table12_11.pdf

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