The pharmacological interactions between direct-acting antivirals for the treatment of chronic hepatitis c and psychotropic drugs

ABSTRACT

Introduction: Most direct-acting antivirals (DAAs) and psychotropic drugs are metabolized by or induct/inhibit CYP enzymes and drug transporters. Although they are frequently coadministered, the drug–drug interactions (DDIs) have been little studied. Therefore, the aim of this review is to describe the interactions between the approved DAA or combination regimens and the main psychoactive substances, including legal and illegal drugs of abuse.

Areas covered: We performed a literature search on PubMed database on drug interactions with the currently available antivirals for hepatitis C and a review of the information on pharmacokinetics, metabolism, and drug interactions from www.hep-druginteractions.org and from all the Summary of Product Characteristics (SmPC). This review covers the DDI between the DAA regimens approved, such as simeprevir and sofosbuvir, paritaprevir, glecaprevir, voxilaprevir, ombitasvir, ledipasvir, daclatasvir and sofosbuvir, elbasvir and grazoprevir, sofosbuvir and velpatasvir, glecaprevir/pibrentasvir, sofosbuvir and velpatasvir, and main psychotropic agents.

Expert Commentary: DAA regimens based on sofosbuvir combination usually have less DDI than protease inhibitor-based regimens. Among protease inhibitors regimens, new combinations, such as glecaprevir/elbasvir and grazoprevir/elbasvir, seemed to have less DDI than the combination POrD (paritaprevir/ombitasvir/ritonavir/dasabuvir). However, the analysis of each interaction is theoretical and further interaction studies would be necessary to confirm actual effect.

KEYWORDS:

• Antivirals
• analgesics
• anticonvulsants
• antidepressants
• antipsychotics
• anxiolytics
• daclatasvir
• dasabuvir
• direct-acting
• drug–drug abuse
• drug interactions
• elbasvir
• grazoprevir
• hepatitis C
• paritaprevir
• ombitasvir
• ledipasvir
• psychotropic drugs
• simeprevir
• sofosbuvir
• velpatasvir
• voxilaprevir

Declaration of interest

C Roncero has received fees to give lectures for Janssen-Cilag, Ferrer-Brainfarma, Pfizer, Indivior, Lundbeck, Otsuka, Servier, GSK, Rovi, Astra, Gilead, MSD, Sanofi and Exceltis. He has received financial compensation for his participation as a board member of the Janssen-Cilag, Lundbeck, Gilead, MSD, Mundipharma, Indivior, Exceltis and Martindole board. He has carried out the PROTEUS project, which was funded by a grant from Reckitt-Benckisert/Indivior. He received two medical education grants by Gilead. M Martínez-Rebollar has received fees to give lectures from Gilead, MSD, VIIV, Abvvie and Janssen-Cilag. M Buti has received fees to give lectures for MSD, Gilead and Abbvie. She has received financial compensation for her participation as a board member of MSD, Gilead and Abbvie. She received a medical education grant by Gilead. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Medical writing and editorial assistance was provided by Content Ed Net (Madrid, Spain) and Irene Perucho.

Additional information

Funding

Medical writing and editorial assistance was funded by Merck Sharp & Dohme Spain.