Table 1.

Selected drugs that should be used with caution in subjects receiving boceprevir or telaprevir based antiviral treatment

Drug Class	Effect on concomitant drug bioavailability (Clinical impact)	Alternative agent(s) and management
Macrolide antibiotics
Clarithromycin Erythromycin Telithromycin	Increased (QT prolongation; Torsade de Pointes)	Amoxicillin Cefazolin Clindamycin Trimethoprim/sulfamethoxazole Ciprofloxacin Levofloxacin Metronidazole
Antidepressants
Escitalopram*	Decreased (Decreased efficacy)	Citalopram Sertraline Venalfaxine Duloxetine
Trazodone Despiramine**	Increased (Dizziness, hypotension, nausea)	As above Use lower dose of trazodone
Anti-fungals
Itraconazole Ketoconazole Posaconazole Voriconazole ***	Increased (QT prolongation, diarrhea, vomiting)	Ketoconazole dose not to exceed 200 mg/day Fluconazole Micafungin Caspofungin
Calcium channel blockers
Amlodipine Diltiazem Nicardipine Nifedipine Verapamil	Increased (Hypotension, bradycardia)	Consider amlodipine dose reduction Metoprolol, atenolol Hydrochlorothiazide Lisinopril, benazepril Losartan, valsartan Clonidine
Immunosuppressants
Cyclosporine Everolimus Sirolimus Tacrolimus	Increased (Nephrotoxicity, hypertension, neurotoxicity)	Significant dose reductions and close monitoring of drug levels
Prednisone Methylprednisolone	Increased (hyperglycemia, osteoporosis, insomnia)	Risk verses benefit Use lowest effective dose.
Anti-arrhtymic
Amiodarone Propafenone Lidocaine Quinidine	Increased (Proarrhtymic)
Digoxin	Increased (Digoxin toxicity)	Use lowest dose and monitor digoxin levels.

^*Only reported with TPV

^**Only reported with BOC

^***Not recommended to be used with TPV. TPV co-administration may increase or decrease voriconazole.

Adapted from boceprevir and telaprevir package insert (26, 27)

Please consult package inserts for complete list of known drug interactions and recommended management.