Table 2.
Paritaprevir/ritonavir-ombitasvir and dasabuvir drug–drug interactions
| Drug class | Drug(s) within the class | Comment |
|---|---|---|
| Alpha1-adrenoreceptor antagonist | Alfuzosin HCl | Contraindicated due to risk of hypotension |
| Anti arrhythmics | Amiodarone, bepridil, disopyramide, flecainide, lidocaine (systemic), mexiletine, propafenone, quinidine | ↑ Concentration of anti arrhythmics TDM recommended when available |
| Anticonvulsants | Carbamazepine, phenytoin, phenobarbital | Contraindicated as ↓ PrOD exposure |
| Antifungals | Ketoconazole | Maximum daily dose of ketoconazole 200/day |
| Voriconazole | Contraindicated due to ↓ voriconazole | |
| Antihyperlipidemic agent | Gemfibrozil | Contraindicated due to ↑ dasabuvir |
| Antimycobacterial | Rifampin | Contraindicated as ↓ PrOD exposure |
| Calcium channel blockers | Amlodipine | Reduce amlodipine by 50% |
| Avoid felodipine and nisoldipine | ||
| Corticosteroids (inhaled) | Fluticasone | Reduced serum concentrations of cortisol |
| Consider alternative corticosteroids | ||
| Ergot derivatives | Ergotamine, dihydroergotamine, ergonovine, methylergonovine | Contraindicated due to risk of ergot toxicity |
| Herbal product | St John’s Wort (Hypericum perforatum) | Contraindicated as ↓ PrOD exposure |
| HIV-antivirals | Atazanavir, atazanavir/r | Unboosted atazanavir 300 mg daily acceptable |
| Darunavir/r | ↓ Darunavir trough – not recommended | |
| Lopinavir/r | ↑ GI side effects of lopinavir and ↓ paritaprevir – not recommended | |
| Efavirenz | ↑ Adverse events with efavirenz – not recommended | |
| Rilpivirine | ↑ Rilpivirine and may prolong QTC interval – not recommended | |
| HMG-CoA reductase | Lovastatin, simvastatin | Contraindicated |
| Pravastatin, rosuvastatin | Dosage reduction recommended | |
| Immunosuppressants | Cyclosporine | Significant ↑ in Cyclosporine levels |
| ↓ Cyclosporine dose to 20% of current dose and monitor blood concentrations | ||
| Tacrolimus | Significant ↑ in tacrolimus exposure requiring dosage adjustment. Typical dose is 0.5 mg every 7 days | |
| Neuroleptics | Pimozide | Contraindicated due to risk of QTC prolongation |
| Oral contraceptives | Ethinyl estradiol/norgestimate | Contraindicated |
| ↓ Paritaprevir/ritonavir and dasabuvir concentration | ||
| Elevated LFTs | ||
| PDE5 inhibitor | Sildenafil when dosed for the treatment of pulmonary arterial hypertension | Contraindicated due to ↓ sildenafil exposure |
| Proton pump inhibitors | Omeprazole | ↓ Omeprazole concentration |
| Avoid >40 mg/day of omeprazole | ||
| Sedatives/hypnotics | Triazolam; orally administered midazolam | Contraindicated due to ↑ risk of side effects, sedation, and respiratory depression |
Abbreviations: LFTs, liver function tests; PrOD, Paritaprevir/ritonavir-ombitasvir and dasabuvir; TDM, therapeutic drug monitoring; GI, gastrointestinal.