Table 2.

Drug–drug interactions with sofosbuvir/velpatasvir combination regimen

Medication	Recommendations
Rifampin, rifabutin, rifapentein	Not recommended.
Statins	Rosuvastatin dose should be 10 mg daily while on combination therapy.
Phenytoin, phenobarbital, carbamazepine, oxcarbazepine	Not recommended.
Histamine receptor blockers and PPIs	PPIs effect decreased when SOF/VEL is given with food. Can use omeprazole 20 mg 4 hours after taking SOF/VEL. Other PPIs have not been studied. Use famotidine 40 mg twice daily or comparable dose with other H2 receptor blockers.
Efavirenz	Not recommended as can decrease efficacy of combination regimen.
Digoxin	Has narrow therapeutic index; needs to be monitored.
Oral contraceptives	Can be administered concomitantly.
Etravirine, nevirapine rilpivirine, rilpivirine	No dose adjustment needed.
Dolutegravir, elvitegravir/cobicistat/tenofovir alafenamide/emtricitabine combination, raltegravir, rlvitegravir/cobicistat/tenofovir disoproxil fumarate/emtricitabine	No dosage adjustment needed. With tenofovir, monitor for renal side effects as SOF/VEL combination can potentially increase tenofovir levels.
Herbal products – St John’s Wort	Not recommended as can decrease efficacy of combination regimen.
Amiodarone	Not recommended as can cause significant bradycardia if used concurrently. Cardiac monitoring is recommended if needs to be used.
Antacids	Separate antacids and SOF/VEL administration by 4 hours.

Abbreviations: SOF/VEL, sofosbuvir/velpatasvir; PPIs, proton pump inhibitors.