TABLE 4.
Major interactions between HCV direct-acting antivirals and standard chemotherapy drugsa
| Chemotherapy drug | Sofosbuvir | Sofosbuvir-ledipasvir | Sofosbuvir-velpatasvir | Ritonavir-boosted paritaprevir-ombitasvir-dasabuvir | Grazoprevir-elbasvir | Daclatasvir | Simeprevir | Ribavirinb |
|---|---|---|---|---|---|---|---|---|
| Alkylating agents | ||||||||
| Chlorambucil | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ |
| Cyclophosphamide | ▲ | ▲ | ▲ | ▼ | ▲ | ▲ | ▲ | ▲ |
| Antifolate | ||||||||
| Methotrexate | ◆ | ◆ | ■ | ◆ | ■ | ■ | ◆ | ■ |
| Antitumor antibiotics | ||||||||
| Doxorubicin | ◆ | ■ | ■ | ■ | ■ | ■ | ■ | ◆ |
| Idarubicin | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ c |
| Cytidine analog | ||||||||
| Gemcitabine | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ■ |
| 5-Fluoropyrimidine | ||||||||
| Capecitabine | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ■ |
| Microtubule agents | ||||||||
| Docetaxel | ▲ | ▼ | ▼ | ▼ | ▼ | ▼ | ▼ | ▲ |
| Paclitaxel | ▲ | ▼ | ▼ | ▼ | ▼ | ▼ | ▼ | ▲ |
| Platinum analogs | ||||||||
| Carboplatin | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ |
| Cisplatin | ◆ | ◆ | ◆ | ■ | ◆ | ◆ | ◆ | ◆ |
| Oxaliplatin | ◆ | ◆ | ◆ | ■ | ◆ | ◆ | ◆ | ◆ |
| Purine antimetabolites | ||||||||
| Fludarabine | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ |
| Mercaptopurine | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ● c |
| Topoisomerase I/II inhibitors | ||||||||
| Etoposide | ◆ | ◆ | ◆ | ■ | ◆ | ◆ | ■ | ◆ |
| Irinotecan | ◆ | ■ | ■ | ■ | ■ | ■ | ■ | ◆ |
| Topotecan | ▲ | ▲ | ▼c | ▲ | ▼ | ▼ | ▲ | ▲ |
| Vinca alkaloids | ||||||||
| Vinblastine | ◆ | ◆ | ◆ | ■ | ◆ | ◆ | ■ | ◆ |
| Vincristine | ◆ | ◆ | ◆ | ■ | ◆ | ◆ | ■ | ◆ |
| Vinorelbine | ◆ | ■ | ■ | ■ | ■ | ■ | ■ | ◆ |
Table does not include all chemotherapeutic agents. Drug interactions are based on metabolism and clearance data rather than direct study of co-administration except where otherwise indicated. Symbols used to indicate clinical significance of drug interactions are based on HEP Drug Interactions (www.hep-druginteractions.org; University of Liverpool), Lexicomp Online (Hudson, Ohio: Lexi-Comp, Inc.; November 2016), and medication package inserts. For additional drug-drug interactions and more extensive range of drugs, detailed pharmacokinetic interaction data, and dosage adjustments, refer to the above-mentioned websites, medication package inserts, and specific references.172,173,179
Ribavirin is often used in combination with DAAs; therefore, it is included to provide a comprehensive drug-drug interaction overview.
Co-administration studied directly.
Legend
| ◆ | No clinically significant interaction expected |
| ■ | Potential interaction that may require a dosage adjustment, altered timing of administration, or additional monitoring |
| ● | These drugs should not be co-administered |
| ▲ | Not included in HEP Drug Interactions; however, metabolism and clearance data suggest that an interaction is unlikely |
| ▼ | Not included in HEP Drug Interactions; however, metabolism and clearance data suggest that an interaction may occur |