TABLE 5.
Major interactions between HCV direct-acting antivirals and monoclonal antibodies, targeted chemotherapy, and endocrine therapya
| Drug | Sofosbuvir | Sofosbuvir-ledipasvir | Sofosbuvir-velpatasvir | Ritonavir-boosted paritaprevir-ombitasvir-dasabuvir | Grazoprevir-elbasvir | Daclatasvir | Simeprevir | Ribavirinb |
|---|---|---|---|---|---|---|---|---|
| Endocrine agents | ||||||||
| Anastrozole | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ |
| Exemestane | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ |
| Letrozole | ◆ | ◆ | ◆ | ■ | ◆ | ◆ | ■ | ◆ |
| Tamoxifen | ◆ | ◆ | ◆ | ■ | ◆ | ◆ | ■ | ◆ |
| HDAC inhibitors | ||||||||
| Vorinostat | ▲ | ▲ | ▲ | ▲ | ▲ | ▲ | ▲ | ▲ |
| Romidepsin | ▲ | ▼ | ▼ | ▼ | ▼ | ▼ | ▼ | ▲ |
| Immunotherapy | ||||||||
| Ipilimumab | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ |
| Nivolumab | ▲ | ▲ | ▲ | ▲ | ▲ | ▲ | ▲ | ▲ |
| Tocilizumab | ▲ | ▲ | ▲ | ▲ | ▲ | ▼ | ▼ | ▲ |
| Immunomodulators | ||||||||
| Lenalidomide | ▲ | ▼ | ▼ | ▼ | ▼ | ▼ | ▼ | ▲ |
| Thalidomide | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ❖ c |
| Monoclonal antibodies | ||||||||
| Rituximab | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ |
| Brentuximab | ▲ | ▲ | ▲ | ▲ | ▲ | ▲ | ▲ | ▲ |
| mTOR kinase inhibitor | ||||||||
| Everolimus | ◆ | ■ | ■ | ■ | ■ | ■ | ■ | ◆ |
| Proteasome inhibitor | ||||||||
| Bortezomib | ◆ | ◆ | ◆ | ■ | ◆ | ◆ | ■ | ◆ |
| TKIs | ||||||||
| Dasatinib | ◆ | ◆ | ◆ | ■ | ◆ | ■ | ■ | ◆ |
| Erlotinib | ◆ | ■ | ■ | ● | ■ | ■ | ■ | ◆ |
| Gefitinib | ◆ | ◆ | ◆ | ■ | ◆ | ◆ | ■ | ◆ |
| Imatinib | ◆ | ◆ | ■ | ■ | ■ | ◆ | ■ | ❖ c |
| Lapatinib | ◆ | ■ | ■ | ■ | ■ | ■ | ■ | ◆ |
| Nilotinib | ◆ | ◆ | ■ | ■ | ■ | ■ | ■ | ◆ |
| Ponatinib | ▲ | ▲ | ▼ | ▼ | ▼ | ▲ | ▼ | ▲ |
| Sorafenib | ◆ | ◆ | ◆ | ■ | ◆ | ◆ | ■ | ❖ c |
| Sunitinib | ◆ | ◆ | ◆ | ■ | ◆ | ◆ | ■ | ◆ |
HDAC, histone deacetylase; mTOR, mammalian target of rapamycin; TKI, tyrosine kinase inhibitor.
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 references170,171,173–175.
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 clear data |
| ◆ | 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 |