TABLE 6.
Major interactions between HCV direct-acting antivirals and common supportive care medications in oncologya
| Medication | Sofosbuvir | Sofosbuvir-ledipasvir | Sofosbuvir-velpatasvir | Ritonavir-boosted paritaprevir-ombitasvir-dasabuvir | Grazoprevir-elbasvir | Daclatasvir | Simeprevir | Ribavirinb |
|---|---|---|---|---|---|---|---|---|
| Acid-reducing agents | ||||||||
| H2 antagonist | ◆ | ■ | ■ | ◆ | ◆ c | ◆ | ◆ | ◆ |
| Proton pump inhibitor | ◆ | ■ | ● | ■ c | ◆ c | ◆ | ◆ c | ❖ |
| Anticoagulant | ||||||||
| Apixaban | ◆ | ■ | ■ | ● | ■ | ■ | ■ | ◆ |
| Dabigatran | ◆ | ■ | ■ | ■ | ■ | ■ | ■ | ◆ |
| Edoxaban | ◆ | ■ | ◆ | ■ | ■ | ■ | ■ | ◆ |
| Rivaroxaban | ◆ | ■ | ■ | ● | ■ | ■ | ■ | ◆ |
| Warfarin | ■ c | ■ c | ■ c | ■ c | ◆ | ◆ | ■ c | ■c |
| Antiemetic | ||||||||
| Aprepitant | ◆ | ◆ | ◆ | ■ | ◆ | ■ | ■ | ◆ |
| Antifungals | ||||||||
| Fluconazole | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ● | ❖ |
| Isavuconazole | ▲ | ▲ | ▲ | ▼ | ▲ | ▲ | ▼ | ▲ |
| Posaconazole | ◆ | ◆ | ◆ | ● | ◆ | ■ | ● | ❖ |
| Voriconazole | ◆ | ◆ | ◆ | ● | ◆ | ■ | ● | ❖ |
| Bisphosphonate | ||||||||
| Pamidronate | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ |
| Immunosuppressants | ||||||||
| Cyclosporine | ◆ c | ◆ | ◆ | ■ c | ● c | ◆ c | ● c | ❖ |
| Mycophenolate | ◆ | ◆ | ◆ | ■ | ◆ c | ◆ | ◆ | ◆ |
| Sirolimus | ◆ | ◆ | ◆ | ■ | ■ | ◆ | ■ | ❖ |
| Tacrolimus | ◆ c | ◆ | ◆ | ■ c | ■ c | ◆ c | ■ c | ❖ |
| Growth factor | ||||||||
| Eltrombopag | ◆ | ◆ | ◆ | ◆ | ● | ■ | ■ | ❖ |
| Filgrastim | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ◆ | ❖ |
| Steroids | ||||||||
| Dexamethasone | ◆ | ■ | ◆ | ■ | ■ | ● | ● | ❖ |
| Methylprednisolone | ◆ | ◆ | ◆ | ■ | ◆ | ◆ | ■ | ❖ |
| Prednisone | ◆ | ◆ | ◆ | ■ | ◆ c | ◆ | ◆ | ❖ |
H2, histamine 2 receptor.
Table does not include all supportive care medications in oncology. Drug interactions are based on metabolism and clearance data rather than direct study of co-administration except where otherwise indicated. Symbols used to rank 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.176–178,187
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 |