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Copyright ©The Author(s) 2019.
World J Gastroenterol. Dec 21, 2019; 25(47): 6799-6812
Published online Dec 21, 2019. doi: 10.3748/wjg.v25.i47.6799
Table 2 Drug-drug interactions among direct-acting antivirals and calcineurin inhibitors
Cyclosporine (CSA)Tacrolimus (TAC)Sirolimus (SRL)Everolimus (EVR)
Sofosbuvir (SOF)4.5-fold ↑ in SOF AUC No dose adjustment necessary13% ↑ in SOF AUC No dose adjustment necessaryNot studied, no interaction expected No dose adjustment necessaryNot studied, no interaction expected No dose adjustment necessary
LedipasvirNot studied, no interaction expectedNot studied, no interaction expectedNot studied, no interaction expectedNot studied, may increase EVR concentrations due to mild inhibition of P-gp by ledipasvir
Paritaprevir / ritonavir / ombitasvir + dasabuvir (PrOD)5.8-fold ↑ in CSA AUC Modeling suggests using 1/5 of CSA dose during PrOD treatment Frequent monitoring necessary57-fold ↑ in TAC AUC Modeling suggests TAC 0.5 mg every 7 days during PrOD treatment38-fold ↑ in SRL AUC Do NOT co-administer27.1-fold ↑ in EVR AUC Do NOT co-administer
Elbasvir / grazoprevir (EBR/GZR)15-fold ↑ in GZR AUC and 2-fold ↑ in EBR AUC Do NOT co-administer43% ↑ in TAC AUC No a priori dose adjustment necessaryNot studied, may increase SRL concentrations due to mild inhibition of P-gp by elbasvirNot studied, may increase EVR concentrations due to mild inhibition of P-gp by elbasvir
VelpatasvirNo interaction observed; no a priori dose adjustment necessaryNo data; no a priori dose adjustment necessaryNo data; no a priori dose adjustment necessaryNot studied, may increase EVR concentrations due to mild inhibition of P-gp by velpatasvir
Glecaprevir / pibrentasvir (GLE/PIB)5-fold ↑ in GLE AUC with higher doses (400 mg) of CSA Not recommended in patients requiring stable CSA doses > 100 mg/day1.45-fold ↑ in TAC AUC No a priori dose adjustment, monitor TAC levels and titrate TAC dose as neededNot studied, may increase SRL concentrations due to mild inhibition of P-gp by pibrentasvirNot studied, may increase EVR concentrations due to mild inhibition of P-gp by pibrentasvir
Sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX)9.4-fold ↑ in VOX AUC Do NOT co-administerNo data; no a priori dose adjustmentNot studied, may increase SRL concentrations due to mild inhibition of P-gp by velpatasvir and voxilaprevirNot studied, may increase EVR concentrations due to mild inhibition of P-gp by velpatasvir and voxilaprevir