Review medications for potential drug interactions with direct-acting antiviral drugs

Direct-acting antiviral drugs for hepatitis C can have significant drug interactions. Always take a detailed medication history (including combined oral contraceptives, over-the-counter preparations and recreational drugs) and check for possible interactions before starting antiviral therapy for hepatitis C, or when making changes to the patient’s regular medications during hepatitis C therapy. The University of Liverpool HEP Drug Interactions website provides detailed information about drug interactions and advice on management.

Note: Take a detailed medication history and check for potential drug interactions before starting hepatitis C therapy.

Drug interactions between direct-acting antivirals and antiretroviral therapy for HIV infection can be challenging to manage; referral to a specialist is recommended.

Co-administration of certain drugs with direct-acting antivirals is contraindicated because of significant drug interactions; for example:

  • amiodarone with sofosbuvir
  • rifamycins with NS3/4A protease inhibitors (eg glecaprevir, grazoprevir, voxilaprevir)
  • antiepileptic drugs with many direct-acting antivirals.

However, in most cases drug interactions with direct-acting antivirals can be managed and do not preclude hepatitis C treatment. Management options for such drug interactions may include reducing the dose or temporarily withholding the interacting drug (eg statins), adjusting the timing of dosage of the interacting drug (eg proton pump inhibitors), or using an alternative drug (eg blood pressure–lowering drugs).

Note: In most cases, drug interactions with direct-acting antiviral drugs can be managed and do not preclude hepatitis C therapy.

Seek advice from an experienced pharmacist or relevant treating specialist if necessary. Inform patients that they need to seek advice before starting or stopping any medications during hepatitis C therapy.