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ARTICLE

Epclusa: What Have We Learned?

JAN 01, 2017 | AMANDA BINKLEY, PHARMD, AAHIVP, AND ASHLEY SHERIDAN, PHARMD

CONCLUSION 

Sofosbuvir/velpatasvir is the first DAA combination tablet that is FDA-approved for treatment of chronic HCV genotypes 1 through 6. The approval of this combination tablet opens the door for patients with all genotypes to receive antiviral treatment with a very efficacious, welltolerated, once-daily therapy. Sofosbuvir/velpatasvir can be used alone or in combination with ribavirin (for those with decompensated cirrhosis) in all genotypes for a total of 12 weeks. The ability to treat all HCV genotypes, with or without cirrhosis, with an efficacious and well-tolerated medication for 12 weeks increases the treatment options for patients throughout the world who are chronically infected with HCV to decrease their risk of liver disease progression and increase the numbers of those who achieve cure.
 
Table. Common Drug-Drug Interactions with Sofosbuvir/Velpatasvir, Effect on Drug Concentration, and Recommendations10 
 
DRUG NAME EFFECT ON CONCENTRATION RECOMMENDATION
Antacids
  • velpatasvir
Separate the administration of sofosbuvir/ velpatasvir and antacids by four hours.
Histamine-2 (H2) antagonists
  • velpatasvir

Sofosbuvir/velpatasvir can be administered with or 12 hours apart from H2 antagonists. Doses administered must not exceed doses comparable to famotidine 40 mg twice daily.
 
Proton pump inhibitors (PPIs)
  • velpatasvir
Not recommended to co-administer with PPIs. If it is deemed medical necessary, sofosbuvir/velpatasvir should be administered with food and taken four hours before omeprazole 20 mg. Sofosbuvir/velpatasvir use with other PPIs has not been studied.
Amiodarone Unknown effect on concentrations of amiodarone, sofosbuvir, and velpatasvir Serious bradycardia can result with co-administration with amiodarone, so it is not recommended. However, if required, cardiac monitoring is recommended.
Digoxin
  • digoxin
If co-administration required, therapeutic monitoring of digoxin is recommended.
Tenofovir disoproxil fumarate
  • tenofovir
Patients receiving sofosbuvir/velpatasvir and HIV regimens containing tenofovir should be monitored for tenofovir-associated adverse reactions.
St. John’s wort
  • sofosbuvir
  • velpatasvir
Not recommended to be co-administered with sofosbuvir/velpatasvir.
Rosuvastatin
  • rosuvastatin
Sofosbuvir/velpatasvir may be co-administered with rosuvastatin when doses of rosuvastatin do not exceed 10 mg. An increase in the risk of myopathy can occur when there are increased concentrations of rosuvastatin.
Atorvastatin
  • atorvastatin
Closely monitor for adverse reactions, such as, myopathy and rhabdomyolysis.
Topotecan
  • topotecan
Not recommended to be co-administered with sofosbuvir/velpatasvir.
Carbamazepine, phenytoin, phenobarbital, oxcarbazepine
  • sofosbuvir
  • velpatasvir
Not recommended to be co-administered with sofosbuvir/velpatasvir.
Rifabutin, rifampin, rifapentine
  • sofosbuvir
  • velpatasvir
Not recommended to be co-administered with sofosbuvir/velpatasvir.
Efavirenz
  • velpatasvir
Not recommended to be co-administered with sofosbuvir/velpatasvir.
 

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