UNIGE document Scientific Article - Review
previous document  unige:134724  next document
add to browser collection

Direct-acting antiviral interactions with opioids, alcohol or illicit drugs of abuse in HCV-infected patients

Published in Liver international. 2020, vol. 40, no. 1, p. 32-44
Abstract The hepatitis C virus (HCV) prevalence is extremely high in patients who consume and inject illicit drugs. Concerns about poor adherence and fear of interaction with drugs of abuse could constitute further disincentive for treatment initiation in these patients. We discussed the pharmacokinetics (PKs) and pharmacodynamics (PD) of currently prescribed direct antiviral agents (NSA5 inhibitors: daclatasvir, elbasvir, ledipasvir, pibrentasvir, velpatasvir; NS5B inhibitor: sofosbuvir; NS3/4A protease inhibitors: glecaprevir, grazoprevir, voxilaprevir) and most common substances of abuse (opioids: buprenorphine, fentanyl, heroin, methadone, morphine, oxycodone; stimulants: amphetamines, cathinones, cocaine; cannabinoids; ethanol). Overall, most direct-acting antivirals (DAAs) are substrates and inhibitors of the transmembrane transporter P-glycoprotein (P-gp), and several of them are metabolized by cytochrome P450 enzymes. Clinically relevant interactions are associated with P-gp and CYP3A modulators. Most substances of abuse are eliminated by Phase I and Phase II metabolizing enzymes, but none of them are either major inhibitors or inducers. PK studies did not show any relevant interactions between DAA and methadone or buprenorphine. Based on pharmacological considerations, neither efficacy loss nor adverse drug event associated with detrimental interaction are expected with opioids, stimulants, cannabinoids and ethanol. In summary, our literature review shows that the interaction potential of DAA with most opioids and illicit drugs is limited and should not be a hurdle to the initiate DAA.
Keywords AlcoholDirect-acting antiviralsDrug-drug interactionOpioidsStimulantsSubstance abuse
PMID: 31654604
Full text
Article (Published version) (731 Kb) - public document Free access
Research group Groupe Desmeules Jules (pharmacologie/toxicologie) (567)
(ISO format)
ING LORENZINI, Kuntheavy, GIRARDIN, François. Direct-acting antiviral interactions with opioids, alcohol or illicit drugs of abuse in HCV-infected patients. In: Liver International, 2020, vol. 40, n° 1, p. 32-44. doi: 10.1111/liv.14283 https://archive-ouverte.unige.ch/unige:134724

197 hits



Deposited on : 2020-04-17

Export document
Format :
Citation style :