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Titles listDirect-acting antiviral interactions with opioids, alcohol or illicit drugs of abuse in HCV-infected patients
Titles listDirect-acting antiviral interactions with opioids, alcohol or illicit drugs of abuse in HCV-infected patients
Scientific Article - Review
unige:134724 
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Direct-acting antiviral interactions with opioids, alcohol or illicit drugs of abuse in HCV-infected patients |
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| Authors | ||
| 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 | Alcohol — Direct-acting antivirals — Drug-drug interaction — Opioids — Stimulants — Substance abuse | |
| Identifiers | DOI: 10.1111/liv.14283 PMID: 31654604 | |
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| Research group | Groupe Desmeules Jules (pharmacologie/toxicologie) (567) | |
| Citation (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 |
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