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

Details

Serval ID
serval:BIB_05EDEEAF88CB
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Title
Direct-acting antiviral interactions with opioids, alcohol or illicit drugs of abuse in HCV-infected patients
Journal
Liver Int
Author(s)
Ing Lorenzini K., Girardin F.
ISSN
1478-3231 (Electronic)
ISSN-L
1478-3223
Publication state
Published
Issued date
01/2020
Volume
40
Number
1
Pages
32-44
Language
english
Notes
Ing Lorenzini, Kuntheavy
Girardin, Francois
eng
Review
Liver Int. 2020 Jan;40(1):32-44. doi: 10.1111/liv.14283. Epub 2019 Nov 12.
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
Pubmed
Create date
10/02/2021 12:32
Last modification date
11/02/2021 7:26
Usage data