Background and importance Co-administration of direct-acting antivirals (DAA) with strong cytochrome P-450 (CYP)-inducing drugs, such as some antiepileptic medications, is contraindicated because it can result in loss of efficacy and virological failure.
The majority of interactions between DAA and the concomitant medication are manageable since the interacting drug can temporarily be stopped or substituted. However, there is usually some reluctance to modify chronic antiepileptic therapy in patients with well-controlled seizures.
This case report contributes to the limited literature regarding co-administration of sofosbuvir/velpatasvir and antiepileptic drugs since there are only two reported cases.1
Aim and objectives The objective was to assess the efficacy of sofosbuvir/velpatasvir for 12 weeks in a patient taking the strong CYP-inducing drugs carbamazepine and phenobarbital.
Material and methods Descriptive and retrospective clinical case. Data were obtained by review of electronic medical records.
Results A 54-year-old woman was diagnosed with chronic hepatitis C infection. Ultrasound transient elastography showed F3 stage liver fibrosis and she was naïve to hepatitis C antiviral agents. The patient was receiving treatment with carbamazepine, clonazepam, phenobarbital, topiramate, folic acid and omeprazole.
The use of the pangenotypic antivirals glecaprevir/pibrentasvir and sofosbuvir/velpatasvir was contraindicated with carbamazepine and phenobarbital. Elbasvir/grazoprevir was also contraindicated.
It was recommended not to stop or change the patient’s anticonvulsant drugs, so it was decided to commence treatment with sofosbuvir/velpatasvir for 12 weeks with viral load measurement at 4 weeks, 12 weeks and 24 weeks post-treatment initiation. Treatment success was defined as an undetectable hepatitis C virus RNA level 24 weeks post-treatment initiation, that is, 12 weeks after completion of therapy (sustained virologic response, SVR12).
Concomitant use of omeprazole can reduce sofosbuvir and velpatasvir concentrations, so omeprazole was administered 4 hours after the antiviral drug.
Treatment adherence to sofosbuvir/velpatasvir was correct according to the dispensing records. No adverse effects were reported during antiviral therapy, and the patient has remained seizure-free.
Viral load was undetectable at every point of measurement and SVR12 was achieved.
Conclusion and relevance Sofosbuvir/velpatasvir administered for 12 weeks in a patient receiving treatment with carbamazepine and phenobarbital achieved SVR12 despite the enzyme-inducing effect of these antiepileptic drugs on the hepatitis C antiviral concentrations.
References and/or acknowledgements 1. Marcos-Fosch C, et al. Anti-epileptic drugs and hepatitis C therapy: real-world experience. J Hepatol 2021;75(4):984–985.
Conflict of interest No conflict of interest
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