OLYSIO (simeprevir), DAKLINZA (daclatasvir) and ZEPATIER (grazoprevir/elbasvir) labels were updated to include information pertaining to changes in International Normalized Ratio (INR) values in patients receiving warfarin.
Section 7: DRUG INTERACTIONS was updated to state fluctuations in INR values may occur in patients receiving warfarin concomitant with HCV treatment. Frequent monitoring of INR values is recommended during treatment and post-treatment follow-up.
INR should be monitored closely during treatment of chronic hepatitis C with direct-acting antivirals in patients also receiving vitamin K antagonists (eg, warfarin), because of possible changes in liver function during treatment.
Advice for healthcare professionals:
changes in liver function due to treatment with direct-acting antivirals for chronic hepatitis C infection may result in fluctuations of INR values in patients taking vitamin K antagonists
in these patients, INR should be monitored closely and, if necessary, anticoagulant therapy adjusted
Note: This is a bit alarmist but important information. Everyone with HIV and hepatitis C coinfection should be managed by both a liver specialist and an HIV specialist who is aware of potential drug-drug interactions (DDIs). If you are a patient being treated with these drugs always speak up and ask your medical providers to check for DDIs the medicians. Actually, whenever receiving a new medication always check with your physician, pharmacy or check the drug package insert for information about DDIs. Alan
Hepatitis C virus (HCV) drugs may clash with HIV drugs, causing adverse events in individuals who use them together.
In a study published in the Journal of Hepatology, investigators found that the HCV drug, sofosbuvir (Sovaldi), can adversely interact with the HIV drug, tenofovir disoproxil (Viread). Both drugs are manufactured and sold by Gilead Sciences Inc.
“Sovaldi has become a standard of hepatitis C therapy since its approval in December 2013,” said investigator Bingfang Yan.