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Dasabuvir / ombitasvir / paritaprevir / ritonavir Disease Interactions

There are 8 disease interactions with dasabuvir / ombitasvir / paritaprevir / ritonavir:

Major

Dasabuvir (Includes Dasabuvir/ombitasvir/paritaprevir/ritonavir) ↔ Liver Impairment

Severe Potential Hazard, Moderate plausibility

Applies to: Liver Disease

The use of dasabuvir is contraindicated in patients with moderate to severe hepatic impairment (Child-Pugh B and C).

Major

Dasabuvir – Hepatitis B Reactivation

Severe Potential Hazard, Moderate plausibility

Applies to: Infectious Hepatitis

The use of dasabuvir is associated with hepatitis B reactivation, some cases have resulted in fulminant hepatitis, hepatic failure, and death, in HCV/HBV coinfected patients. Screening for current or prior viral hepatitis B/C infection should be performed per published guidelines before starting therapy with this agent. It is recommended to monitor patients coinfected with HCV/HBV for hepatitis flare or HBV reactivation during and after HCV therapy. Prescribers should exercise caution when using dasabuvir in patients previously infected with HBV/HCV. Initiate appropriate patient management for HBV infection as clinically indicated.

Major

Pis (Includes Dasabuvir/ombitasvir/paritaprevir/ritonavir) ↔ Hemophilia

Severe Potential Hazard, Low plausibility

Applies to: Coagulation Defect

There have been postmarketing reports of increased bleeding, including spontaneous skin hematomas and hemarthrosis, in types A and B hemophiliac patients treated with protease inhibitors. However, a causal relationship has not been established. In some patients, additional Factor VIII was given. In more than half of the reported cases, protease inhibitor therapy was continued or reintroduced following an interruption. Hemophiliacs and patients with other coagulation defects should be monitored closely for bleeding during protease inhibitor therapy.

References

  1. "Product Information. Crixivan (indinavir)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Kaletra (lopinavir-ritonavir)" Abbott Pharmaceutical, Abbott Park, IL.
  3. "Product Information. Viracept (nelfinavir)." Agouron Pharma Inc, La Jolla, CA.
  4. "Product Information. Invirase (saquinavir)." Roche Laboratories, Nutley, NJ.
  5. "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Agenerase (amprenavir)." Glaxo Wellcome, Research Triangle Pk, NC.
  7. "Product Information. Aptivus (tipranavir)." Boehringer-Ingelheim, Ridgefield, CT.
  8. "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. Lexiva (fosamprenavir)." GlaxoSmithKline, Research Triangle Park, NC.
  10. "Product Information. Fortovase (saquinavir)" Roche Laboratories, Nutley, NJ.
View all 10 references
Major

Ritonavir (Includes Dasabuvir/ombitasvir/paritaprevir/ritonavir) ↔ Hepatotoxicity

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Hepatotoxicity, including jaundice, hepatitis and hepatic transaminase elevations exceeding five times the upper limit of normal, has been reported in patients receiving ritonavir alone and in combination with nucleoside reverse transcriptase inhibitors or other protease inhibitors. In addition, ritonavir is primarily metabolized by the liver and may accumulate in patients with hepatic impairment. Therapy with ritonavir should be administered cautiously in patients with preexisting liver disease, liver enzyme abnormalities, or hepatitis. Ritonavir is not recommended for patients with severe hepatic impairment.

References

  1. Danner SA, Carr A, Leonard JM, Lehman LM, Gudiol F, Gonzales J, Raventos A, Rubio R, Bouza E, Pintado V, et al "A short-term study of the safety, pharmacokinetics, and efficacy of ritonavir, an inhibitor of HIV-1 protease. European-Australian Collaborative Ritonavir Study Group." N Engl J Med 333 (1995): 1528-33
  2. Markowitz M, Saag M, Powderly WG, Hurley AM, Hsu A, Valdes JM, Henry D, Sattler F, La Marca A, Leonard JM, et al "A preliminary study of ritonavir, an inhibitor of HIV-1 protease, to treat HIV-1 infection." N Engl J Med 333 (1995): 1534-9
  3. Sommadossi JP "HIV protease inhibitors: pharmacologic and metabolic distinctions." AIDS 13 (1999): s29-40
  4. Pai VB, Koranyi K, Nahata MC "Acute hepatitis and bleeding possibly induced by zidovudine and ritonavir in an infant with HIV infection." Pharmacotherapy 20 (2000): 1135-40
  5. "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical, Abbott Park, IL.
View all 5 references
Moderate

Dasabuvir (Includes Dasabuvir/ombitasvir/paritaprevir/ritonavir) ↔ Cirrhosis

Moderate Potential Hazard, Moderate plausibility

Applies to: Cirrhosis

Hepatic decompensation and hepatic failure, including liver transplantation or fatal outcomes, have been reported in patients with cirrhosis treated with dasabuvir. Therapy with dasabuvir should be administered cautiously in patients with cirrhosis. It is recommended to monitor signs and symptoms of hepatic decompensation. Patients should have liver functions tests (ALT, AST, alkaline phosphatase, total bilirubin) at baseline and during the first 4 weeks of therapy and periodically as clinically indicated. Discontinue treatment in patients who develop evidence of hepatic decompensation, ALT elevation is accompanied by signs or symptoms of liver inflammation or if ALT levels remain persistently greater than 10 times the ULN, increasing direct bilirubin, alkaline phosphatase, or INR.

Moderate

Pis (Includes Dasabuvir/ombitasvir/paritaprevir/ritonavir) ↔ Hyperglycemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Abnormal Glucose Tolerance, Diabetes Mellitus

New onset or exacerbation of preexisting diabetes mellitus, glucose intolerance, and hyperglycemia have been reported during postmarketing surveillance in HIV patients treated with protease inhibitors (PIs). Frequently, insulin resistance may accompany fat redistribution and serum lipid elevations in what is collectively termed the HIV-associated lipodystrophy syndrome. Although a causal relationship has not been established, these metabolic disturbances have most often occurred in HIV patients during treatment with potent antiretroviral regimens containing PIs. Patients with or predisposed to glucose disorders should be monitored during PI therapy. Dosage adjustments in insulin or oral hypoglycemic medications may be necessary in patients with diabetes. In some cases, glucose abnormalities persisted despite discontinuation of PI therapy.

References

  1. Hardy H, Esch LD, Morse GD "Glucose disorders associated with HIV and its drug therapy." Ann Pharmacother 35 (2001): 343-51
  2. "Product Information. Viracept (nelfinavir)." Agouron Pharma Inc, La Jolla, CA.
  3. "Product Information. Invirase (saquinavir)." Roche Laboratories, Nutley, NJ.
  4. "Product Information. Lexiva (fosamprenavir)." GlaxoSmithKline, Research Triangle Park, NC.
  5. Tsiodras S, Mantzoros C, Hammer S, Samore M "Effects of protease inhibitors on hyperglycemia, hyperlipidemia, and lipodystrophy - A 5-year cohort study." Arch Intern Med 160 (2000): 2050-6
  6. Noor MA, Lo JC, Mulligan K, Schwarz JM, Halvorsen RA, Schambelan M, Grunfeld C "Metabolic effects of indinavir in healthy HIV-seronegative men." Aids 15 (2001): f11-8
  7. "Product Information. Crixivan (indinavir)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Kaletra (lopinavir-ritonavir)" Abbott Pharmaceutical, Abbott Park, IL.
  9. Dube MP, Johnson DL, Currier JS, Leedom JM "Protease inhibitor-associated hyperglycaemia." Lancet 350 (1997): 713-4
  10. Carr A "HIV protease inhibitor-related lipodystrophy syndrome." Clin Infect Dis 30 (2000): s135-42
  11. Pujol RM, Domingo P, XavierMatiasGuiu, Francia E, Sanbeat MA, Alomar A, Vazquez G "HIV-1 protease inhibitor-associated partial lipodystrophy: Clinicopathologic review of 14 cases." J Am Acad Dermatol 42 (2000): 193-8
  12. Walli R, Demant T "Impaired glucose tolerance and protease inhibitors." Ann Intern Med 129 (1998): 837-8
  13. Brambilla AM, Novati R, Calori G, et al. "Stavudine or indinavir-containing regimens are associated with an increased risk of diabetes mellitus in HIV-infected individuals." AIDS 17 (2003): 1993-5
  14. Kaufman MB, Simionatto C "A review of protease inhibitor-induced hyperglycemia." Pharmacotherapy 19 (1999): 114-7
  15. Struble K, Piscitelli SC "Syndromes of abnormal fat redistribution and metabolic complications in HIV-infected patients." Am J Health Syst Pharm 56 (1999): 2343-8
  16. Mauss S, Wolf E, Jaeger H "Impaired glucose tolerance in HIV-positive patients receiving and those not receiving protease inhibitors." Ann Intern Med 130 (1999): 162-3
  17. "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb, Princeton, NJ.
  18. Qaqish RB, Fisher E, Rublein J, Wohl DA "HIV-associated lipodystrophy syndrome." Pharmacotherapy 20 (2000): 13-22
  19. "Product Information. Agenerase (amprenavir)." Glaxo Wellcome, Research Triangle Pk, NC.
  20. "Product Information. Fortovase (saquinavir)" Roche Laboratories, Nutley, NJ.
  21. "Product Information. Aptivus (tipranavir)." Boehringer-Ingelheim, Ridgefield, CT.
  22. "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical, Abbott Park, IL.
View all 22 references
Moderate

Pis (Includes Dasabuvir/ombitasvir/paritaprevir/ritonavir) ↔ Hyperlipidemia

Moderate Potential Hazard, High plausibility

Applies to: Ischemic Heart Disease, Hyperlipidemia, History - Myocardial Infarction

Hyperlipidemia has been observed in 10% of patients receiving ritonavir during clinical trials. Increases of 30% to 40% from baseline have been reported for total cholesterol and 200% to 300% or more for triglycerides. These effects have also been reported during postmarketing experience with other protease inhibitors (PIs) but may be the most dramatic with ritonavir. The clinical significance of these elevations is unclear. Severe hyperlipidemia is known to sometimes cause pancreatitis. In addition, some patients have reportedly developed symptomatic atherosclerosis and coronary artery disease after initiating PI treatment. Patients with preexisting hyperlipidemia may require closer monitoring during PI therapy, and adjustments made accordingly in their lipid-lowering regimen. PI therapy should be administered cautiously in patients with coronary artery disease or a history of ischemic heart disease.

References

  1. "Product Information. Invirase (saquinavir)." Roche Laboratories, Nutley, NJ.
  2. "Product Information. Lexiva (fosamprenavir)." GlaxoSmithKline, Research Triangle Park, NC.
  3. "Product Information. Crixivan (indinavir)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Agenerase (amprenavir)." Glaxo Wellcome, Research Triangle Pk, NC.
  5. "Product Information. Fortovase (saquinavir)" Roche Laboratories, Nutley, NJ.
  6. Costa A, Pulido F, Rubio R, Cepeda C, Torralba M, Costa JR "Lipid changes in HIV-infected patients who started rescue therapy with an amprenavir/ritonavir-based highly active antiretroviral therapy." AIDS 16 (2002): 1983-4
  7. "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Aptivus (tipranavir)." Boehringer-Ingelheim, Ridgefield, CT.
  9. "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical, Abbott Park, IL.
  10. Noor MA, Lo JC, Mulligan K, Schwarz JM, Halvorsen RA, Schambelan M, Grunfeld C "Metabolic effects of indinavir in healthy HIV-seronegative men." Aids 15 (2001): f11-8
  11. Flynn TE, Bricker LA "Myocardial infarction in HIV-infected men receiving protease inhibitors." Ann Intern Med 131 (1999): 548
  12. "Product Information. Viracept (nelfinavir)." Agouron Pharma Inc, La Jolla, CA.
  13. Segerer S, Bogner JR, Walli R, Loch O, Goebel FD "Hyperlipidemia under treatment with proteinase inhibitors." Infection 27 (1999): 77-81
  14. Sullivan AK, Feher MD, Nelson MR, Gazzard BG "Marked hypertriglyceridaemia associated with ritonavir therapy." AIDS 12 (1998): 1393-4
  15. "Product Information. Kaletra (lopinavir-ritonavir)" Abbott Pharmaceutical, Abbott Park, IL.
  16. Echevarria KL, Hardin TC, Smith JA "Hyperlipidemia associated with protease inhibitor therapy." Ann Pharmacother 33 (1999): 859-63
  17. Tsiodras S, Mantzoros C, Hammer S, Samore M "Effects of protease inhibitors on hyperglycemia, hyperlipidemia, and lipodystrophy - A 5-year cohort study." Arch Intern Med 160 (2000): 2050-6
  18. Karmochkine M, Raguin G "Severe coronary artery disease in a young HIV-infected man with no cardiovascular risk factor who was treated with indinavir." AIDS 12 (1998): 2499
  19. Struble K, Piscitelli SC "Syndromes of abnormal fat redistribution and metabolic complications in HIV-infected patients." Am J Health Syst Pharm 56 (1999): 2343-8
View all 19 references
Moderate

Ritonavir (Includes Dasabuvir/ombitasvir/paritaprevir/ritonavir) ↔ Heart Block

Moderate Potential Hazard, Moderate plausibility

Applies to: Heart Disease

Ritonavir may prolong the PR interval in some patients. Post marketing cases of second or third degree atrioventricular block have been reported. Ritonavir should be administered cautiously in patients with underlying structural heart disease, preexisting conduction abnormalities, ischemic heart disease, and cardiomyopathies as these patients might be at increased risk for developing cardiac conduction abnormalities.

dasabuvir / ombitasvir / paritaprevir / ritonavir drug Interactions

There are 888 drug interactions with dasabuvir / ombitasvir / paritaprevir / ritonavir

dasabuvir / ombitasvir / paritaprevir / ritonavir alcohol/food Interactions

There are 3 alcohol/food interactions with dasabuvir / ombitasvir / paritaprevir / ritonavir

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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