Drug Interaction Report

MONITOR: Coadministration with ledipasvir may increase the plasma concentrations of orally administered drugs that are substrates of the P-glycoprotein (P-gp) and/or breast cancer resistance protein (BCRP) transporters. The proposed mechanism is decreased clearance in the intestine due to inhibition of P-gp or BCRP-mediated drug efflux by ledipasvir.

MANAGEMENT: Caution is advised if ledipasvir must be used concurrently with medications that are substrates of the P-gp and/or BCRP transporters, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate for some drugs whenever ledipasvir is added to or withdrawn from therapy.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.