Sofosbuvir + velpatasvir – interactions with other medicines

The fixed-dose combination of sofosbuvir + velpatasvir (sold as Epclusa) has activity against all major strains, or genotypes, of hepatitis C virus (HCV). The combination of these drugs has been evaluated for possible and potential interactions with other drugs.

Results

Here are recommendations from Epclusa manufacturer Gilead Sciences:

In people co-infected with HIV and HCV, the following drugs can be used:

Nukes (nucleoside and nucleotide analogues)

• FTC (emtricitabine)
• TAF (tenofovir alafenamide)
• TDF (tenofovir DF; the original formulation of tenofovir)

Non-nukes

• rilpivirine (Intelence and in Complera)

Integrase inhibitors

• dolutegravir (Tivicay and in Triumeq)
• elvitegravir (in Genvoya and Stribild)
• raltegravir (Isentress)

Protease inhibitors

• atazanavir (Reyataz)
• darunavir (Prezista and in Prezcobix)
• lopinavir (in Kaletra)

Boosters

• ritonavir (Norvir and in Kaletra)
• cobicistat (in Genvoya and Stribild)

What is clear from the drug interaction studies with Epclusa is that the anti-HIV drug efavirenz (Sustiva, Stocrin and in Atripla) must not be used because it can reduce absorption of velpatasvir by about 50%.

Hormonal contraceptives (“the pill”)

No loss of efficacy with oral contraceptives containing norgestimate/thinly estradiol should occur.

Transplant drugs

Sofosbuvir-velpatasvir does not appear to have significant interactions with cyclosporine (Neoral, Sandimmune) or tacrolimus (Advagraf, Prograf).

Complete details about drug interactions between sofosbuvir-velpatasvir and other medicines will be released in the future by Gilead.

—Sean R. Hosein

REFERENCE:

Mogalian E, McNally J, Shen G, et al. Drug-drug interaction profile of sofosbuvir-velpatasvir fixed-dose combination. The International Liver Congress, 13-17 April 2017, Barcelona, Spain. Abstract FRI-168.