Drug-Drug Interactions Between Direct-Acting Antivirals and Psychoactive Medications.
Treatment options for chronic hepatitis C virus (HCV) infection have drastically changed since the development and licensing of new potent direct-acting antivirals (DAAs). The majority of DAAs are extensively metabolized by liver enzymes and have the ability to influence cytochrome P450 (CYP) enzymes. Additionally, these DAAs are both substrates and inhibitors of drug transporters, which makes the DAAs both possible victims or perpetrators of drug-drug interactions (DDIs). There is a high prevalence of mental illnesses such as depression or psychosis in HCV-infected patients; therefore, psychoactive medications are frequently co-administered with DAAs. The majority of these psychoactive medications are also metabolized by CYP enzymes but remarkably little information is available on DDIs between psychoactive medications and DAAs. Hence, the aim of this review is to provide an overview of the interaction mechanisms between DAAs and psychoactive agents. In addition, we describe evidenced-based interactions between DAAs and psychoactive drugs and identify safe options for the simultaneous treatment of mental illnesses and chronic HCV infection.
Department of Pharmacy, Radboud university medical center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
E J
EJ
Smolders
Department of Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.
C T M M
CT
de Kanter
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
R J
RJ
de Knegt
Division of Infectious Diseases, Academic Medical Center, Center for Infection and Immunity Amsterdam (CINIMA), Amsterdam, The Netherlands.
M
M
van der Valk
Department of Gastroenterology and Hepatology, Radboud university medical center, Nijmegen, The Netherlands.
J P H
JP
Drenth
Department of Pharmacy, Radboud university medical center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. David.Burger@radboudumc.nl.
D M
DM
Burger
D000998:Antiviral Agents / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D003577:Cytochrome P-450 Enzyme System / Q000187:drug effects*; D004347:Drug Interactions; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D011619:Psychotropic Drugs / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use
D000998:Antiviral Agents; D011619:Psychotropic Drugs; D003577:Cytochrome P-450 Enzyme System