Ledipasvir / Sofosbuvir

Phenytoin

Not recommended association.

Available pharmaceutical opinion

Document made available to the pharmacist to communicate a drug interaction to the doctor.

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Mechanism

Phenytoin may induce P-gp and decrease the plasma concentration of Ledipasvir / Sofosbuvir.

Ledipasvir / Sofosbuvir

Pharmacodynamic effects

Possible decrease of clinical efficacy.

Recommendations

Alternative solution(s)

Phenytoin

Pharmacodynamic effects

Recommendations

Avoid association. Choose an alternative.

Alternative solution(s)

Gabapentin, pregabalin, valproic acid, clobazam, leviracetam, topiramate, lacosamide or lamotrigine.

Monitor

Tests

Pharmacokinetic parameters

Comment

Ref #3524 : Case report of five patients who received standard doses for the treatment of chronic hepatitis C infection while being maintained on first generation anticonvulsants (carbamazepine, phenobarbital, phenytoin). Four patients were treated with glecaprevir/pibrentasvir for 8 weeks and one patient with ledipasvir/sofosbuvir for 12 weeks. All five patients achieved a sustained virologic response (SVR) despite this drug interaction. The authors conclude that all efforts to prevent concomitant use with strong inducers should be made.

Reference
  • 3073
    Ledipasvir/Sofosbuvir (Harvoni), Gilead, Ontario, Canada, 16 avril 2018.
  • 3524
    Natali KM, Jimenez HR, and J Slim. When Coadministration Cannot Be Avoided: Real World Experience of Direct Acting Antivirals for the Treatment of Hepatitis C Virus Infection in Patients on First Generation Anticonvulsants. Journal of Pharmacy Practice. December 15, 2020; 897190020977762.