Glecaprevir / Pibrentasvir

Carbamazepine

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

Carbamazepine may induce CYP 3A4 and P-gp and decrease the plasma concentration of Glecaprevir / Pibrentasvir.

Glecaprevir / Pibrentasvir

Pharmacodynamic effects

Possible decrease of clinical efficacy.

Recommendations

Alternative solution(s)

Carbamazepine

Pharmacodynamic effects

Recommendations

Avoid association.

See comments.

Alternative solution(s)

Gabapentin, pregabalin, levetiracetam, brivaracetam, or valproic acid

Monitor

Tests

Pharmacokinetic parameters
Parameters
Reference number
# patients
HCV
Dose
Frequency
AUC
Cmax
Glecaprevir / Pibrentasvir
3373
10
-
300/120 mg
x 1
- 66%/- 51%
- 67%/- 50%
Carbamazepine
3373
10
-
200 mg
BID
 
 
Comment

Ref #3373 : No significant changes in carbamazepine concentrations.

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
  • 3373
    Glecaprevir/Pibrentasvir (Maviret), Abbvie, Québec, Canada, 30 octobre 2020.
  • 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..