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Glecaprevir / Pibrentasvir can decrease the P-gp and increase the plasma concentration of Digoxin.
P-gp and BCRP; OATP1B1/3 (glecaprevir)
P-gp, BCRP, OATP1B1/3; 3A4, 1A2 and UGT 1A1 (weak probably without clinical consequences)
Possible increase of adverse effects.
Use this combination with caution.
Therapeutic concentration monitoring of is recommended before initiating and during glecaprevir/pibrentasvir therapy.
Product monograph suggests to decrease the dose by approximately 50% or modify the dosing frequency and continue monitoring.
Adverse effects of digoxin: Gastrointestinal effects (abdominal discomfort, nausea/vomiting, diarrhea, anorexia, dyspepsia), central nervous system effects, vision disorders, fatigue, headache, bradycardia and rhythm disorders.
Ref #3373 : No significant changes in glecaprevir or pibrentasvir concentrations.