Glecaprevir / Pibrentasvir

Digoxin

Monitor more closely.

Available pharmaceutical opinion

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

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Mechanism

Glecaprevir / Pibrentasvir can decrease the P-gp and increase the plasma concentration of Digoxin.

Glecaprevir / Pibrentasvir

Pharmacodynamic effects

Recommendations

Alternative solution(s)

Digoxin

Pharmacodynamic effects

Possible increase of adverse effects.

Recommendations

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.

Alternative solution(s)

Monitor

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.

Tests

Digoxinemia

Pharmacokinetic parameters
Parameters
Reference number
# patients
HCV
Dose
Frequency
Cmax
AUC
Glecaprevir / Pibrentasvir
3373
12
-
400/120 mg
QD
 
 
Digoxin
3373
12
-
0.5 mg
x 1
+ 72%
+ 48%
Comment

Ref #3373 : No significant changes in glecaprevir or pibrentasvir concentrations.

Reference
  • 3373
    Glecaprevir/Pibrentasvir (Maviret), Abbvie, Québec, Canada, 19 février 2020.