https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=19452

Glecaprevir / Pibrentasvir

Fentanyl

Combination to avoid or use with caution.

Available pharmaceutical opinion

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

DOWNLOAD
Mechanism

Glecaprevir / Pibrentasvir can inhibit the metabolism (CYP 3A4) and increase the plasma concentration of Fentanyl.

Glecaprevir / Pibrentasvir

Pharmacodynamic effects

–

Recommendations

–

Alternative solution(s)

–

Fentanyl

Pharmacodynamic effects

Possible increased risk of opioids toxicity.

Recommendations

Avoid association, if possible.

If deemed necessary, a decrease in the dose and/or close monitoring is recommended.

The product monograph recommends avoiding the combination with drugs that are CYP3A4 inhibitors.

See comments for further details.

Alternative solution(s)

Morphine and hydromorphone.

Monitor

Fentanyl toxicity: decrease of vigilance, sedation, extended or recurrent respiratory depression.

Tests

–

Pharmacokinetic parameters

–

Comment

Ref #3373 : Glecaprevir/pibrentasvir is a weak inhibitor of CYP 3A4. Administration with midazolam did not show a clinically significant increase.

Administration with fentanyl has not been studied, but since fentanyl has a narrow therapeutic index, concomitant use especially with illicit fentanyl use could have serious consequences for the patient. Indeed, high concentrations of fentanyl following drug interactions are associated with a risk of respiratory distress and death.

Comment
Reference
  • 3103
    Fentanyl (Fentora), Teva Canada Ltée, Québec, Canada, 28 mai 2020.
  • 3526
    Fentanyl (Duragesic), Product information, Janssen Pharmaceuticals, Inc., NJ USA, october 2019.
  • 3525
    Fentanyl (Effentora), European public assessment report (EPAR) Product Information, London, United Kingdom, 3 septembre 2020.
  • 3373
    Glecaprevir/Pibrentasvir (Maviret), Abbvie, Québec, Canada, 30 octobre 2020.