Drug–Drug Interactions in Children and Adolescents Receiving Ledipasvir/Sofosbuvir for the Treatment of Hepatitis C Virus Infection

• Published in: Clinical drug investigation 2019-09, Vol.39 (9), p.857-864
• Main Authors: Abdullatif, Hala Mohsen, Ramzi, Rania, Mogahed, Engy Adel, Ghobrial, Carolyne Morcos, El Rasheed Abd El Zaher, Basma Abd, El Raziky, Mona S., El-Karaksy, Hanaa Mostafa
• Format: Article
• Language: English
• Subjects: Adolescent; Anemia; Antiviral Agents - therapeutic use; Antiviral drugs; Benzimidazoles - therapeutic use; Cardiovascular disease; Child; Chronic illnesses; Congenital diseases; Drug administration; Drug Interactions; Drug therapy; Female; Fever; Fluorenes - therapeutic use; Hepatitis C; Hepatitis C - drug therapy; Hepatitis C, Chronic - drug therapy; Hepatology; Humans; Hydrocephalus; Inflammatory bowel disease; Internal Medicine; Liver; Lupus; Male; Medicine; Medicine & Public Health; Metabolism; Metabolites; Original Research Article; Pediatrics; Pharmacokinetics; Pharmacology/Toxicology; Pharmacotherapy; Risk Assessment; Teenagers; Treatment Outcome; Uridine Monophosphate - analogs & derivatives; Uridine Monophosphate - therapeutic use
• ISSN: 1173-2563; 1179-1918
• DOI: 10.1007/s40261-019-00805-5

Background and Objective Drug–drug interactions need to be considered to optimize the pharmacotherapeutic outcome of direct-acting antivirals. The aim of this study was to report on possible drug–drug interactions between ledipasvir/sofosbuvir and other medications received by children and adolescents with hepatitis C virus, in addition to suggested management for these drug–drug interactions. Methods Hepatitis C virus-infected children and adolescents, 12–17 years of age and/or weighing ≥ 35 kg, who presented to the Pediatric Hepatology Unit at Cairo University Pediatric Hospitals for ledipasvir/sofosbuvir treatment were included. Medication history was taken including long-term medications for chronic conditions and on-demand medications for inter-current illnesses. Medications were reviewed by the Kasr Alainy Drug Information Center to identify possible drug–drug interactions with prescribed ledipasvir/sofosbuvir and their management. HEP Drug Interactions provided by the University of Liverpool, Lexicomp ® , and Medscape were the utilized references. Each drug–drug interaction was assigned a risk rating of A, B, C, D, or X. Results Sixty hepatitis C virus-infected children and adolescents assigned to receive ledipasvir/sofosbuvir were enrolled. Thirty percent of patients had associated chronic co-morbid conditions. The overall number of medications received was 48; 39 were prescribed as long-term medications with a median of 3 (interquartile range 4.24) medications per patient. Proton pump inhibitors, antacids, histamine H 2 receptor antagonists, sodium bicarbonate, and colchicine were reported to be associated with a drug–drug interaction risk D necessitating therapy modification, which occurred prior to administration. Conclusions Early identification and prompt response to drug–drug interactions with the aid of pharmacists optimize the pharmacotherapeutic outcome and eliminate possible morbidities when using direct-acting antivirals in children and adolescents with hepatitis C virus.