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P-gp inducers and/or moderate-to-strong CYP2B6, CYP2C8, or CYP3A4 inducers (such as rifampicin, St. John's wort, carbamazepine) may reduce the plasma concentrations of sofosbuvir and/or velpatasvir. Concomitant use with Sofosbuvir/Velpatasvir is not recommended. Sofosbuvir/Velpatasvir can be used concomitantly with P-gp, BCRP, and CYP inhibitors.
Velpatasvir is an inhibitor of P-gp, BCRP, OATP1B1, OATP1B3, and OATP2B1. Concomitant use with substrates of these transporters may increase the exposure of the latter.
Amiodarone: Concomitant use is not recommended. If unavoidable, cardiac monitoring is required.
Anticonvulsants: Carbamazepine, phenytoin, phenobarbital. Concomitant use is not recommended.
Antimycobacterial drugs: Rifabutin, rifampicin, rifapentine. Concomitant use is not recommended.
HIV antiretroviral drugs: Efavirenz, tipranavir/ritonavir. Concomitant use is not recommended. For regimens containing tenofovir disoproxil fumarate (TDF), monitor for tenofovir-related adverse reactions.
Herbal supplements: St. John's wort. Concomitant use is not recommended.
HMG-CoA reductase inhibitors: When used concomitantly with rosuvastatin, the dose of rosuvastatin should not exceed 10 mg. When used concomitantly with atorvastatin, closely monitor the risk of myopathy and rhabdomyolysis.
Gastric acid modifiers:
Antacids: Administer with a 4-hour interval from Sofosbuvir/Velpatasvir.
H2-receptor antagonists: Can be taken concomitantly with Sofosbuvir/Velpatasvir or with a 12-hour interval. The dose should not exceed the equivalent of 40 mg famotidine twice daily.
Proton pump inhibitors: Concomitant use is not recommended. If unavoidable, Sofosbuvir/Velpatasvir should be taken with food and administered 4 hours before a 20 mg omeprazole dose.
Digoxin: Therapeutic drug concentration monitoring is recommended.
Topotecan: Concomitant use is not recommended.
Elimination of HCV infection may lead to changes in liver function, which in turn affect the safe and effective use of concomitant drugs. Frequent monitoring of relevant laboratory parameters (such as INR, blood glucose) is required, and dosage adjustments of concomitant drugs should be made if necessary.
A variety of drugs have no clinically significant interactions with Sofosbuvir/Velpatasvir; please refer to the full prescribing information for the specific list.
FDA，2022.04
