Navigating Clinically Significant Drug Interactions Between Hepatitis C Direct Acting Antiviral Agents and Statins

By:

• Elizabeth Sherman, PharmD, AAHIVP
  South Florida, Southeast AETC
  College of Pharmacy, Nova Southeastern University
• Danielys Martinez, PharmD Candidate
  College of Pharmacy, Nova Southeastern University

Chronic hepatitis C virus (HCV) infection should not be considered a contraindication to treatment with statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors). While the mainstay of treatment for hyperlipidemia is use of a statin, the management of patients with hepatitis HCV centers on the use of combinations of direct acting antivirals (DAAs). Importantly, clinically significant drug interactions exist between HCV DAAs and statins due to similar cytochrome P450 metabolism of these medications and consideration should be given to changing the statin to one without the potential drug interaction or to limit the statin to lower doses. Table 1 below provides recommendations on the concomitant use of DAAs for treatment of HCV infection and statins. As shown in the table, many statins may either be contraindicated or have dose limitations when used concomitantly with commonly prescribed HCV DAAs. Table 2 below provides a list of FDA-approved DAAs for HCV infection. Finally, Table 3 provides information on statin dose equivalencies for those providers needing to modify statin medications and doses. Additional guidance on the treatment and management of HCV can be found at http://www.hcvguidelines.org/. Additional resources for viral hepatitis drug interaction information can be found in product prescribing information and at www.hep-druginteractions.org.