Direct-acting Antiviral Interactions With Opioids, Alcohol or Illicit Drugs of Abuse in HCV-infected Patients

Kuntheavy Ing Lorenzini; François Girardin


Liver International. 2020;40(1):32-44. 

In This Article


In order to review the main pharmacokinetic (PK) and pharmacodynamic (PD) characteristics and interaction potential of currently available DAAs (based on 2018 EASL recommendations[6]), and of selected substances of abuse, we performed a PubMed search of articles published until June 2019. The following keywords were used: drug-drug interaction, pharmacokinetics, pharmacodynamics, daclatasvir, elbasvir/grazoprevir, glecaprevir/pibrentasvir, sofosbuvir/ledipasvir, sofosbuvir/velpatasvir, sofosbuvir/velpatasvir/voxilaprevir, substance of abuse, opioids, buprenorphine, fentanyl, methadone, morphine, oxycodone, amphetamine, ecstasy, cathinones, cocaine, cannabis and ethanol. The paritaprevir/ombitasvir/ritonavir ± dasabuvir combination was not considered in our review since this regimen is no longer recommended.[11,12]

The following article types were eligible: PK/PD reviews, original articles, articles on physiologically based pharmacokinetic (PBPK) models and case reports. Only articles written in English or in French were selected. The following types of studies were eligible: in vitro PK studies, human clinical studies (PK phase 1 studies or phase 2/3 clinical studies) and post hoc or pooled analysis of clinical studies. Only studies regarding interactions of currently available DAAs with the selected substances of abuse were eligible.

For currently available DAAs, we included in our search the summary of product characteristics and the European public assessment report on the European Medicines Agency website (

Finally, we performed a Google search to find congress abstracts or conference proceeding reporting unpublished interaction studies or data.

Papers involving other molecules than the keywords, and not considering PK, PD or drug-interaction data, were excluded.