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Psychiatric treatment considerations with direct acting antivirals in hepatitis C

Sanjeev Sockalingam1, Alice Tseng, Pierre Giguere

  • 1University Health Network, Program in Medical Psychiatry, Toronto General Hospital, 200 Elizabeth Street 8EN-228, Toronto, ON M5G 2C4, Canada. sanjeev.sockalingam@uhn.ca

BMC Gastroenterology
|May 16, 2013
PubMed

Insights

Direct acting antivirals (DAAs) for hepatitis C (HCV) show minimal neuropsychiatric risk but pose a high potential for drug-drug interactions (DDIs) with psychiatric medications. Careful consideration of DDIs is crucial for safe and effective HCV treatment.

Area of Science:

  • Hepatology
  • Psychiatry
  • Pharmacology

Background:

  • Pegylated interferon-alpha is central to hepatitis C (HCV) therapy, despite advances with direct acting antivirals (DAAs).
  • Neuropsychiatric effects and drug interactions of DAAs with psychiatric drugs are a concern during HCV treatment.

Purpose of the Study:

  • To review neuropsychiatric adverse effects of DAAs.
  • To examine drug-drug interactions (DDIs) between DAAs and psychiatric medications.

Main Methods:

  • Literature search of Pubmed and conference abstracts.
  • Hand-searched reference lists of review articles.
  • Contacted pharmaceutical companies for additional data.

Main Results:

  • DAAs demonstrate minimal neuropsychiatric risk in clinical trials.
  • DAAs can interact with psychotropic agents via cytochrome P450 and p-glycoprotein pathways.
  • Contraindicated drugs include triazolam, midazolam, St. John's Wort, carbamazepine, and pimozide.

Conclusions:

  • DAAs do not significantly increase neuropsychiatric risk.
  • High potential for DDIs between DAAs and psychiatric drugs necessitates careful management.
  • Managing DDIs is essential for medication adherence and mitigating adverse effects in HCV therapy.
Abstract

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