Psychiatric treatment considerations with direct acting antivirals in hepatitis C

BMC Gastroenterology

David Wong¹  Pierre Giguere³  Alice Tseng⁴  Sanjeev Sockalingam² 

[1] Faculty of Medicine, University of Toronto, Toronto, ON, Canada;Department of Psychiatry, University of Toronto, Toronto, ON, Canada;The Ottawa Hospital Research institute, Ottawa, ON, Canada;Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

关键词: Telaprevir;    Boceprevir;    Psychotropic drugs;    Mental disorders;    Hepatitis C;   

Others  :  857978
DOI  :  10.1186/1471-230X-13-86

 received in 2013-01-26, accepted in 2013-05-04,  发布年份 2013

【 摘 要 】

Background

Despite recent advances in hepatitis C (HCV) treatment, specifically the addition of direct acting antivirals (DAAs), pegylated interferon-alpha remains the backbone of HCV therapy. Therefore, the impact of DAAs on the management of co-morbid psychiatric illness and neuropsychiatric sequalae remains an ongoing concern during HCV therapy. This paper provides a review of the neuropsychiatric adverse effects of DAAs and drug-drug interactions (DDIs) between DAAs and psychiatric medications.

Methods

We conducted a Pubmed search using relevant search terms and hand searched reference lists of related review articles. In addition, we searched abstracts for major hepatology conferences and contacted respective pharmaceutical companies for additional studies.

Results

Limited data is available on the neuropsychiatric adverse effects of DAAs; however, data from major clinical trials suggest that DAAs have minimal neuropsychiatric risk. DAAs can potentially interact with a variety of psychotropic agents via cytochrome P450 and p-glycoprotein interactions. Triazolam, oral midazolam, St. John’s Wort, carbamazepine and pimozide, are contraindicated with DAAs. DDIs between DAAs and antidepressants, anxiolytics, hypnotics, mood stabilizers, antipsychotics and treatments for opioid dependence are summarized.

Conclusions

Although DAAs do not add significant neuropsychiatric risk, the potential for DDIs is high. Consideration of DDIs is paramount to improving medication adherence and mitigating adverse effects during HCV therapy.

【 授权许可】

   
2013 Sockalingam et al.; licensee BioMed Central Ltd.