Psychiatric treatment considerations with direct acting antivirals in hepatitis C

BMC Gastroenterology

Research Article

Pierre Giguere¹  David Wong²  Alice Tseng³  Sanjeev Sockalingam⁴ 

[1] The Ottawa Hospital, Immunodeficiency Clinic, Ottawa, ON, Canada;The Ottawa Hospital Research institute, Ottawa, ON, Canada;Toronto Western Hospital Liver Centre, Toronto, ON, Canada;Faculty of Medicine, University of Toronto, Toronto, ON, Canada;University Health Network, Immunodeficiency Clinic, Toronto, ON, Canada;Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada;University Health Network, Program in Medical Psychiatry, Toronto General Hospital, 200 Elizabeth Street 8EN-228, M5G 2C4, Toronto, ON, Canada;Department of Psychiatry, University of Toronto, Toronto, ON, Canada;

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

DOI  :  10.1186/1471-230X-13-86

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

来源: Springer

【 摘 要 】

BackgroundDespite 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.MethodsWe 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.ResultsLimited 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.ConclusionsAlthough 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】

CC BY   
© Sockalingam et al.; licensee BioMed Central Ltd. 2013