due to treatment with Viekirax or Viekirax with dasabuvir, doses should be re-adjusted after administration of Viekirax or Viekirax with dasabuvir is completed.
Table 2 provides the Least Squares Means Ratio (90% Confidence Interval) effect on concentration of Viekirax with or without dasabuvir and concomitant medicinal products.
The magnitude of interaction when administered with medicinal products listed in Table 2 are similar (≤25% difference in the Least Square Means ratio) for Viekirax with or without dasabuvir, unless otherwise noted. Drug interactions were eva luated for the Viekirax and dasabuvir regimen, but not for the Viekirax without dasabuvir, with carbamazepine, furosemide, zolpidem, darunavir twice daily, darunavir (evening administration), atazanavir (evening administration) or rilpivirine. Thus, for these medicinal products, results and dosing recommendations of the Viekirax and dasabuvir regimen can be extrapolated to Viekirax without dasabuvir.
The direction of the arrow indicates the direction of the change in exposures (Cmax, and AUC) in paritaprevir, ombitasvir, dasabuvir and the co-administered medicinal product (↑ = increase (more than 20%), ↓ = decrease (of more than 20%), ↔ = no change or change less than 20%). This is not an exclusive list.
Table 2. Interactions between Viekirax with or without dasabuvir and other medicinal products
Paediatric population
Drug interaction studies have only been performed in adults.
Women of childbearing potential / contraception in males and females
Extreme caution must be taken to avoid pregnancy in female patients and female partners of male patients when Viekirax is taken in combination with ribavirin. Significant teratogenic and/or embryocidal effects have been demonstrated in all animal species exposed to ribavirin; therefore, ribavirin is contraindicated in women who are pregnant and in the male partners of women who are pregnant. Women of childbearing potential and their male partners should not receive ribavirin unless they are using an effective form of contraception during treatment with ribavirin and for 6 months after treatment. Ethinylestradiol is contraindicated in combination with Viekirax (see sections 4.3 and 4.4).
Pregnancy
There are very limited data from the use of Viekirax in pregnant women. Studies with ombitasvir and paritaprevir/ritonavir in animals have shown malformations (see section 5.3). The potential risk for humans is unknown. Viekirax should not be used during pregnancy or in women of childbearing potential not using effective contraception.
If ribavirin is co-administered with Viekirax, the contraindications regarding use of ribavirin during pregnancy apply (see also the Summary of Product Characteristics of ribavirin).
Breast-feeding
It is not known whether paritaprevir /ritonavir or ombitasvir and their metabolites are excreted in human breast milk. Available pharmacokinetic data in animals have shown excretion of active substance and metabolite in milk (see section 5.3). Because of the potential for adverse reactions from the medicinal product in breastfed infants, a decision must be made whether to discontinue breast-feeding or discontinue treatment with Viekirax, taking into account the importance of the therapy to the mother. For patients co-administered ribavirin refer to
