together may increase velpatasvir plasma concentrations, potentially resulting in adverse events. Velpatasvir is a CYP2B6 substrate; ticlopidine is a potent inhibitor of CYP2B6.
Tipranavir: Avoid coadministration of sofosbuvir with inducers of P-glycoprotein (P-gp), such as tipranavir. Taking these drugs together may significantly decrease sofosbuvir plasma concentrations, potentially resulting in loss of antiviral efficacy. Sofosbuvir is a P-gp substrate. Tipranavir is a P-gp substrate, a weak P-gp inhibitor, and appears to be a potent P-gp inducer. The administration with ritonavir appears to result in a net P-gp induction at steady state, even though, when given alone, ritonavir is a P-gp inhibitor. Avoid coadministration of velpatasvir with inducers of P-glycoprotein (P-gp), such as tipranavir. Taking these drugs together may significantly decrease velpatasvir plasma concentrations, potentially resulting in loss of antiviral efficacy. Velpatasvir is a P-gp substrate. Tipranavir is a P-gp substrate, a weak P-gp inhibitor, and appears to be a potent P-gp inducer. The administration with ritonavir appears to result in a net P-gp induction at steady state, even though, when given alone, ritonavir is a P-gp inhibitor.
Tolvaptan: Use caution when administering velpatasvir with tolvaptan. Taking these medications together may increase the plasma concentrations of both drugs, potentially resulting in adverse events. Both drugs are substrates and inhibitors of the drug transporter P-glycoprotein (P-gp).
Topiramate: Use caution when administering velpatasvir with topiramate. Taking these drugs together may decrease velpatasvir plasma concentrations, potentially resulting in loss of antiviral efficacy. Velpatasvir is a CYP3A4 substrate; topiramate is a weak inducer of CYP3A4.
Topotecan: Coadministration of topotecan and velpatasvir is not recommended due to the potential increase in topetecan serum concentrations. Topotecan is a substrate of the breast cancer resistance protein (BCRP) and P-glycoprotein (P-gP) transporters, while velpatasvir inhibits both BCRP and P-gP. This inhibition alters oral topotecan concentrations more and has less of an effect on intravenous topotecan. If coadministration of velpatasvir and oral topotecan is necessary, carefully monitor for increased toxicity of topotecan, including severe myelosuppression and diarrhea. In a pharmacokinetic cohort study, coadministration of oral topotecan with elacridar, a potent P-gp and BCRP inhibitor, (n = 8) increased the Cmax and AUC of topotecan by 2 to 3 fold (p = 0.008); coadministration with intravenous topotecan (n = 8) increased total topotecan exposure by 1.2-fold (p = 0.02) and topotecan lactone by 1.1-fold (not significant). In a separate study, when oral topotecan was administered concomitantly with escalating doses of a dual BCRP and P-gp inhibitor, exposure to both total topotecan and topotecan lactone increased by approximately 2.5-fold compared with control.
Trametinib: Use caution when administering velpatasvir with trametinib. Taking these drugs together may increase velpatasvir plasma concentrations, potentially resulting in adverse events. Velpatasvir is a CYP2C8 substrate; trametinib is a weak in vitro inhibitor of CYP2C8.
Trandolapril; Verapamil: Use caution when administering velpatasvir with verapamil. Taking these medications together may increase the plasma concentrations of both drugs, potentially resulting in adverse event |
