Decreased INR after acenocoumarol, ombitasvir/paritaprevir/ritonavir and dasabuvir co-administration

Abstract

Because of possible INR abnormalities during the concomitant use of acenocoumarol, ombitasvir/paritaprevir/ritonavir and dasabuvir, clinicians should closely monitor INR values.

Cardiovascular Risk Management and Hepatitis C: Combining Drugs

“…Some interactions are easy to manage (monitoring blood pressure), whereas others are highly complex due to the metabolic profile of the DAAs and the CVD (e.g., clopidogrel). This is, for instance, reported by de Lorenzo-Pinto et al [ 11 ], who reported a significantly increased acenocoumarol dose because of the interaction with paritraprevir/ritonavir, ombitasvir, and dasabuvir (PrOD). Comparable interaction was seen with warfarin, resulting in a subtherapeutic international normalized ratio (INR) during concomitant treatment with PrOD [ 11 ].…”

“…This is, for instance, reported by de Lorenzo-Pinto et al [ 11 ], who reported a significantly increased acenocoumarol dose because of the interaction with paritraprevir/ritonavir, ombitasvir, and dasabuvir (PrOD). Comparable interaction was seen with warfarin, resulting in a subtherapeutic international normalized ratio (INR) during concomitant treatment with PrOD [ 11 ]. Both of these cases showed that there were significant DDIs between anticoagulants and PrOD, making increased monitoring necessary.…”

Influence of Successful Chronic Hepatitis C Virus Treatment with Ledipasvir/Sofosbuvir on Warfarin Dosing Requirements in Four Veterans

“…To our knowledge, no case reports of a drug interaction between warfarin and LDV/SOF have been published, although there have been reports of interactions with OBV/PTV/r + DSV and first‐generation DAAs . Patients in our case series required increased warfarin doses after beginning HCV treatment, and two patients subsequently required a dose reduction at the end of treatment.…”

“…Patients in our case series required increased warfarin doses after beginning HCV treatment, and two patients subsequently required a dose reduction at the end of treatment. Case reports have previously described a suspected interaction between warfarin and the following regimens: IFN + RBV; PEG‐IFN + RBV + telaprevir; PEG‐IFN + RBV + boceprevir; and OBV/PTV/r with DSV + RBV . These cases reported warfarin dose increases ranging from 39–137% in the weeks following initiation of HCV treatment to maintain therapeutic INR, followed by dose reductions of 21–24% following HCV treatment completion …”

“…To our knowledge, the only in vivo description of a drug interaction between vitamin K antagonists (warfarin and acenocoumarol) and the second‐generation DAAs is a case report that describes a potential drug interaction between acenocoumarol and the HCV combination regimen of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) with dasabuvir (DSV) plus RBV 400 mg twice/day for 24 weeks . The patient required higher doses of warfarin to maintain a therapeutic international normalized ratio (INR) during HCV treatment and subsequently developed supratherapeutic INRs and clinically relevant bleeding after HCV treatment was completed.…”