Astagraf XL and Zepatier

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Grazoprevir may increase the blood levels of tacrolimus in some patients. This may increase the risk of serious side effects such as infections, lymphoma and other cancers, diabetes, kidney problems, nervous system disorders (mental status changes, seizures, visual disturbances, tremors, abnormal sensations such as burning, pricking, tingling or numbness), high blood pressure, heart problems (myocardial hypertrophy), and high blood levels of potassium. High levels of potassium can develop into a condition known as hyperkalemia, which in severe cases can lead to kidney failure, muscle paralysis, irregular heart rhythm, and cardiac arrest. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Contact your doctor immediately if you develop signs and symptoms of infection such as fever, chills, diarrhea, sore throat, muscle aches, shortness of breath, blood in phlegm, weight loss, red or inflamed skin, body sores, and pain or burning during urination. You should also seek medical attention if you experience nausea, vomiting, loss of appetite, increased or decreased urination, sudden weight gain or weight loss, fluid retention, swelling, muscle cramps, tiredness, weakness, dizziness, confusion, tingling of the hands and feet, feelings of heaviness in the legs, a weak pulse, or a slow or irregular heartbeat, as these may be signs and symptoms of kidney problems or hyperkalemia. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR: Coadministration with elbasvir-grazoprevir may increase the blood concentrations of tacrolimus. The proposed mechanism is inhibition of the CYP450 3A4-mediated metabolism of tacrolimus by grazoprevir, a weak inhibitor of the isoenzyme. In 16 study subjects, administration of a single 2 mg dose of tacrolimus during treatment with elbasvir-grazoprevir 50 mg-200 mg once daily increased tacrolimus systemic exposure (AUC) and trough plasma concentration (Cmin) by 43% and 70%, respectively, compared to administration of tacrolimus alone. Elbasvir-grazoprevir also decreased tacrolimus peak plasma concentration (Cmax) by 40%. In contrast, the pharmacokinetics of elbasvir and grazoprevir were not significantly affected by tacrolimus.

MANAGEMENT: Given the narrow therapeutic index and the large interindividual variability in the pharmacokinetics of tacrolimus, caution is advised if the drug is used in combination with elbasvir-grazoprevir. Renal function and tacrolimus blood levels should be monitored more closely whenever elbasvir-grazoprevir is added to or discontinued from therapy, and the tacrolimus dosage adjusted as necessary. Patients should be advised to contact their doctor if they experience potential signs and symptoms of tacrolimus toxicity such as fever, infection, diarrhea, tremor, headache, fatigue, lethargy, and changes in motor function, mental status, or sensory function.

Astagraf XL

Generic Name: tacrolimus

Brand name: Astagraf XL, Envarsus XR, Prograf, Hecoria

Synonyms: n.a.

What is Astagraf XL?

Zepatier

Generic Name: elbasvir / grazoprevir

Brand name: Zepatier

Synonyms: n.a.

What is Zepatier?