(Q.2:) Which of the following antidepressant have Level 1 evidence for treating depression during Hepatitis C treatment?
Ans: 3. Escitalopram
Antidepressant Treatment During Hepatitis C Treatment & Drug Interactions with Direct Acting Antivirals (DAAs)
Level I Evidence (≥ 2 RCTs or meta-analysis)
Only Escitalopram currently has Level 1 evidence for treating or preventing depression emerging during HCV treatment.
Drug Interactions of Escitalopram with DAAs:
- No interaction observed with Boceprevir.
- 35% ↓ escitalopram AUC with Telaprevir: so may need to titrate escitalopram dose according to clinical response.
Level 2 Evidence (1 RCT):
Antidepressant Drug Interactions with DAAs Citalopram Potential for ↓ antidepressant concentrations. Paroxetine No interaction expected based on known pharmacologic characteristics
Level 4 (Case reports/series or expert opinion):
Antidepressant Drug Interactions with DAAs Bupropion, Fluoxetine No interaction expected Sertraline, Mirtazapine, Venlafaxine, Desvenlafaxine Potential for ↑ sertraline, mirtazapine, venlafaxine, desvenlafaxine concentrations (Use with Caution) Desipramine, Imipramine Potential increase in TCA concentrations resulting in dizziness, hypotension and syncope. Nortriptyline No interaction expected
Avoid Use of Following Antidepressants:
Antidepressant Drug Interactions with DAAs Duloxetine risk of hepatotoxicity Nefazodone Potential for ↑ nefazodone and/or DAA concentrations; also risk of hepatotoxicity.
Herbal Product Drug Interactions with DAAs St. John’s Wort (hypericum perforatum)
- Potential for ↓ DAA concentrations.
- Contraindicated with Boceprevir and Telaprevir.
Full Article Available Here: Sockalingam et al. BMC Gastroenterology 2013, 13:86.
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Dr. Harvinder Singh, M.D. (Admin)
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