Q&A Series: (Q.2)

question-mark-blue-1630386-639x1115Q&A SERIES:


(Q.2:) Which of the following antidepressant have Level 1 evidence for treating depression during Hepatitis C treatment?

    1. Paroxetine


    1. Citalopram


    1. Escitalopram


    1. Sertraline


  1. Buporpion

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 Products:

Herbal Product Drug Interactions with DAAs
St. John’s Wort (hypericum perforatum)
  • Potential for ↓ DAA concentrations.
  • Contraindicated with Boceprevir and Telaprevir.

Full Article Available HereSockalingam et al. BMC Gastroenterology 2013, 13:86.

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Dr. Harvinder Singh, M.D. (Admin)

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