Drug interactions and Hep C treatment

[Aquavelva_Gigi]

Hi.  

I'm new to this forum and have a question.  I am going to start treatment in a week or two.  I understand that certain drugs do not interact well with the Hep C treatment.  Is there a complete list of what's not allowed?  What about pain meds like morphine or other opiate based meds?  Will taking them mess up my treatment?

[ceanothus]

For the last 30 years I've lived with a spinal cord injury that is very painful and for the last 15 years I've required strong narcotics to cope with it. Perhaps my first 2 HCV treatments would have been more successful had the narcotics not been needed, but I do seem to be responding finally to my 3rd tx. What I wanted to say is that if you are going to be taking Incivek you may find that it much intensifies the effects of the narcotics. Be careful! I was not warned but fortunately I did reduce my intake initially out of caution. As it turned out, for the entire time I took Incivek I had to halve my narcotics dosage. When I finished the Incivek the pain meds went back to being less effective, but I've been persisting at keeping my dose down in spite of the pain, as I hope it will help my liver heal. Just be sure to be very cautious while on the Incivek, and good luck.

[pooh55811]

Thanks for posting that Will.

I looked on the net and could not find anything condraindicating Hep C treatment and opiates, although I do know it is never a good thing to be over-using opiates. Plus, although I did not state it, my answer was based on prescribed opiates (not over use of opiates) that the doctor would know about.

It is very informative to know that the over-use of opiates can, indeed, have a negative impact on Hep C and Hep C treatment.

[micheall]

I am disabled with a back injury.When I started first tx  and took a pain pill latter on,I didn't feel well.I stopped all my pain pills for 2 years.I have learned from a pain clinic alternate ways to treat my pain.Also getting off my pain pill made me itch.I didn't need the itch.The side effects were bad enough.I went through 2 tx in the last 2 years and got a shoulder operation before 2nd tx.My shoulder was painful but I seem to not notice it when starting Incevek.Hope this helps in your tx.Also your dr will have a complete list of medications not to be taking when you start tx.Hope the best for you.We are here to help.

[willbb]

Hi..You haven't mentioned to what extent your morphine or opiate use is.
If these drugs are used by prescription occasionally for pain and not being over-used or above the recommended doses then as pooh has copied there is not a drug inter-action per se to the HCV therapy meds.

However if there is a over -use or possibly an addictive nature to your opiate and/or morphine use this should be thoroughly addressed before embarking on HCV therapy.

Good luck..and welcome to the group..
Will

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1603777/



Thus, based on current and previous studies with respect to the liver, it appears that chronic opiate abuse leads to: 1) increased risk of viral infection; 2) enhanced viral replication; 3) increased liver injury; 4) decreased hepatic glutathione levels; and 5) increased hepatic fibrosis. The growing implication from these and other studies is that continued opiate abuse leads to enhanced viral replication, liver injury, and hepatic fibrosis. Further studies are required to determine whether these effects occur in humans as well.
Therapy for HCV has been successful even when patients have not abstained from continued drug or alcohol use or are receiving daily methadone. Methadone treatment has been shown to reduce risk behavior that can spread HCV or impair adherence to treatment, and it is not a contraindication to HCV treatment. However, current data suggest that elevated levels of HCV replication, caused by opiates and their withdrawal, may impair responses to interferon. In light of the effect of opiates on HCV replication and immune responses, it is clear that studies on viral kinetics during methadone therapy are warranted to ensure comparable responses to current regimens in patients with ongoing opiate use.






Thus, based on current and previous studies with respect to the liver, it appears that chronic opiate abuse leads to: 1) increased risk of viral infection; 2) enhanced viral replication; 3) increased liver injury; 4) decreased hepatic glutathione levels; and 5) increased hepatic fibrosis. The growing implication from these and other studies is that continued opiate abuse leads to enhanced viral replication, liver injury, and hepatic fibrosis. Further studies are required to determine whether these effects occur in humans as well.
Therapy for HCV has been successful even when patients have not abstained from continued drug or alcohol use or are receiving daily methadone. Methadone treatment has been shown to reduce risk behavior that can spread HCV or impair adherence to treatment, and it is not a contraindication to HCV treatment. However, current data suggest that elevated levels of HCV replication, caused by opiates and their withdrawal, may impair responses to interferon. In light of the effect of opiates on HCV replication and immune responses, it is clear that studies on viral kinetics during methadone therapy are warranted to ensure comparable responses to current regimens in patients with ongoing opiate use.

[pooh55811]

Hello and welcome to the forum.

What drugs will you be taking? Is it Interferon and Riba or is it Interferon, Riba, and one of the new PIs (Incivek or Victrelis)?

I don't know for positive, but I do not think opiate drugs, per se, will mess up your treatment as long as you stick rigidly to the Hepatitis C treatment schedule and Hepatitis C medication schedule. However, you need to talk with your Hep C treating doctor about taking opiates while on treatment. In fact, the treating doc needs to know all medications and supplements you are on, prescription and over the counter.

There is a web site that let you put in the various medication you will be on, as many as you will be on, and it will let you know if it knows of any intereactions. However, the website cautions that not all substances have been tested with all drugs so there could be something that does not show up. I do know there is a list of meds people should not take on Incivek.

http://www.drugs.com/drug_interactions.php

You can type in as many drugs as you want, each in a separate box (it will ask if you want to add more meds).


There are many other drugs that can cause serious or life threatening medical problems if you take them together with Incivek. The following drugs should not be used while you are taking Incivek:
•alfuzosin (Uroxatral);
•atorvastatin (Lipitor, Caduet), lovastatin (Mevacor, Altoprev, Advicor), or simvastatin (Zocor, Simcor, Vytorin);
•cisapride (Propulsid);
•pimozide (Orap);
•midazolam (Versed) or triazolam (Halcion);
•sildenafil (Revatio) or tadalafil (Adcirca) when used to treat pulmonary arterial hypertension;
•St. John's wort;
•rifampin (Rifadin, Rifater, Rifamate); or
•ergonovine, ergotamine (Ergomar, Cafergot, Migergot), dihydroergotamine (D.H.E. 45, Migranal), or methylergonovine (Methergine).

http://www.drugs.com/incivek.html

Again, it is important that you discuss all medications (prescription and over the counter) and all supplements with your doctor before starting treatment. If there is a problem with one of them, you want to know before starting treatment.

Best of luck.