Two Potentially Hepatoprotective Agents Proved Compatible With Technivie

In an article published October 21 2015 in the journal Clinical Therapeutics, investigators Zha and colleagues reported results of a pharmacokinetic drug interaction study between the ingredients in Technivie (ombitasvir, paritaprevir, and ritonavir) and 2 hepatoprotective drugs: ursodeoxycholic acid (also known as ursodiol in the United States), and glycyrrhizin, which is found in extracts of licorice and is known for hepatoprotective properties.

A total of 24 Japanese patients with hepatitis C received the 2 medications with either a 2-drug combination of ombitasvir and paritaprevir, or a 3-drug combination of ombitasvir, paritaprevir, and ritonavir (the components of Technivie).

While ursodiol with the 2-drug regimen reduced steady-state exposure to ombitasvir, paritaprevir, and ritonavir by 9% or less, and ursodiol exposure was reduced 20% or more, neither interaction was considered clinically significant.

With glycyrrhizin, levels of the 2-drug combination were reduced, but levels of glycyrrhizin in the presence of the anti—hepatitis C therapy increased approximately 50%. Considering that glycyrrhizin can raise blood pressure, it is important to monitor its clinical effects in patients using this supplement.

In the United States, Technivie is indicated for use in patients with genotype 4 chronic hepatitis C virus who do not have cirrhosis. This medication interacts with several medications, although neither ursodiol nor glycyrrhizin are mentioned in the package insert.

Whether the use of hepatoprotective drug is worthwhile in patients with chronic hepatitis C virus has yet to be determined. However, the relatively mild pharmacokinetic interactions between ursodiol and glycyrrhizin may be important in assuring patients of the safety of hepatoprotective treatments to help reduce the risk of liver damage associated with use of Technivie.

These results are potentially clinically important given that the FDA has added a warning to both Technivie and Viekira Pak for the potential risk of liver damage.

With a pharmacokinetic study showing no substantial interactions between key ingredients in Technivie and Viekira Pak and 2 hepatoprotective medications, more patients may use ursodiol (which is available by prescription) and glycyrrhizin (which is available as a dietary supplement in the United States) as an additional measure of safety when using Technivie and Viekira Pak.

References

• Zha J, Badri PS, Ding B, et al. Drug Interactions Between Hepatoprotective Agents Ursodeoxycholic Acid or Glycyrrhizin and Ombitasvir/Paritaprevir/Ritonavir in Healthy Japanese Subjects. Clin Ther. 2015.
• Szabo C. FDA Warning: Viekira Pak and Technivie May Cause Serious Liver Injury. http://www.specialtypharmacytimes.com/news/fda-warning-viekira-pak-and-technivie-may-cause-serious-liver-injury. Accessed October 2015.