Drug interactions
Carbamazepine + Sofosbuvir-velpatasvir
Severity: Major
Carbamazepine and Sofosbuvir-velpatasvir: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Carbamazepine is a potent inducer of P-glycoprotein and of several CYP enzymes, and it can substantially lower plasma concentrations of sofosbuvir and velpatasvir. This may lead to loss of antiviral activity and treatment failure or resistance. The combination is not recommended in labeling.
What this interaction means in plain words
Carbamazepine and Sofosbuvir-velpatasvir can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Carbamazepine belongs to Central Nervous System; Sofosbuvir-velpatasvir belongs to Anti Virals.
Why it happens
Carbamazepine induces P-gp and CYP2B6, CYP2C8 and CYP3A4, increasing clearance and reducing absorption of sofosbuvir and velpatasvir.
What to do
Avoid the combination and switch to an anticonvulsant without enzyme-inducing activity, such as levetiracetam, if clinically possible. If it cannot be avoided, consult a hepatology or infectious disease specialist and confirm sustained virologic response.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Sofosbuvir-velpatasvir
- Rifampin + Sofosbuvir-velpatasvir Contraindicated
- Rifapentine + Sofosbuvir-velpatasvir Contraindicated
- Sofosbuvir-velpatasvir + St john's wort Contraindicated
- Amiodarone + Sofosbuvir-velpatasvir Major
- Apalutamide + Sofosbuvir-velpatasvir Major
- Dabrafenib + Sofosbuvir-velpatasvir Major
Other interactions of Carbamazepine
- Artemether / lumefantrine + Carbamazepine Contraindicated
- Cabotegravir + Carbamazepine Contraindicated
- Carbamazepine + Delamanid Contraindicated
- Carbamazepine + Dienogest / estradiol valerate Contraindicated
- Carbamazepine + Doravirine Contraindicated
- Carbamazepine + Elbasvir / grazoprevir Contraindicated
Frequently asked questions
Can I take Carbamazepine with Sofosbuvir-velpatasvir?
MediHelp rates the interaction as major. Carbamazepine and Sofosbuvir-velpatasvir can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Carbamazepine is a potent inducer of P-glycoprotein and of several CYP enzymes, and it can substantially lower plasma concentrations of sofosbuvir and velpatasvir. This may lead to loss of antiviral activity and treatment failure or resistance. The combination is not recommended in labeling.
How serious is the interaction between Carbamazepine and Sofosbuvir-velpatasvir?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination and switch to an anticonvulsant without enzyme-inducing activity, such as levetiracetam, if clinically possible. If it cannot be avoided, consult a hepatology or infectious disease specialist and confirm sustained virologic response.
What other medicines interact with Sofosbuvir-velpatasvir?
MediHelp also lists interactions of Sofosbuvir-velpatasvir with, for example, Rifampin, Rifapentine, St john's wort. The full list is on the Sofosbuvir-velpatasvir page.
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