Table 2 Characteristics of DAA and dose adjustments for renal or hepatic impairment
Drug | Inhibition | Induction | Substrate | Renal impairment | Hepatic impairment |
|---|---|---|---|---|---|
Asunaprevir | Moderate inhibitor of CYP2D6 | Weak inhibitor of CYP3A4 and P-gp | Substrate of CYP3A4, P-gp, and OATP1B1 | No adjustment needed | Should likely be avoided in patients with CTP class B or C disease |
Daclatasvir | Moderate inhibitor of P-gp and OATP | NA | Substrate of CYP3A and P-gp | No adjustment needed | No adjustment needed |
Ledipasvir | Mild inhibitor of P-gp, BCRP | NA | Substrate of P-gp | No adjustment needed | No adjustment needed |
Paritaprevir, ritonavir, and ombitasvir plus dasabuvir | Inhibitor of CYP3A4, CYP2D6, P-gp, OATP, and BCRP | Inhibitor of CYP1A2, CYP2C8, CYP2C9, and CYP2C19 (based on ritonavir pharmacokinetics) | Substrate of CYP3A4, CYP2C8, and CYP2D6 | Likely no adjustment needed | Not recommended in patients with CTP class B disease and contraindicated in patients with CTP class C disease |
Simeprevir | Mild inhibitor of intestinal CYP3A and CYP1A2; mild inhibitor of OATP and P-gp | NA | Substrate of CYP3A | No adjustment needed | Should be used with caution in patients with CTP class B or C disease |
Sofosbuvir | NA | NA | Substrate of P-gp | Not recommended if GFR <30 mL/min/1.73 m2 | No adjustment needed |