Victrelis Boceprevir Contraindications

Victrelis™ (boceprevir) and Hepatitis C

When is Victrelis™ contraindicated?

The same contraindications that pertain to peginterferon and ribavirin also apply to the Victrelis™ combination treatment. This combination treatment is contraindicated in the following:

Pregnant women and men whose female partner is pregnant due to the risks for birth defects and fetal death associated with ribavirin.
Coadministration with drugs that are highly dependent on CYP3a4/5 for clearance, and for which elevated plasma concentrations are associated with serious and/or life-threatening events including:

Drug Class	Specific Drugs Within Class Contraindicated with Victrelis™
Alpha 1-Adrenoreceptor antagonist	Alfuzosin (Uroxatral®)
Anticonvulsants	Carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol XR ®, Teril®) Phenobarbital Phenytoin (Dilantin®)
Antimycobacterial	Rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®)
Ergot Derivatives	Dihydroergotamine (D.H.E. 45®, Migranal®) Ergonovine and methylergonovine (Ergotrate®, Methergine®) Ergotamine (Cafergot®, Migergot®, Ergomar®, Ergostat®, Medihaler Ergotamine®, Wigraine®, Wigrettes®)
GI Motility Agent	Cisapride (Propulsid®)
Herbal Products	St. John’s Wort (hypericum perforatum) or products containing St. John’s Wort
HMG-CoA Reductase Inhibitors	Lovastatin (Advicor®, Altoprev®, Mevacor®) Simvastatin (Simcor®, Vytorin®, Zocor®)
Oral Contraceptives	Drosperinone (including Yaz®, Yasmin®, Zarah®, Ocella®, Gianvi®, Beyaz®, Safyral®)
PDE5 enzyme Inhibitor	Soldenafil (REVATIO®) or tadalafil (ADCIRCA®) when used for the treatment of pulmonary arterial hypertension or lung problems
Neuroleptic	Pimozide (Orap®)
Sedative/Hypnotics	Triazolam (Halcion®) or midazolam (Versed®) when taken by mouth

Other potentially significant drug interactions include:

Drug Class: Drug Name	Effect on Concentration of Boceprevir or Drug
Antiarrhythmics: amiodarone (Cordarone®, Exterone®, Pacerone®), bepridil (Vascor®), flecainide (Tambocor®), propafenone (Rhythmol®, Rhythmol SR®), quinidine digoxin (Lanoxin®)	Increases antiarrhythmics Increases digoxin
Anticoagulant: warfarin (Coumarin®)	Increases or decreases warfarin
Antidepressants: trazadone (Desyrel®), desipramine (Norpramin®)	Increases trazadone Increases desipramine
Antifungals: ketoconazole (Nizoral®), Itraconazole (Sporanox®), posaconazole (Noxafil®), Voriconazole (Vfend®)	Increases boceprevir Increases itraconazole Increases ketoconazole Increases posaconazole Increases voriconazole
Anti-gout: colchicines (Colcrys®, Probenecid and Colchicine, COL-Probenecide)	Increases colchicine
Anti-infective: clarithromycin (Biaxin®, Biaxin XL®, Prevpac®)	Increases clarithromycin
Antimycobacterial: Rifabutin (Mycobutin®)	Decreases boceprevir Increases rifabutin
Calcium Channel Blockers, dihydropyridine: felodipine (Plendil®), nifedipine (Procardia®, Adala CC®, Procardia XL®, Afeditab CR®), nicardipine (Cardene SR ®, Cardene®)	Increases dihydropyridine calcium channel blockers
Corticosteroid, systemic: Dexamethasone	Decreases boceprevir
Corticosteroid, inhaled: Budesonide (Pulmicort®, Pulmicort Flexihaler®, Rhinocort®, Pulmicort Respules®, Symbicort®), fluticasone (Veramyst®, Flovent HFA®, Flovent Diskus®, Advair HFA®, Advair Diskus®)	Increases budesonide Increases fluticasone
Endothelin Receptor Antagonist: Bosentan (Tracleer®)	Increases bosentan
HIV Non-Nucleoside Reverse Transcriptase Inhibitors: efavirenz (Sustiva®, Atripla®)	Decreases boceprevir
HIV Protease Inhibitors: ritonavir (Norvir®, Kaletra®)	Decreases boceprevir Increases or decreases HIV protease inhibitors
HMG-CoA Reductase Inhibitors: Atorvastatin (Lipitor®)	Increases atorvastatin
Immunosuppressants: Cyclosporine (Gengraf®, Neoral®, Sandimmune®), sirolimus (Rapamune®), tacrolimus (Prograf®)	Increases immunosuppressants
Inhaled beta-agonist: salmeterol (Advair HFA®, Advair Diskus®, Serevent®)	Increases salmeterol
Narcotic Analgesic/Opioid Dependence: methadone (Dolophine®), Buprenorphine (Butrans®, Buprenex®, Suboxone®, Subutex®)	Increases or decreases methadone Increases or decreases buprenorphine
Oral hormonal contraceptives: drospirenone/ethinyl estradiol	Increases drospirenone Decreases ethinyl estradiol
PDE5 inhibitors: sildenafil, tadalafil, vardenafil (Staxyn®, Levitra®)	Increases sildenafil Increases tadalafil Increases vardenafil
Sedative/hypnotics: alprazolam (Xanax®); IV midazolam	Increases midazolam Increases alprazolam