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Hepatitis C virus treatment with glecaprevir and pibrentasvir in patients co-prescribed carbamazepine:Three case reports

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2023年第4期14卷 33-38页

作者： Michael Braude Dilip T Ratnam Louise Marsh Joshua H Abasszade Anouk T Dev Department of Gastroenterology and Hepatology Monash HealthClayton 3168VICAustralia General Practice Margaret River Medical CentreMargaret River 6285Australia

BACKGROUND Highly effective and well-tolerated direct-acting antiviral(DAA)therapies have revolutionised the management of hepatitis C virus(HCV);however,niche populations face treatment *** co-prescribed with several firstgeneration anti-epileptic drugs(AEDs)are contraindicated due to drug-drug interactions.A common example is carbamazepine whereby steady-state carbamazepine reduces the maximum concentration and area under the curve of velpatasvir,glecaprevir and pibrentasvir due to potent cytochrome P450(CYP)3A4 *** also induces P-glycoprotein which reduces glecaprevir and pibrentasvir’s area under curve to infinite *** and glecaprevir-pibrentasvir are contraindicated in patients who are co-prescribed carbamazepine due to the risk of reduced DAA therapeutic effect and consequently,virological treatment *** presents a challenge for patients in whom carbamazepine substitution is medically unfeasible,impractical or ***,the properties of current generation DAA therapies,including high-potency non-structural protein 5A inhibitory effect,may be sufficient to overcome reduced bioavailability arising from carbamazepine related CYP 3A4 and P-glycoprotein *** SUMMARY We present a case series of three patients with non-cirrhotic,treatment-naïve,genotype 1a,1b,and 3a HCV who were treated with a 12 wk course of glecaprevir-pibrentasvir,while co-prescribed carbamazepine for seizure ***-pibrentasvir combination therapy was chosen due to its potent in vitro activity and low barrier to pan-genotypic resistance associated *** therapy was dose-separated from carbamazepine to maximise time to peak concentration,and taken with meals to improve *** virological response at 12 wk was achieved in each patient with no adverse *** DAA therapies,including glecaprevir-pibrentasvir,warrant consideration as a therapeutic agent in people with HCV w

关键词： Antiepileptic drugs Drug interactions Hepatitis C virus Sustained virological response health care access Case repor

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Dimensions of access to Antihypertensive Medications in Ceilandia,Distrito Federal,Brazil

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health 2015年第11期7卷 1517-1526页

作者： Fabiana Xavier Cartaxo Salgado Dayani Galato Gislane Ferreira de Melo Marileusa Dosolina Chiarello Aline Gomes de Oliveira Letícia Farias Gerlack Micheline Marie Milward de Azevedo Meiners Margo Gomes de Oliveira Karnikowski Graduate Program in health Sciences and Technology Campus of CeilandiaUniversity of Brasília(FCE/UnB)BrasíliaBrazil Graduate Program in Gerontology Catholic University of Brasília(UCB)BrasíliaBrazil Graduate Program in Public health University of Brasília(UnB)BrasíliaBrazil

access can be understood as the sum of a number of elements of the interface between patients and the health care system. This study took a comprehensive approach to the dimensions of access to medications, employing indicators to evaluate the dimensions of access to antihypertensive medications in Ceilandia, DF, Brazil. This was a cross-sectional epidemiological study, administering questionnaires during home visits. The survey covered epidemiological and socioeconomic profiles, behavioral habits and the dimensions of access to antihypertensive medications comprising physical, financial, and geographic availability and accept ability according to the hypertensive population of Ceilandia. The total sample comprised 400 individuals and the hypertensive subset numbered 140 (35%). Indicators of physical availability of medications revealed that users found it difficult to acquire their drugs on almost one third of occasions and in some cases were unable to access any of these products. The greatest barriers to access were reported by users of pharmacies belonging to the Brazilian National health Service (SUS) and on the “People’s Pharmacies” network. More than one third of the hypertensive sample spent their own money on medications they could not find at these pharmacies. The majority of the hypertensive subsets were overweight/obese, a minority engaged in physical activity and 40% were smokers/ex-smokers. More women reduced their salt intake. Men had higher incomes, educational level, and socioeconomic status. Failure to keep the public health care system supplied has prejudiced access to essential medications for hypertension treatment, transferring the costs onto users. This population has lifestyle habits that increase the risk of exacerbation of hypertension. These results reveal a need for effective public policies to ensure access to antihypertensive medications and involve users of the health care system in changing their habits and behaviors in order to achie

关键词： health care access Systemic Arterial Hypertension Drug Treatments

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