simeprevir (Discontinued)

Brand and Other Names:Olysio
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Dosing & Uses

AdultPediatric

Chronic Hepatitis C

May 2018: Discontinued from market as it has been largely replaced by new drugs with higher cure rates

Safety and efficacy not established

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Interactions

Interaction Checker

and simeprevir

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                • berotralstat

                  simeprevir increases levels of berotralstat by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Reduced berotralstat dose to 110 mg/day when coadministered with P-gp inhibitors.

                Minor (0)

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                  Adverse Effects

                  >10%

                  Rash; including photosensitivity (28%)

                  Hyperbilirubinemia, grade 1 (27%)

                  Pruritus (22%)

                  Nausea (22%)

                  Hyperbilirubinemia, grade 2 (18%)

                  Myalgia (16%)

                  Dyspnea (12%)

                  1-10%

                  Hyperbilirubinemia, grade 3 (4%)

                  Alkaline phosphatase elevation, grade 1 (3%)

                  <1%

                  Hyperbilirubinemia, grade 4

                  Alkaline phosphatase elevation, grade 2

                  Postmarketing reports

                  Serious symptomatic bradycardia (patients taking amiodarone who initiate treatment with sofosbuvir in combination with another HCV direct acting antiviral, including simeprevir

                  Hepatic decompensation and hepatic failure, including fatal cases reported in patients receiving therapy in combination with peginterferon alfa and ribavirin or in combination with sofosbuvir

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                  Warnings

                  Black Box Warnings

                  Test all patients for evidence of current or prior hepatitis B virus (HBV) infection before initiating treatment with HCV direct acting antivirals (DDAs)

                  HBV reactivation has been reported in HCV/HBV coinfected patients who were undergoing or had completed treatment with DDAs and were not receiving HBV antiviral therapy

                  Some cases have resulted in fulminant hepatitis, hepatic failure, and death

                  Monitor HCV/HBV coinfected patients for hepatitis flare or HBV reactivation during HCV treatment and post-treatment follow-up

                  Initiate appropriate patient management for HBV infection as clinically indicated

                  Contraindications

                  Hypersensitivity

                  Also consider contraindications to peginterferon alfa and ribavirin

                  Because ribavirin may cause birth defects and fetal death, simeprevir in combination with peginterferon alfa and ribavirin is contraindicated in pregnant women and in men whose female partners are pregnant

                  Cautions

                  Hepatitis B virus (HBV) reactivation has been reported in HCV/HBV coinfected patients who were undergoing or had completed treatment with HCV DDAs, and who were not receiving HBV antiviral therapy; HBV reactivation is characterized as an abrupt increase in HBV replication manifesting as a rapid increase in serum HBV DNA level (see Black Box Warnings and Dosing Considerations)

                  Serious symptomatic bradycardia in patients taking amiodarone with sofosbuvir in combination with simeprevir reported, especially in patients receiving beta blockers, or those with underlying cardiac comorbidities and/or advanced liver disease; coadministration of amiodarone with simeprever in combination with sofosbuvir not recommended; in patients without alternative treatment options, cardiac monitoring is recommended

                  Hepatic decompensation and hepatic failure, including fatal cases, reported when coadministered with peginterferon alfa and ribavirin or in combination with sofosbuvir; most cases were reported in patients with advanced and/or decompensated cirrhosis who are at increased risk for hepatic decompensation or hepatic failure; monitor liver chemistry tests before and during simeprevir combination therapy

                  Photosensitivity reported, including serious reactions which resulted in hospitalization

                  Rash may occur, most frequently within the first 4 weeks; mild-to-moderate rashes should be followed for possible progression of rash, including the development of mucosal signs (eg, oral lesions, conjunctivitis) or systemic symptoms; discontinue if rash becomes severe

                  Contains a sulfonamide moiety; in subjects with a history of sulfa allergy (n=16), no increased incidence of rash or photosensitivity reactions was observed; however, insufficient data exist

                  Must NOT be used as monotherapy

                  Drug interaction overview

                  • Avoid coadministering with moderate or strong CYP3A inhibitors; simeprevir AUC increased >7-fold
                  • Avoid coadministering with moderate or strong CYP3A inducers; simeprevir trough levels decreased >90%
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                  Pregnancy & Lactation

                  Pregnancy

                  Simeprevir is coadministered with ribavirin and peginterferon alfa; extreme caution must be taken to avoid pregnancy in female patients and female partners of male patients while taking this combination (see Contraindications)

                  Significant teratogenic and/or embryocidal effects have been demonstrated in all animal species exposed to ribavirin; and therefore ribavirin is contraindicated

                  Women of childbearing potential and their male partners should not receive ribavirin unless they are using effective contraception (2 reliable forms) during treatment with ribavirin and for 6 months after treatment

                  Ribavirin may cause birth defects and fetal death; avoid pregnancy in female patients and female partners of male patients; patients must have a negative pregnancy test prior to therapy; use 2 or more forms of contraception, 1 of these forms of contraception can be a combined oral contraceptive product containing at least 1 mg of norethindrone (lower doses of norethindrone and other forms of hormonal contraception have not been studied or are contraindicated)

                  Lactation

                  Unknown if distributed in human breast milk; because of the potential for adverse reaction, breastfeeding is not recommended

                  Pregnancy Categories

                  A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                  B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                  C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                  D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                  X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                  NA: Information not available.

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                  Pharmacology

                  Mechanism of Action

                  In a biochemical assay simeprevir inhibited the proteolytic activity of recombinant genotype 1a and 1b HCV NS3/4A proteases, with median Ki values of 0.5 nM and 1.4 nM, respectively

                  NS3/4A protease is needed for proteolytic cleavage of the HCV encoded polyprotein into mature forms

                  Absorption

                  Food increases systemic exposure by 60-70%

                  Peak plasma time: 4-6 hr

                  Predose plasma concentration: 1936 ng/mL

                  AUC: 57,469 ng•hr/mL

                  Distribution

                  Protein bound: >99.9%

                  Metabolism

                  Substrate: CYP3A (major); CYP2C8 (minor) and CYP2C19 (minor)

                  Inhibits OATP1B1/3 and P-gp transporters

                  Mildly inhibits CYP1A2 and intestinal CYP3A, but does not affect hepatic CYP3A4 activity

                  Elimination

                  Half-life: 41 hr (HC- infected); 10-13 hr (HCV-uninfected)

                  Excretion: Hepatobiliary; 91% feces (31% unchanged); <1% urine

                  Pharmacogenomics

                  Efficacy is substantially reduced in patients infected with HCV genotype 1a with an NS3 Q80K polymorphism at baseline; screening patients for the presence of virus with the NS3 Q80K polymorphism at baseline is strongly recommended

                  Simeprevir exposures are higher in populations with lower amounts of CYP3A and/or OATP1B1/3 including patients of East Asian ancestry

                  IL28B genetic variant

                  • A genetic variant near the gene encoding interferon-lambda-3 (IL28B rs12979860, a C to T change) is a strong predictor of response to peginterferon alfa and ribavirin
                  • Overall, sustained viral response rates were lower in subjects with the CT and TT genotypes compared to those with the CC genotype
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                  Administration

                  Oral Administration

                  Take with food (bioavailability improved)

                  Swallow capsule whole

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                  Images

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                  Patient Handout

                  A Patient Handout is not currently available for this monograph.
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                  Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.