Health care providers are being reminded not to prescribe certain cholesterol-reducing medications—notably members of the “statin” drug class—for people living with hepatitis C virus (HCV) using either Incivek (telaprevir) or Victrelis (boceprevir), according to a recent U.S. Food and Drug Administration (FDA) safety announcement.
The February 28 document, announcing various safety changes to package inserts for cholesterol-reducing medications, specifically notes that these hepatitis C protease inhibitors should never be taken with Mevacor (lovastatin).
In addition to Mevacor, people using Vertex’s HCV protease inhibitor Incivek should also avoid Liptor (atorvastatin) and Zocor (simvastatin).
And people who take Merck’s Victrelis should avoid both Zocor and Mevacor. It is possible for them to use Lipitor, though the dose should be increased carefully and shouldn’t exceed a maximum daily dose of 20 milligrams (mg).
The central concern is that the hepatitis C protease inhibitors are metabolized, or broken down, in the body using the same enzyme systems that metabolize several statins. This can raise blood levels of the statins, sometimes substantially, potentially increasing the risk of myopathy (muscle damage), which can be serious enough to damage the kidneys and lead to kidney failure.
Other medications to avoid when using Incivek include:
- Uroxatral (alfuzosin): Used to treat enlarged prostates.
- Rifadane (rifampin): An antibiotic frequently prescribed for tuberculosis.
- DHE 45 (dihydroergotamine), Cafergot/Wigraine (ergotamine), Methergine (methylergonovine): Prescribed for migraines.
- Propulsid (cisapride): Prescribed for heartburn.
- St. John’s wort: An herbal product
- Orap (pimozide): An anti-psychotic medication.
- Revatio (sildenafil) or Adcirca (tadalafil): Prescribed for pulmonary hypertension; lower-dose versions are prescribed as Viagra and Cialis, respectively, for erectile dysfunction.
- Halcion (triazolam) or oral Versed (midazolam): Sedatives.
Other medications to avoid when using Victrelis: