Diabetics may experience improved glucose control, potentially resulting in symptomatic hypoglycaemia, after initiating HCV DAA treatment. Glucose levels of diabetic patients initiating DAA therapy should be closely monitored, particularly within the first 3 months, and their diabetic medication modified when necessary. The physician in charge of the diabetic care of the patient should be informed when DAA therapy is initiated.

Clearance of HCV infection with direct acting antivirals may lead to changes in hepatic function, which may impact the safe and effective use of concomitant medications. For example, altered blood glucose control resulting in serious symptomatic hypoglycemia has been reported in diabetic patients in postmarketing case reports and published epidemiological studies. Management of hypoglycemia in these cases required either discontinuation or dose modification of concomitant medications used for diabetes treatment. Frequent monitoring of relevant laboratory parameters (e.g. blood glucose levels in diabetic patients) is recommended to ensure safe and effective use. Dose adjustments of concomitant medications may be necessary.

Coadministration of daclatasvir (60 mg once daily) and metformin (500 mg twice daily, days 1-2; 1000 mg twice daily, days 3-8) was studied in healthy subjects. Pharmacokinetic data from 19 subjects showed no effect of daclatasvir on metformin AUC (9% increase), Cmax (8% increase) or C12 (12% increase). No pharmacodynamic effect was observed using the oral glucose tolerance test (n=19).