No dose adjustment of Sofosbuvir/velpatasvir or ciclosporin is required at initiation of co-administration. Afterwards, close monitoring and potential dose adjustment of ciclosporin may be required. Coadministration of ciclosporin (600 mg single dose) and sofosbuvir (400 mg single dose) had no effect on ciclosporin Cmax or AUC, but increased sofosbuvir Cmax and AUC by 150% and 350%. Coadministration of ciclosporin (600 mg single dose) and velpatasvir (100 mg single dose) had no effect on ciclosporin Cmax, but decreased AUC by 12%; velpatasvir Cmax and AUC increased by 60% and 100%.
The pharmacokinetics of drugs that are metabolized by the liver (e.g. immunosuppressive agents such as calcineurin inhibitors) may be impacted by changes in liver function during DAA therapy, related to clearance of HCV.