Site News

New primary drug, HCV DAA Ravidsavir

We have added Ravidasvir (Ravida®) to the drug interaction checker, in our first addition to the lineup of Direct Acting Antivirals for many years. 

Ravidasvir is an NS5A inhibitor approved for use with sofosbuvir, which achieved a 97% cure rate in clinical trials in Malaysia. Ravidasvir is an affordable medication, that will expand access to an HCV cure to low-to-middle-income...

Niacin (Vitamin B3) added to checker

We have added niacin (also known as vitamin B3) to the interaction checker. Although prescription-strength niacin is used as a lipid-lowering agent, we have added it to the Herbals/Supplements/Vitamins class to represent its wider use.

Simeprevir interactions retired

We have taken the decision to remove interactions with the HCV primary simeprevir from our website, as this DAA is no longer in use globally for the treatment of HCV. Streamlining our list of primary medications to only include current medications allows us to focus on clinically relevant drug combinations, freeing up more time to add new drugs and to review our database. If there any concerns o...

Six new monoclonal antibodies added to the comedication list

The following monoclonal antibodies have been added to the hepatology interaction checker:

• Eptinezumab - Antimigraine Agents
• Faricimab - Other
• Gemtuzumab ozogamicin - Cancer Therapies
• Inotuzumab ozogamicin - Cancer Therapies
• Ixekizumab - Immunosuppressants
• Loncastuximab tesirine - Cancer Therapies

Changes to interactions with vernakalant

Four new comedications

Four new monoclonal antibody medications have been added to the drug interaction checker.

• Abciximab- Anticoagulant, Anti-platelet and Fibrinolytic
• Amivantamab - Cancer Therapies
• Ansuvimab - Antivirals
• Burosumab - Other

New Cancer Therapies comedication added

The comedication Hydroxyurea (Hydroxycarbamide) has been added to the interaction checker, in the Cancer Therapies class. An update is available for the apps and the PDFs will be updated in due course.

New comedications added the the hepatology checker

The following six new comedications have been added to the interaction checker.

• L-lysine (Herbals/Supplements/Vitamins)
• Olaparib (Cancer Therapies)
• Omega-3-6-9 fatty acids (Herbals/Supplements/Vitamins)
• Oregano oil (Herbals/Supplements/Vitamins)
• Reboxetine (Antidepressants)
• Vilanterol (Bronchodilators)

These comedicatio...

New Treatment Selector: Hormone Therapy for Gender Affirmation

Five new comedications

New comedication: Umeclidinium bromide

We have added umeclidinium bromide as a new comedication to the bronchodilators class. This comedication was suggested to us by users of the website. All of the PDFs have been updated.

Three New Comedications

Three new comedications have been added to the interaction checker. Etizolam is a benzodiazepine not licensed in the UK but used as a recreational drug. Leuproline acetate is a GnRH analogue used for cancer, endometriosis, and precocious puberty. Triptorelin is a GnRH agonist used for cancer and endometriosis. We have added them onto the site as they are used off-label as gender-affirming therap...

Dexamethasone interactions split into low and high dose

Given that dexamethasone displays dose-dependent enzyme induction, we have decided to split dexamethasone in the steroid class into two entries - dexamethasone (low dose) and dexamethasone (full dose). This will allow interactions to be more specific and take into consideration the extent of enzyme induction due to the dose of dexamethasone. 

Last batch of monoclonal antibodies added to site

We have concluded our additions of monoclonal antibodies to the hepatology website. The following fifteen drugs have been added in this batch: 

Bronchodilators: Reslizumab.

Cancer Therapies: Ramucirumab, Sacituzumab govitecan, Trastuzumab, Trastuzumab deruxtecan, and Trastuzumab emtansine.

Immunosuppressants: Ravulizumab, Risankizumab, Secukinumab, Siltuximab, Tildra...

Interactions updated: DOACs and DAA

A recent study examined the risk of clinically relevant bleeding in patients prescribed both DAAs and DOACs. They found a low incidence of bleeding which was not statistically different to historic controls of liver patients on DOACs alone. We have revised our summaries to reflect these new data. Interactions between daclatasvir, elbasvir/grazoprevir, glecaprevir/pibrentasvir, ledipasvir/sofosbu...

New comedication: Testosterone

We have added testosterone to the contraceptives and hormone replacements class. An update is due for the app, and the PDFs will be updated shortly.

New comedication: micronized progesterone (HRT)

Thanks to fruitful conversations at INHSU 2022, we have added micronized progesterone to our database. This bioidentical progesterone is used by cis and trans women for HRT. We anticipate further improving our resources for HRT and gender-affirming therapies.

The app and all PDFs have been updated.

New monoclonal antibodies added to the checker.

We are continuing to add monoclonal antibodies to the HEP checker. The following drugs are now available on the website and the app. The PDFs will be updated with these drugs in due course.

• Galcanezumab - Antimigraine Agents
• Golimumab - Immunosuppressants
• Guselkumab - Immunosuppressants
• Idarucizumab - Other
• Isatuximab - Cancer Therapies
• Lanade...

Interactions with remdesivir updated to reflect QT risk

CredibleMeds have reviewed the QT risk for the COVID-19 drug, remdesivir, and placed it in the Possible Risk category for torsade de pointes. Therefore, we have updated our interactions with the QT-prolonging HCC drugs lenvatinib and sorafenib from green to yellow.

We have also renamed the comedication Valproate (anticonvulsants class, known as Divalproex in the US) to help people find it....

New Prescribing Resource: DAA Formulations for Swallowing Diffculties

New comedications: monoclonal antibodies

The following monoclonal antibodies have been added to the interaction checker:

• Belantamab mafodotin - Cancer Therapies
• Belimumab - Immunosuppressants
• Bezlotoxumab - Antibacterials
• Bimekizumab - Immunosuppressants
• Brolucizumab - Other
• Caplacizumab - Anticoagulant, Anti-platelet and Fibrinolytic
• Cemiplimab - Cancer Therapies
• Cri...

Interaction updated: Sofosbuvir and rifabutin

We have downgraded the interaction between sofosbuvir and rifabutin from red to yellow, due to the publication of new data in the European Summary of Product Characteristics.

"Coadministration of sofosbuvir with rifabutin decreased sofosbuvir Cmax by 56% and AUC by 24%. GS-331007 Cmax increased by 15% and AUC by 3% (induction of P-gp). No dose adjustment of sofosbuvir is required when co...

Monkeypox Antivirals Added to the Checker

In response to the current increase in monkeypox infections seen in previously non-endemic areas, we have added brincidofovir and tecovirimat to the antivirals class.

Antiepileptic and Recreational Drug Treatment Selectors Updated

Nirmatrelvir/ritonavir (Paxlovid) is now available on the HEP website

Interactions for nirmatrelvir/ritonavir are now on the interaction checker. Some of these interactions can be quite complex, so please read the summaries carefully. The interactions with the ritonavir component are based on the 5-day treatment course, and as such may differ from other interactions with long-term ritonavir treatment.

New comedications

The following comedications have been added to the HEP drug interaction checker:

• Infliximab (Immunosuppressants)
• Molnupiravir (Antivirals)
• Niclosamide (Anthelmintics)
• Sotrovimab (Antivirals)
• Tixagevimab/cilgavimab (Antivirals)

The PDF charts have been updated. An update is available for the mobile app.

New comedication: sacubitril/valsartan

We have added the combination sacubitril/valsartan to the Hypertension/Heart Failure Agents class, following a user request. Valsartan interactions have also been reviewed and updated at this time, with some interactions changing from green to amber.

All PDFs have been updated.

New HIV Comedications

We have added six antiretrovirals for HIV as comedications to our database.

• Albuvirtide - HIV Entry/Integrase Inhibitors
• Cabotegravir (oral) - HIV Entry/Integrase Inhibitors
• Cabotegravir/rilpivirine (LA) - HIV Entry/Integrase Inhibitors
• Dapivirine - HIV NNRTIs
• Enfuvirtide - HIV Entry/Integrase Inhibitors
• Fostemsavir - HIV Entry/...

Hepatitis D: Bulevirtide

Our portfolio of liver diseases has grown again, this time to include hepatitis D. The new HDV entry inhibitor, bulevirtide (Hepcludex®) is now listed on our interactions checker. Bulevirtide is currently licensed in Europe and is expected to be approved by the FDA in 2022. 

Recreational drug 'street names' added

As part of our drive to make the website more accessible to people who inject drugs, we have added commonly used street/slang names for several recreational drugs to the interaction checker. The interaction summaries and risk grades are identical to the parent comedication, but typing in a street name (e.g. weed) into the search box will now return an interaction. Commonly used street names were...

New Comedications

We have added the following three comedications to the interactive checker:

• Emicizumab (Other)
• Alirocumab (Lipid Lowering Agents)
• Evolocumab (Lipid Lowering Agents)

The Overview of Interaction PDFs have been updated to reflect this.

New Treatment Selector: Antipsychotics and Neuroleptics

We have added a new Treatment Selector for Antipsychotics and Neuroleptics in response to queries on prescribing HCV drugs to those on medication for their mental health. As a part of this work, all of the interactions of this class with HCV medications has been reviewed and updated as necessary. 

New Comedications

We have added eight new comedications to the checker:

• Canakinumab (Immunosuppressants)
• Convalescent plasma (COVID-19) (Other)
• Interferon beta (Other)
• Nitazoxanide (Antiprotozoals)
• Remdesivir (Antivirals)
• Ruxolitinib (Cancer therapies)
• Sarilumab (Immunosuppressants)
• Tocilizumab (Immunosuppressants)

Two new HCC primaries: lenvatinib and sorafenib

We have added lenvatinib and sorafenib to the interaction checker, completing our hepatocellular carcinoma indication. All the PDFs have been updated, and there are two new PK factsheets for the new primaries.

New Comedications

The following comedications from the COVID-19 website have been added to the HEP interaction checker:

Anakinra - Immunosuppressants

Bamlanivimab - Other

Casirivimab/imdevimab - Other

Baricitinib - Immunosuppressants

Favipiravir - Antivirals

Upadacitinib - Immunosuppressants

All the overview of interactions PDFs hav...

New Antiepileptic Treatment Selector

We have reviewed all our HCV interactions with antiepileptic drugs, as this is a combination we often receive queries about. A new treatment selector is now available, with more sedative drugs added to the list.

Buprenorphine interactions

Carfentanil interactions

Following review, the drugs listed below are now GREEN with carfentanil. These interactions were originally listed as RED due to the extreme danger of carfentanil use, however, no pharmacokinetic drug interaction exists, and carfentanil use should not be a barrier to treatment.

• Adefovir
• Daclatasvir
• Entecavir
• Lamivudine (HBV)
• Obeticholic a...

Interactions with zonisamide

Zonisamide interactions with daclatasvir, ledipasvir/sofosbuvir and simeprevir have been changed from AMBER (Potential Interaction) to GREEN (No Interaction Expected). Increased clinical experience of zonisamide use shows that the inhibition of P-gp does not cause a clinically relevant interaction. 

Influenza vaccine

Influenza vaccine has been added to the comedications list and overview of interactions charts. There is an update available for the app.

New Comedications

A couple more drugs suggested to us via the 'suggest a comed' form have been added; adalimumab, in the immunosuppressants class; and cyclophosphamide, in the cancer therapies class.

New Additions to the Contraceptives and Hormone Replacement class

We have expanded the list of contraceptive and HRT comedications available on the checker, and updated the names to make it clear if the drug is coformulated with an estrogen. The following comedications have been added:

• Conjugated estrogens (HRT)
• Desogestrel/ethinylestradiol (COC)
• Drospirenone/ethinylestradiol (COC) 
• Drospirenone/estradiol ...

New Comedications Added

The following comedications have been added following users' requests.

• Alcohol - Illicit/Recreational
• Cannabidiol (CBD) - Other
• Carfentanil - Illicit/Recreational
• Clofazimine - Antibacterials
• Heroin - Illicit/Recreational
• Mesna - Cancer Therapies

The treatment overview charts and the app have been updated.

New Resource: Interpreting the Liverpool HEP Interactions Checker

New HCC Medication: Pembrolizumab

We have added a new hepatic indication, hepatocellular carcinoma (HCC). The first drug for this indication, the humanised monoclonal antibody pembrolizumab (Keytruda®), has been added to the checker. A PK factsheet for pembrolizumab is available in the Prescribing Resources. Other medications for HCC will be added to the interaction checker soon.

New PBC Medication: Ursodeoxycholic acid

Ursodeoxycholic acid has been added to the interaction checker, under PBC agents.

An Overview of Interactions in the Prescribing Resources has now been added for PBC agents, showing interactions with both obeticholic acid and ursodeoxycholic acid. A new PK fact sheet for ursodeoxycholic acid has also been added to the Prescribing Resources.

New Herbal Comedications

We have added twelve new medications to the herbals/supplements/vitamins class. These new comedications are live on the app and the interaction charts will be updated shortly.

The new herbal drugs are:

• Black cohosh (Actaea racemosa)
• Cat's claw (Uncaria tomemtosa)
• Cyanocobalamin (Vitamin B12)
• Eucalyptus globulus
• Ginger (Zingiber officinal...

New Website Feature: Indication

We are working on a project to expand the scope of the website to cover other drugs for hepatic disease. Previously, viral hepatitis drugs could be sorted on the checker by A-Z, by class, or by trade name. Now, drugs are searchable by indication instead of class.

The first of the new indications is Primary Biliary Cholangitis (PBC) and we have added interactions for the bile acid obetich...

Additions and changes to HIV comedications

Some new HIV drugs and combinations have been added to the list of comedications, along with some changes to two of the existing HIV drugs.

Two new HIV drugs have been added (doravirine and ibalizumab) and five new combinations are now included:

• darunavir/cobicistat/emtricitabine/tenofovir alafenamide
• dolutegravir/rilpivirine
• doravirine/lamivud...

Interactions with hepatitis B drugs

Over the past few months, we have been working on a project to include full interactions with the hepatitis B drugs which has involved assessing and adding ~6700 new interactions. Prior to the completion of this project, many of the interactions with the HBV drugs had not been assessed and were blank.

As part of this project we have added tenofovir alafenamide (Vemlidy®) as a new HBV dru...

Look for alternatives – a new feature for the interaction checker

A new feature has been added to the website interaction checker to make it easier to find possible alternatives when an interaction is amber or red. For these interactions, you now have the option to click on “look for alternatives”. This will take you to a new page showing interactions for the antiretroviral with other comedications in the same class.

The look for alternatives option is...

Additional contraceptives/HRT and a new comedication for TB

The contraceptive/HRT comedication class has been expanded to include 10 new entries, comprising three new drugs with various routes of administration. The new additions are:

• Etonogestrel (implant, progestogen only)
• Etonogestrel (vaginal ring, with ethinylestradiol)
• Levonorgestrel (combined oral contraceptive, COC)
• Levonorgestrel (emergency contraception)

New Comedications

Thirty new comedications have been added to the interaction checker and are listed below. The “Overview of Interactions” PDF chart (available in Prescribing Resources section of this website) has been updated to include these drugs and, for HEP iChart users, an update is available that will add these additional drugs to the app.

• Anaesthetics and Muscle Relaxants: Nitr...

Treatment Selectors – a new prescribing resource

Over 700 comedications now on the interaction checker

The latest update to the comedication list takes the total number of comedications to over 700. This update has seen the addition of 16 new drugs listed below. (You will also notice that the “Cytotoxic” drug class has been renamed “Cancer Therapies” to reflect more accurately the type of drugs included in this class.)

• Antibacterials: Bedaquiline
• Antifungals:

New additions to the interaction checker

The interaction checker has been updated to include 23 new drugs and the addition of a new therapeutic comedication class.

The following new comedications have been added to the classes as shown belown: 

• Analgesic: aceclofenac
• Antidepressants: dosulepin
• Antihistamine: doxylamine
• Antipsychotic/Neuroleptics: ...

New comedications for pulmonary hypertension

Four new comedications for the treatment of pulmonary hypertension have been added to the interaction checker. The new comedications listed are: 

• Epoprostenol
• Riociguat
• Selexipag
• Treprostinil

Six new comedications

Six new comedications have been added to the interaction checker. The new drugs (and their therapeutic classes) are listed below.

• Betahistine (Other)
• Calcium carbimide (Other)
• Clotiapine (Anxiolytic/Sedatives/Hypnotics)
• Dexketoprofen (Analgesics)
• Diosmin (Herbals/Supplements)
• Isosorbide mononitrate ...

New DAA combinations

Two new DAA combinations have been added to the interaction charts - glecaprevir/pibrentasvir (Maviret®, Mavyret®) and sofosbuvir/velpatasvir/voxilaprevir (Vosevi®). Interactions with these combinations are now available on the web, app and printable versions of the interaction charts.

Yellow - a new addition to the interaction classification system

Our interaction classification system has recently been expanded to include a new “yellow” interaction, which now sits between the original green and amber classifications. Yellow interactions are likely to be of weak intensity and as such, additional action or monitoring, or a dosage adjustment is unlikely to be required. However, healthcare professionals should be aware of the potential for an...

Expansion of the interaction classification to include "yellow".

We are have recently expanded our interaction classification to include a new “yellow” classification. In contrast to the existing amber interactions which are “potential clinically significant and likely to require additional monitoring, alteration of drug dosage or timing of administration”, the new yellow classification is for potential interactions likely to be of weak intensity where additi...

A few new comedications

Three new drugs have been added to the comedication list. Metamizole can be found in the analgesic class, and fluindione and phenprocoumon can be found in the “anticoagulant, anti-platelet and fibrinolytic” class.

All versions of the charts (web, app...

New comedications and new therapeutic classes

There have been some additions to the list of comedications and therapeutic classes – 38 new comedications have been added and two new therapeutic classes created (Anaesthetics & Muscle Relaxants, and Oxytocics).

The following comedications have been added to existing therapeutic classes:

• Antibacterial: aztreonam,&nbsp...

Interactions and Hepatic Impairment

We have reviewed all interactions which mentioned a dose modification was required in hepatic impairment. These interactions were previously classed as “amber”, but where there is no other indication for an amber classification, these have now been changed to “green”.

Velpatasvir/Sofosbuvir

Epclusa® (velpatasvir/sofosbuvir) has been approved by the FDA and EMA. Interactions with velpatasvir/sofosbuvir are now available on the web, app and printable versions of the interaction charts. 

New HIV combinations added as comedications

Three new HIV antiretroviral fixed-dose combinations have been added to the interaction charts. The new comedications are:

• emtricitabine/tenofovir alafenamide (Descovy^®)
• elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (Genvoya^®)
• elvitegravir/cobicistat/emtric...

Latest additions to the comedications list

Some new comedications have been added to the interaction charts and are listed below.

Antidepressants - vortioxetine
Anxiolytics/Hypnotics/Sedatives - bromperidol
Cytotoxics - chlorambucil, estramustine, etoposide, exemesta...

Elbasvir/Grazoprevir

Zepatier® (elbasvir/grazoprevir) has been approved by the FDA and is now available on the web, app and printable versions of the interaction charts. 

Comedications – some new, some moved

The latest update to the comedication list has seen the addition of 14 new comedications and the movement of 9 existing comedications from “other” to more specific treatment classifications.

The new comedications are apixaban, benazepril, chlorothiazide, cisplatin, danaparoid, dofetilide, dronedarone, edoxaban, flucloxacillin, ipilimumab, minoxidil, oxaliplatin, ticlopidine and tinzapa...

New comedications

Sixteen new comedications have been added to the web, app and printable versions of the charts. The new drugs are listed below.

• Bortezomib
• Calcitonin
• Calcium resonium
• Conivaptan
• Cyclobenzaprine
• Darbepoetin
• Desogestrel
• Dienogest
• Echinacea
• Estradiol
• Fingolimod
• Flunisolide
• Lysergic acid di...

New anticonvulsants and other comedications

New cytotoxics and additional comedications

Updated list of comedications

* Acebutolol, Albendazole, Alverine Citrate, Aprepitant, Atomoxetine, Atropine, Azilsartan

* Betamethasone, Bilastine, Bromocriptine, Bupivacaine, Buspirone

* Carbidopa, Cetirizine, Ciclesonide,...

European product labels for OBV/PTV/r + DSV

Ombitasvir, Paritaprevir and Ritonavir

It is important to note that the recommendations for Viekirax (OBV/PTV/r) are based on its European SPC and may differ from the current website recomm...

Ombitasvir, Paritaprevir, Ritonavir + Dasabuvir

Ledipasvir/Sofosbuvir

Harvoni®, a fixed-dose combination of ledipasvir (an HCV NS5A inhibitor) and sofosbuvir (an HCV nucleotide analog NS5B polymerase inhibitor, has been recently approved by the FDA and is awaiting marketing authorisation in Europe. Interactions between ledipasvir/sofosbuvir and comedications have been added to the web, app and printed versions of the charts.

Pharmacokinetic information f...

Daclatasvir

Daclatasvir (Daklinza®), a directly acting antiviral for HCV, has been added to the interactions charts.  Interactions between daclatasvir and comedications can be found on the web, app and printed versions of the charts. A PK fact sheet for daclatasvir replaces the earlier investigational drug fact sheet and is listed with the other fact sheets in the Pharmacology Resources section of this...

New Comedications

Twenty four new comedications have been added to the web, app and printable versions of the interaction charts. The new additions are shown below.

Simeprevir

Simeprevir, a directly acting antiviral for HCV, has been added to the interactions charts.  Interactions between simeprevir and comedications can be found on the web, app and printed versions of the charts. A PK fact sheet for simeprevir replaces the earlier investigational drug fact sheet and is listed with the other fact sheets in the Pharmacology Resources section of this website.

Sofosbuvir

Sofosbuvir, the recently approved directly acting antiviral for HCV, has been added to the interactions charts.  Interactions between sofosbuvir and comedications can be found on the web, app and printed versions of the charts. A PK fact sheet for sofosbuvir replaces the earlier investigational drug fact sheet and is listed with the other fact sheets in the Pharmacology Resources section of...

A few more comedications

The following comedications have been added to the web and app versions of the interaction charts.  The printable versions will be updated in the next few weeks.

• Aciclovir
• Brivudine
• Cytisine
• Desvenlafaxine
• Dorzolamide
• Glipizide
• Letrozole
• Rasagiline
• Ropinirole
• Serenoa repens
• Strontium ranelate
...

Further Comedications Added

Improved list of comedications

Additional comedications

Approximately 40 new comedications have been added to the web and app versions of the interaction charts (the printable charts will be updated in next few weeks).  Details of the new drugs are listed below.

Anthelmintics: ivermectin, praziquantel
Anticoagulant and Anti-platelet: dalteparin, enoxaparin, fondaparinux
Antifungals: ...

Interaction Query Service

We are pleased to offer a new service for Health Care Professionals who have queries relating to drug-drug interactions with telaprevir.

The Interaction Query Service allows you to submit a query for assessment by a specialist hepatitis pharmacist. Replies will normally be sent within two working days and an edited version of queries will be posted on the website for ...

New Comedications Added

Printable Charts Updated

New additions to the comedication list

New comedications added to Analagesics, Antidepressants and Anxiolytics/Hypnotics/Sedatives.

Further additions to the comedication list

Updated printable charts

The printable charts have been updated to include all the recent additions to the list of comedications. 

Additional Comedications

Editorial Board

New Comedications Added

Chart Updates

Boceprevir and Telaprevir

Chart Updates

Customised Interaction Charts and PDF Generator

Printable Chart