TOPIC:

Hi LG,

In simple terms Daclatasvir is metabolised in the body by the CYP3a4 enzyme, as are many other drugs. How well CYP3a4 metabolises drugs like Dac is effected by other drugs and foods we eat and drink. if something causes it to metabolise the Dac quicker like Taurine then it is an inducer and we don't get the full dose and if it makes it less effective like Grapefruit or in this case Grapes then it is an inhibitor and we get too large a dose of Dac and more sides.

en.m.wikipedia.org/wiki/CYP3A4

On the other hand Ledipasvir isn't metabolised by CYP3a4 but has absorption issues depending on acidity levels in the stomach.

Ok I have been following what not to eat among the different fruits etc. well I'm in the clear I thought. I am on my 13th day of compounded API Sof/Dac. But as I was thinking this I was eating my nightly bowl of Raisin Bran...raisins = dried grapes! Would this be considered the same as grapes? And thus avoided?

In small quantities and on a not-every-day basis you can eat just about anything.

The only patients I'm aware of who have got into a bit of trouble have been creatures of daily habit - paw-paw every day, grapes every day.....

All that happens with CYP3A4 inhibitors is that you end up with higher blood levels of daclatasvir. This would be expected to be slightly more effective BUT at the expense of more side effects. The dose of 60 mg chosen is because it's about the strongest the average person can take and good enough to do the job.

I was thinking the same thing...I eat muesli most mornings. Guess I'll have to mix up the breakfasts a bit!

Ok I have been following what not to eat among the different fruits etc. well I'm in the clear I thought. I am on my 13th day of compounded API Sof/Dac. But as I was thinking this I was eating my nightly bowl of Raisin Bran...raisins = dried grapes! Would this be considered the same as grapes? And thus be avoided?

Hi Radtek,

If you check my post on the previous page, I was greedily eating 5-6 big handfuls of grapes per day. The effect was mild but noticeable. I don't know how many raisins your Raisin Bran has in it but doubt it would be anywhere near the level I was eating. If you are still worried eat it at the opposite end of the day from the meds and maybe think about alternating daily with a different cereal/bran that doesn't have raisins.

Thanks for the info on fruits to avoid with /Dac. Have looked further online but see nothing regarding other citrus fruits. Has anyone heard of any reactions between Dac and fresh lemons or limes?? Blueberries or other berries? Thx!

Most foods are Ok but I try and not have an abundance of anything and just eat normaly. If you arn't having any side effects and the meds are working your probably ok.

cheers

Hi Shady
I ate a few blueberries and other berries with muesli. I didn't drink or use lemons or lime and kept away from Seville oranges, marmalade, grapefruit and grapes. I think it's as Paul says ' moderation' is key. At times I found I had to withdraw from coffee but I know this didn't affect others on sof/dac.
Cheers

Uh oh...coffee is one I hadn't heard of. I drink about 3 to 4 large mugs a day. Is that a no-no as well?

Coffee is not an inhibitor or inducer of CYP3a4 went taking Daclatasvir. I suspect pat1 just meant that coffee didn't agree with her while on treatment. One common item that may be a problem is Taurine which is found in many energy drinks and health supplement type things.

fixhepc.com/forum/experts-corner/714-tau...t-failure.html#10953

A recent study of Daclatasvir interactions funded by BMS and including the following conclusion.

The robust characterization of the DCV clinical pharmacology program has demonstrated that DCV has few or no clinically relevant DDIs with medications with which it is likely to be co-administered, and the majority of DDIs that do occur can be predicted and easily managed.

link.springer.com/article/10.1007%2Fs12325-016-0407-5

Probably not a great deal of new information for those who have read this site extensively but it does officially confirm the Taurine found in many energy drinks as something to be avoided as suggested by Dr Freeman.

In addition to herbal and dietary supplements which may increase DCV exposure via CYP3A4 inhibition, others may induce or modulate the induction of CYP3A4 and thus potentially reduce the antiviral activity of DCV. Such extracts include St. John’s wort (Hypericum perforatum; a strong inducer of CYP3A4 and thus contraindicated for concomitant use with DCV) [36] and taurine (commonly found in body-building supplements and energy drinks) [38].

Thank Gaj,

When we initially contacted BMS about Taurine they said there was no literature about it. I mentioned rifampacin CYPD3A4 taurine induction and reduced response.

Looks like they have added it to the literature.....

Another habit I hope hasn't mucked up tx. Tart cherry juice..(sigh) seems it has Quercetin that messes with CYP3A4. Just wanted to pass that on. The juice helps with blood pressure, insomnia, muscle cramps and other pains. Hope this is helpful.

Quercetin INHIBITS CYPD3A4 so can lead to elevation of Daclatasvir levels which is a side effect risk but not a treatment failure risk.