So as you probably know I'm keeping an eye on everyone's progress and for the vast majority (as in 96.2% to be exact) we see HCV RNA <LLOQ (ie <12, <15, <25 or <30 depending on the test) by 4 weeks.
As we know daclatasvir levels go up if you take inhibitors of CYP3A4 and down if you take inducers. To date we have only see issues with inhibitors like grapefruit, grapes, paw paw, star fruit and pomegranate causing toxic daclatasvir levels. Bad for patient, ok for SVR.
Today I got a shock. A patient with F0-1 GT3a and an initial viral load of 3,100,000 came back with a 4 week viral load of 935.
This was previously unheard of. So we started looking why.
First the source of the medications (FixHepC) so I know they passed testing, but I can also see the results for the patients immediately before and after which are all as expected - <15 or UND everywhere. Rule out dodgy batch of drugs as the cause.
Next her medications. All green light on the interactions checker:
www.hep-druginteractions.org/checker
Now her supplement - a body building energy potion taken daily and containing:
- Taurine
- Caffeine
- Green tea extract
- Green coffee extract
- And the list went on...
So I Google for taurine and find and article called
Taurine modulates induction of cytochrome P450 3A4 mRNA by rifampicin in the HepG2 cell line.
In plain english this says taurine increases the levels of the enzyme CYP3A4 that removes daclatasvir from your system - in other words it's like you're taking a 1/2 dose, or maybe even a 1/4 dose.
Now taurine may not be the only cause each and every "... extract" will contain dozens of chemicals, all of which could induce or inhibit CYP3A4
So here is my advice:
Do not take random supplements in the hope they may help. They may, they may not - nobody knows and these drugs work without special care. If you want to take extras Vit D and Vit B12 have evidence and there is a long discussion on the forums about many others.
And remember that Red Bull, V, Monster and other "Energy" drinks all contain taurine
Here's more about taurine if you're interested
www.mayoclinic.org/healthy-lifestyle/nut...taurine/faq-20058177