TOPIC:

Hi there, I am starting an 8 week Sofosburvir + Daclatasvir treatment, Genotype 1a
Over the last 3 months I have been taking KRATOM ,It is an Indonesian herb with relaxing anti-anxiety properties.
I am finding it surprisingly hard to quit and am wondering about any interactions?

Yes this could be a problem for both the Sofosbuvir and the Daclatasvir, both of which would be expected to be at higher levels in your blood stream due to Kratom inhibiting their metabolism. This might be helpful for you as 8 weeks treatment with Sof+Dac for GT1 is borderline - you should take 12 weeks, but is not to be recommended.

www.dovepress.com/pharmacokinetics-of-mi...ulltext-article-DDDT

Kratom has the potential herb–drug interaction on cytochrome P450 (CYP) enzyme activity. This was shown in one study, with potent inhibitory effect for CYP3A4 and CYP2D6, moderate effect for CYP1A2, and weak effect for CYP2C19,22 whereas in another study, mitragynine and 7-hydroxymitragynine also showed the inhibitory effect on P-glycoprotein.23 However, there were a few reports of Kratom-related fatalities.

Daclatasvir is metabolised by CYPD3A4 so if you inhibit it with Kratom you will run high levels of Daclatasvir in your blood.

www.medscape.com/viewarticle/842315

Sofosbuvir, like many drugs, is partially cleared via the p-glycoprotein transporter (P-GP) system.

So Kratom is also expected to elevate your Sofosbuvir levels and it can be cardiotoxic in high doses.

Advice

You should seriously consider not taking Kratom for the duration of treatment.

You should also seriously consider getting another 4 weeks treatment.

Thank you for this reply, I Will stop Kratom usage before starting medication. My hepc specialist here in Canada wrote the 8 week prescription, my viral load is low, but I agree and I will look into doing an extra 4 weeks.

What genotype are you? Please don't say 3.

The extra 4 weeks is $500 worth of damn good insurance.

!a

Well that's a relief.

With the GT1a the 8 week duration for treatment naive low fibrosis patients with a viral load of less than 6 million the data related to Sofosbuvir/Ledipasvir and has been shown to be optimistic ie in the real world patients with this profile get better results with 12 weeks treatment.

Sof/Dac is probably slightly better but it is an extrapolation from data for a different drug combo.

My viral load was 220000 I think.

DrJames:

How do you feel about low to moderate kratom use while on Epclusa? Prescribing information for Epclusa specifically states that

EPCLUSA may be coadministered with P-gp, BCRP, and CYP inhibitors.

The metabolism of Kratom has been studied.

www.ncbi.nlm.nih.gov/pmc/articles/PMC4425236/

It is a potent inhibitor of a number of cytochromes including the CYP3A4 one that metabolised daclatasvir so would be expected to cause daclatasvir toxicity or increased side effects.

It is also an inhibitor of P-glycoprotein, but as you note that is allowed for Epclusa.

So the answer is a guarded "it should be ok" but...

DrJames wrote: The metabolism of Kratom has been studied.

www.ncbi.nlm.nih.gov/pmc/articles/PMC4425236/

It is a potent inhibitor of a number of cytochromes including the CYP3A4 one that metabolised daclatasvir so would be expected to cause daclatasvir toxicity or increased side effects.

It is also an inhibitor of P-glycoprotein, but as you note that is allowed for Epclusa.

So the answer is a guarded "it should be ok" but...

DrJames,

Thanks for your advice. I underwent treatment with 12 weeks Epclusa: had serious fatigue as a side effect, but that was the DAA doing its job, everyone responds differently. Reached SVR24 so cured now. I did discontinue kratom use a month before starting treatment as the jury is still out it seems. Felt so much better after finishing Epclusa I never bothered with kratom again. Thanks for the service you provide to the Hep C community!

Congratulations on your cure Lamussa, and on feeling well again, that's fantastic

Hello lamussa,

Thanks for the update and congratulations on your SVR12.

My observation is that while Epclusa is a good drug it does seem to have a few more side effects than either Haroni or Sovaldi+Daklinza.

It's awesome to hear your improvement is sufficient that you don't need other medications. This is common and one of the nice things about helping people get treated - patients come back and say "Hey, I really do feel better"

Thank you Mar and DrJames. My gastroenterologist told me he prefers prescribing Mavyret and Epclusa now, using Harvoni if dictated by a patient's insurance. The extreme fatigue I felt while on Epclusa was unusual in his experience and vanished at week ten. I was a fast responder to Epclusa with viral load dropping to 50 in two weeks. All in the past now.

We are lucky that all the new medications - Harvoni, Epclusa and Mavyret are remarkably clean in terms of having minimal side effect in most patients. Some people do it harder than others, but overall it's like chalk and cheese compared to the bad old days of PEG/Riba for 12 months of hell and a 50% chance of cure.

I just started epclusa 3 weeks ago and I started taking kratom a week ago. Has anyone taken kratom during their treatment? Should I stop taking it? Are there anything I should be worried about if I don't stop? Will it decrease the chances of curing it? Any general information would be appreciated, thank you.