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TOPIC: Sofosburvir + Daclatasvir Worried about KRATOM usage

Sofosburvir + Daclatasvir Worried about KRATOM usage 1 year 4 months ago #24038

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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?
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Sofosburvir + Daclatasvir Worried about KRATOM usage 1 year 4 months ago #24044

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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.
YMMV
Last Edit: 1 year 4 months ago by DrJames.
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Sofosburvir + Daclatasvir Worried about KRATOM usage 1 year 4 months ago #24045

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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.
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Sofosburvir + Daclatasvir Worried about KRATOM usage 1 year 4 months ago #24046

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

The extra 4 weeks is $500 worth of damn good insurance.
YMMV
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Sofosburvir + Daclatasvir Worried about KRATOM usage 1 year 4 months ago #24051

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!a
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Sofosburvir + Daclatasvir Worried about KRATOM usage 1 year 4 months ago #24053

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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.
YMMV
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Sofosburvir + Daclatasvir Worried about KRATOM usage 1 year 4 months ago #24056

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My viral load was 220000 I think.
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Sofosburvir + Daclatasvir Worried about KRATOM usage 3 months 1 week ago #26432

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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.
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Sofosburvir + Daclatasvir Worried about KRATOM usage 3 months 1 week ago #26433

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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...
YMMV
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