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Right, now I’m confused lol. Looked up hep-interactions and there are no contraindications with codeine for Dac – just wondering as I had to take panadeine yesterday as the nerve pain in my arm got so that it was pretty unbearable…anyone have any ideas about this? I know the doc uses this site when prescribing as he ran Gabapetin through it for me when writing up my script…and wikipedia is well, not the University of Liverpool lol
http://www.hep-druginteractions.org/checker
Substrates of CYP3A4 are the drugs that are metabolised by it. The inhibitors and inducers are the chemicals/drugs that effect the rate of metabolisation and are the ones we want to avoid. The link gives a reasonable explanation.
Daclatasvir is one of the substrates of CYP3A4 as are the others Phoenix listed. Now, two substrates at the same time can effect how efficiently CYP3A4 works if one is monopolising the enzyme but we just need to check the drug interactions chart which should pick those up.
http://www.straighthealthcare.com/cytochrome-p450-3a4.html
G3a since ’78 – Dx ’12 – F4 (2xHCC)
24wk Tx – PEG/Riba/Dac 2013 relapsed
24wk Tx – Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx – 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 – 22/06/17 UND
SRV12 – 27/07/17 UND
SVR24 – 26/10/17 UND
Hi Phoenix,
Thanks for the tip about pomegranate and noni juice too!
I was also told that Seville Oranges and marmalade made with them should be avoided during my 2013 trial.
G3a since ’78 – Dx ’12 – F4 (2xHCC)
24wk Tx – PEG/Riba/Dac 2013 relapsed
24wk Tx – Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx – 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 – 22/06/17 UND
SRV12 – 27/07/17 UND
SVR24 – 26/10/17 UND
Hi Phoenix,
We need to keep in mind that CYP3A4 is one of our more important enzymes so pretty much anything we ingest is involved.
We are only concerned about potent inhibitors or inducers. So yes, per the cited article Star Fruit, Paw Paw, Pomeganate, Grapefruit are all inadvisable as are things like Echinacea, Ginko, Soy and Grape Seed extracts. Also keep in mind that these are inhibitors so will result in slower metabolisation of Dac. i.e. They will tend to retain Dac in our bodies for longer which could caused too high levels and sides.
OTOH St Johns Wort is an inducer so it causes our body to lose the Dac too quickly and is therefore an even bigger problem as the Dac may get removed before it does its job.
Garlic apparently does both so a bit difficult to determine effect, but would be warned against by BMS if it was potent at either. I would suggest a bit of garlic for flavour won’t have any effect but eating cloves of raw garlic, particularly within a few hours of when we take our meds is probably something to avoid.So basically avoid items listed as potent inhibitors/inducers and for mild ones don’t consume in large quantities or at the same time as you take the Dac.
G3a since ’78 – Dx ’12 – F4 (2xHCC)
24wk Tx – PEG/Riba/Dac 2013 relapsed
24wk Tx – Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx – 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 – 22/06/17 UND
SRV12 – 27/07/17 UND
SVR24 – 26/10/17 UND
Whoops! I just saw the comment about avoiding everything on the substrate list….that may prove a bit difficult as substrates are the things that the enzyme works on such as Dac and many other things we ingest. Just avoid the potent inhibitors/inducers and check for substrate clashes via the drug interaction charts.
PS BMS may not have listed things like Pawpaw because it is not common in U.S./Europe or they may have checked it and found that the inhibiting it does doesn’t impact Dac due to the chemical pathways involved. Best to be cautious with things like that but they will have checked many common items and do not see them as an issue. Ginko and Ginseng are listed on the drug interaction charts though.
G3a since ’78 – Dx ’12 – F4 (2xHCC)
24wk Tx – PEG/Riba/Dac 2013 relapsed
24wk Tx – Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx – 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 – 22/06/17 UND
SRV12 – 27/07/17 UND
SVR24 – 26/10/17 UND
Ah, so eating the pawpaw on my kitchen bench and the miso (soy extract) in my fridge gives me a higher dose of Dac for free! Maybe I should tuck in until I get bad sides!
ick:' />Yeah I’d already ditched my daily soy protein powder for a whey-isolate based one a few weeks ago. As for the inhibiting-effect, I’m getting a larger dose in any case due to bodyweight ratio – possibly not a good idea to enhance it lol But too early to tell what sx (if any) I’m going to get…watch & wait
Well i’m stuffed then as I take my daily meds with coffee every morning, eat some of the listed fuits and love garlic
Two time relapser.
SVR 4 achieved 12/16 at last
SVR 12 achieved 22/02/2017 The Bastard has been defeatedGT 3 – about 28 yrs with HCV
You should be fine Paul, coffee is a substrate that has no effect on Dac (phew!) and later research on garlic shows:
“Exposure of hepatocytes to garlic extract may reduce the expression and activity of CYP2C9 with no detectible effects on CYP3A4.”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951329/
Just avoid the top four fruits on that list where possible and definitely don’t wash the Dac down with a glass of grapefruit juice.
G3a since ’78 – Dx ’12 – F4 (2xHCC)
24wk Tx – PEG/Riba/Dac 2013 relapsed
24wk Tx – Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx – 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 – 22/06/17 UND
SRV12 – 27/07/17 UND
SVR24 – 26/10/17 UND
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