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- W2922449229 abstract "Oral direct-acting antiviral agents are currently the main-stay treatment of hepatitis C. In August 2017, a combination of direct-acting agents of NS5A inhibitor pibrentasvir and NS3/4A protease inhibitor glecaprevir (Mavyret) was FDA approved to treat HCV, genotypes 1-6 in adults without cirrhosis or with compensated cirrhosis. Mayyret has known side effects including HBV reactivation, nausea, fatigue and headache. We report a patient with chronic HCV who experienced a drug - drug interaction: Mavyret and bupropion (Wellbutrin) during treatment, manifested by manic behavioral changes resulting in discontinuation of treatment after 1 week. A treatment naive 67- year old male with chronic HCV genotype 1b due to remote IV drug use, viral load 3,460,000 IU was referred for therapy. Some months earlier he had been prescribed bupropion to assist in smoking cessation. He was not taking any herbal agents nor drinking grapefruit juice or extract. His physical exam was unremarkable. Labs: FibroSure F3- fibrosis, HBcAb(+), HBsAb (+), HBSsAg (-), HAVAb (+), HIV(-). BUN, creatinine, iron studies, ceruloplasmin, AST, ALT, and bilirubin were normal. After one week of treatment his family members reported behavioral changes in the patient: unprovoked anger, agitation, frustration & short-temper. Subsequently, the patient stopped taking Mavyret and bupropion. Within four days of discontinuation of both agents his mood and behavior returned to the baseline and agitation resolved. The patient elected to reattempt therapy with Mavyret which was restarted 3 weeks from initial discontinuation. However, an alternative agent, nicotine patches, was employed to aid with smoking cessation. The patient tolerated retreatment of HCV without further episodes of changes to mental status. Treatment was completed without evidence of viremia at the end of treatment. Tests for SVR are pending. We report a previously unrecognized potential drug-drug interaction with Mavyret and bupropion. Treatment for HCV has evolved rapidly, is generally well tolerated and results in sustained virologic response in the vast majority of patients. Due to this relative simplicity and the short duration of therapy treatment is now slowly moving away from specialty care providers into the primary care environment. This case highlights the need for continued vigilance, careful review of concomitant medications and for the close monitoring of patients during treatment with anti-viral therapy." @default.
- W2922449229 created "2019-03-22" @default.
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- W2922449229 date "2018-10-01" @default.
- W2922449229 modified "2023-09-26" @default.
- W2922449229 title "Losing My Mind Over Mavyret: An Unexpected Drug Reaction" @default.
- W2922449229 doi "https://doi.org/10.14309/00000434-201810001-02314" @default.
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