Coadministration has not been studied but may increase daclatasvir concentrations due to inhibition of CYP3A4 by amlodipine. Use with caution.

Coadministration has not been studied. Carvediol and daclatasvir are substrates and inhibitors of P-gp and concentrations of both drugs may increase. Carvedilol can also commonly cause anaemia. Close monitoring is recommended for increased side effects and toxicities including dizziness, bradycardia and GI disturbances for carvedilol. [Note, the US Prescribing Information contraindicates carvedilol in patients with severe liver impairment and the European SmPC contraindicates it in patients with hepatic dysfunction.]

Coadministration has not been studied. Clopidogrel is metabolised by CYP enzymes and a clinically significant interaction is unlikely as sofosbuvir does not affect CYP enzymes. Sofosbuvir is a prodrug and formation of its active metabolite is unlikely to be affected by comedications. [Note, the European SmPC for clopidogrel contraindicates it use in severe hepatic impairment but the US Prescribing Information states no dose alteration.]

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as metoprolol is metabolised by CYP2D6 which is not affected by sofosbuvir. Sofosbuvir is a prodrug and formation of its active metabolite is unlikely to be affected by comedications. [Note, in patients with severe hepatic dysfunction a reduction in dosage may be necessary.]

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clopidogrel is a prodrug that is converted to its active metabolites by CYPs 2C19, 3A4, 2B6, and 1A2. Daclatasvir has no effect on CYPs 2C19, 2B6 or 1A2 and is only a mild inducer of CYP3A4 so a pharmacokinetic interaction is unlikely at clinically relevant concentrations. [Note, the European SmPC for clopidogrel contraindicates clopidogrel in severe hepatic impairment but the US Prescribing Information states no dose alteration.]

Coadministration has not been studied but, based on metabolism and clearance, a clinically significant interaction is unlikely as metoprolol is metabolised via CYP2D6 which is not affected by daclatasvir. [Note, in patients with severe hepatic dysfunction a reduction in dosage may be necessary.]

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely. Ramipril is metabolised by hydrolysis to ramiliprat followed by renal elimination.

Coadministration has not been studied. As both carvedilol and sofosbuvir are substrates of P-gp, concentrations of sofosbuvir may be increased. However, increasing sofosbuvir concentrations has been shown not to increase the predominant metabolite GS-331007, therefore no dose change should be required. [Note, the US Prescribing Information contraindicates carvedilol in patients with severe hepatic impairment and the European SPC contraindicates it in patients with hepatic dysfunction.]