Coadministration has not studied but may increase concentrations of amlodipine or ledipasvir due to P-gp inhibition. Although a clinically significant effect of ledipasvir is considered unlikely, close monitoring of heart rate, blood pressure and for increased side effects of amlodipine is recommended.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bisoprolol is metabolised by CYP3A4 but ledipasvir is only a weak inhibitor of CYP3A4 in vitro. [Note, the European SmPC for bisoprolol recommends a maximum of 10 mg in severe hepatic impairment whereas the US Prescribing Information recommends an initial 2.5 mg in hepatic impairment with caution in further dose titration.]

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Valsartan is eliminated unchanged mostly through biliary excretion and is a substrate of OATP1B1/3, OAT1/3, and MRP2. [Note, the European SmPC for valsartan states a maximum dose of 80 mg in mild to moderate hepatic impairment (contraindicated in severe hepatic impairment) the US Prescribing Information states no dosage requirement in this level of impairment.]