Coadministration has not been studied and is not recommended as concentrations of velpatasvir may decrease. If use of a proton pump inhibitor is considered medically necessary, the US Prescribing Information recommends sofosbuvir/velpatasvir to be administered with food and taken 4 hours before omeprazole 20 mg but does not recommend the use of other proton pump inhibitors. The European Summary of Product Characteristics states that sofosbuvir/velpatasvir could be administered with food and taken 4 hours before a proton pump inhibitor at a dose not to exceed that comparable to omeprazole 20 mg.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bromazepam is metabolised by CYP1A2 and CYP2D6 which are not affected by sofosbuvir/velpatasvir.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Hydrochlorothiazide is mainly excreted in urine.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Olmesartan is substrate but not inhibitor of OATP1B1. Although concentrations may increase due to mild inhibition of OATP1B1 by velpatasvir, this is unlikely to be of clinical significance. [Note, the European SmPC for olmesartan recommends an initial 10 mg dose of olmesartan (with a maximum 20 mg daily dose) in moderate hepatic impairment. It does not recommend olmesartan in severe hepatic impairment. No dosage restrictions are given in the US Prescribing Information.]

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paracetamol is metabolised by multiple pathways (UGT1A1, GSH conjugation, CYP2E1, CYP1A2), none of which is expected to be affected by sofosbuvir/velpatasvir.

Coadministration has not been studied but based on the metabolism and clearance a clinically significant interaction is unlikely. Dexketoprofen is mainly glucuronidated, with CYP mediated metabolism (CYP2C8/9) playing only a minor role. Sofosbuvir/velpatasvir is not expected to induce or inhibit UGTs or CYP2C8/2C9. [Note, use in patients with severe hepatic impairment (Child Pugh class C) is contraindicated in the European product label for dexketoprofen.]

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bisoprolol is metabolised by CYP3A4 which is not affected by sofosbuvir/velpatasvir. [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.]