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Question : 1 / 258

59-year-old man with a history of recurrent depression, anxiety, hypertension, and obstructive sleep apnea presents for follow-up appointment after a new diagnosis of Hepatitis C. His symptoms are well controlled on fluoxetine, propranolol, and modafinil. His gastroenterologist is requesting collaboration to facilitate integrated care. Gastroenterology recommends starting an oral direct acting antiviral regimen consisting of elbasvir-grazoprevir. What is the most significant medication-related concern?

Bradycardia due to impaired metabolism of propranolol
Increased risk of severe depression as direct effect of antiviral treatment
Reduced efficacy of antiviral treatment with modafinil
Increased toxicity of antiviral treatment with fluoxetine
Increased risk of insomnia and irritability when combining antiviral and modafinil

The answer is C--reduced efficacy of antiviral treatment with modafinil. Modafinil induces CYP 450 3A and induces p-glycoproteins which reduces efficacy of many of the oral direct acting antiviral regimens. A is incorrect because no interaction is noted between new oral direct acting antiviral regimens and propranolol. B and E are incorrect because side effect profile of new oral direct acting antiviral regimens is minimal--primarily consisting of fatigue, headache and nausea. D is incorrect because there are no drug interactions noted with fluoxetine and oral direct acting antiviral regimens.

Publication reference : Chasse Y, Kim AY, Freudenreich O. Hepatitis C treatment: Clinical issues for psychiatrists in the post-interferon era. Psychosomatics 2017; 58 (1): 1-10.
Reference URL: https://www.ncbi.nlm.nih.gov/pubmed/27871760
Reference URL: https://www.hep-druginteractions.org/checker

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