Indications for DAKLINZA:
In combination with sofosbuvir, with or without ribavirin, to treat chronic HCV genotype 1 or 3 infection.
Limitations of Use:
Reduced SVR rates in genotype 3-infected patients with cirrhosis receiving daclatasvir with sofosbuvir for 12 weeks.
Test for HBV infection prior to initiation. ≥18yrs: 60mg once daily for 12 weeks (with sofosbuvir). For recommended treatment regimens and duration based on HCV genotype and patient population: see full labeling. Concomitant strong CYP3A inhibitors (eg, clarithromycin, itraconazole, ketoconazole, ritonavir, nefazodone), protease inhibitors, cobicistat-containing regimens (except with darunavir): 30mg once daily. Concomitant moderate CYP3A inducers (eg, bosentan, dexamethasone, efavirenz, etravirine, modafinil, nafcillin, rifapentine, nevirapine): 90mg once daily. If sofosbuvir is permanently discontinued, daclatasvir should also be discontinued.
<18yrs: not established.
Concomitant strong CYP3A inducers (eg, phenytoin, carbamazepine, rifampin, St. John’s wort). When co-administered with sofosbuvir and ribavirin, their contraindications also apply to this combination regimen (eg, Pregnancy).
Risk of HBV reactivation in patients coinfected with HCV/HBV. Test all patients for HBV infection by measuring HBsAg and anti-HBc; if positive serologic evidence, monitor for hepatitis flare or HBV reactivation during and at post-treatment follow-up; treat if clinically indicated. Increased risk of symptomatic bradycardia when concomitant amiodarone and with sofosbuvir, esp. in patients taking beta-blockers, or those with underlying cardiac comorbidities and/or advanced liver disease. Diabetes (monitor). Pregnancy. Nursing mothers.
HCV NS5A inhibitor.
See Adults & Contraindications. Concomitant amiodarone with daclatasvir in combination with sofosbuvir: not recommended; if no alternatives, monitor cardiac function. Concomitant certain immunosuppressants or chemotherapeutic agents: may increase risk of HBV reactivation. May potentiate P-gp, OATP 1B1, OATP 1B3, or BCRP substrates, buprenorphine, statins (monitor). Potentiates dabigatran etexilate mesylate: not recommended in specific renal impairment groups (see full labeling). Concomitant digoxin: if already on daclatasvir, initiate digoxin at lowest appropriate dose and monitor; if already receiving digoxin prior to daclatasvir initiation, reduce digoxin dose by 15–30% or modify dosing frequency and monitor. Monitor warfarin, antidiabetics, CYP450 substrates with narrow therapeutic index; may need to adjust these.
Headache, fatigue, nausea, diarrhea; symptomatic bradycardia; with ribavirin: anemia.
For sofosbuvir specific dosing and safety information, refer to the prescribing information.