Drug Interactions of Non-HIV Antiviral Agents

Abstract

Critically ill and immunocompromised patients, particularly within the transplant and human immunodeficiency virus (HIV)-infected populations, are at higher risk for severe viral infections such as those caused by cytomegalovirus (CMV), adenovirus, and disseminated herpes simplex virus (HSV). Infection with hepatitis C virus (HCV) is common, and many new antiviral regimens have come into use for management of infected patients. Influenza continues to be a significant public and global health problem as well. Many of the currently available antiviral agents have been in clinical use for many years, and clinically significant drug interactions are reasonably well characterized, while interaction data are often unavailable for newer antiretroviral and immunosuppressant agents. Some of the non-HIV antiviral drugs such as acyclovir, famciclovir, oseltamivir, and amantadine are associated with relatively few clinically significant drug interactions. However, there are a number of significant interactions which must be considered for the safe and effective use of drugs such as ganciclovir, foscarnet, cidofovir, ribavirin, and the interferons. This chapter summarizes available data regarding pharmacokinetic and toxic interactions with the current antiviral agents, excluding those used specifically for HIV infections as well as the newer direct-acting antiviral (DAA) drugs for HCV.